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Does Medicare Cover Caregiver Costs and Services?

The key to qualifying for some paid services is whether your loved one is ‘homebound’

spinner image Older man does arm exercises with dumbbells with the assistance of his home healthcare physical therapist
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Medicare, the government’s medical insurance for people age 65 and older and younger people receiving Social Security disability benefits, isn’t designed to pay for 24-hour care for a loved one at home.

But with a doctor’s orders and plan of care, costs may be covered for several necessary services for loved ones who are homebound because of a chronic illness or injury.

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Medicare beneficiaries have no copayments for approved services, which can help with recuperation.

“Not only can home health care help to avoid accidents and falls, but it can increase your loved one’s happiness,” says Gretchen Jacobson, vice president of Medicare for the Commonwealth Fund.

What does ‘homebound’ mean?

Someone is considered ‘homebound’ when he or she has trouble leaving home without the help of either a person or medical equipment because of illness or injury.

A patient whose doctor recommends not leaving home because of a medical condition is also considered homebound.

Note: Attending adult day care, religious services, medical appointments or some special occasions will not cause patients to lose their homebound status under Medicare rules. ​

The home benefits have proved popular: From 2002 to 2019, the number of Medicare beneficiaries using home health grew by more than 30 percent, according to a Commonwealth Fund report. 2020 had a 6 percent decline as the COVID-19 pandemic took hold, but even that year had nearly 2.9 million home health users among beneficiaries and about 8.9 million home health claims. 

What kind of help is covered by Medicare?

Medicare will pay for several categories of workers at home. Each type of home health care professional delivers different services.

  • Home health aides. They can provide either part-time or intermittent home health care. They may assess pain; check blood pressure, breathing, heart rate and temperature; and ensure that medications are being taken correctly. They may also evaluate the safety of the home, monitor food and drink intake, and teach patients and caregivers about the plan of care and how to carry it out. Medicare will only cover home health aides if you’re also receiving skilled nursing or therapy.
  • Medical social workers. These professionals help with emotional concerns and with understanding a disability or illness.
  • Occupational therapists. They help people do the daily activities they need to live life more easily.
  • Physical therapists. They help restore movement in those who might have weakened from time spent in the hospital.
  • Skilled nursing care. Registered nurses or licensed practical nurses under the supervision of a registered nurse can change wound dressings and give injections, intravenous drugs or tube feedings. They can also teach about diabetes care and prescription drugs.
  • Speech-language pathologists. They may be used after strokes to help restore communication and swallowing.

Does Medicare caregiving coverage have limits?

Services are restricted to either fewer than seven days a week or to less than eight hours a day for up to 21 days.

Medicare home health benefits do not cover full-time skilled nursing care or prescription drugs. They also do not cover housekeeping, meal delivery or transportation.

What are the costs under Medicare?

If you qualify for home care benefits and use a Medicare-certified home care agency, you don’t have to pay a deductible or copayments for eligible home care.

Home care is generally covered under Medicare Part B. But it can be covered through Part A in some cases after you have been in a hospital as an inpatient for at least three days or a Medicare-covered skilled nursing facility.

In that case, Medicare Part A can cover your first 100 days of home care. Part B covers any days beyond 100. But either way, you don’t have any cost-sharing for covered benefits.

The home health agency sends the bills to Medicare, and the agency must tell you if Medicare won’t cover any items or services its workers provide and the related costs you will incur.

Medicare covers medical supplies and up to 80 percent of the cost of medical equipment, such as a wheelchair or walker, if a doctor certifies it is medically necessary.

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How does my loved one qualify for home health care benefits?

To ensure that your loved one can take maximum advantage of Medicare home health benefits, follow these requirements:

1. Follow a plan of care. Patients must be under a doctor’s care, and the doctor must issue a plan of care that certifies the patient needs one or more of the services listed above.

In addition to certifying that need, a plan of care specifies:

  • The type of health care professional who should provide the services.
  • How often the services will be provided.
  • Any needed medical equipment.
  • The results the doctor expects.

The doctor and the home health team review and recertify the plan of care at least once every 60 days.

2. Visit a physician. Patients must see their doctor in person less than 90 days before or 30 days after home health services begin.

3. Use a certified agency. A Medicare-certified agency must deliver Medicare home health services. Agency personnel will coordinate the services the doctor orders.

For help finding a certified agency near you, Medicare offers a tool called home health compare on its website. To find out whether an item, service or test is covered under home health benefits, check Medicare’s home health services page and its home care booklet.

“Most family caregivers aren’t familiar with Medicare,” says Amy Goyer, AARP’s family caregiving expert. “It’s important that caregivers learn what it covers and what it does not. Part of our role as caregivers is to advocate for our loved ones.”

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Does Medicare Advantage cover home health care?

Private Medicare Advantage plans, also known as Medicare Part C, must provide the same home care benefits as original Medicare. But they may have additional requirements.

For both original Medicare and Medicare Advantage a health care provider, such as a doctor or nurse, must order the plan of care and the beneficiary must need skilled care, Jacobson says. But if you have a Medicare Advantage plan, you may need to use a home care agency in the plan’s network, and you may have additional prior authorization requirements.

Some Medicare Advantage plans provide extra benefits. For example, 17 percent of Medicare Advantage enrollees in standard plans and 31 percent in special needs plans have some coverage for in-home support services in 2023, according to KFF, formerly the Kaiser Family Foundation.

These benefits are separate from Medicare’s home health benefits — providing nonskilled care to help with the activities of daily living without the same requirements as the home health benefit.

However, these benefits may be limited. A Center for Medicare Advocacy study found that some Medicare Advantage plans cover only 12 visits a year or four four-hour shifts after a patient is discharged from the hospital. They may also cover some of the costs of bathroom safety devices, such as handrails.

Some Medicare Advantage plans offer people with chronic conditions extra benefits such as some transportation and meals, and can include a grocery allowance. You may need to use certain service providers, says Jeannie Fuglesten Biniek, associate director with the program on Medicare policy for KFF. Read the plan’s evidence of coverage for details, and find out what type of chronic condition you need to have to qualify.

Editor’s note: This article was originally published Oct. 11, 2019. It has been updated with new information.

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