DOES MEDICARE COVER IN-HOME CARE?

When people say “in-home care,” there are several different types of care to which they could be referring. This range of options is one of the appealing things about home care, as it can be customized to meet each individual’s needs. In-home care can range from tasks as basic as providing companionship during the day to as involved as round-the-clock medical monitoring.

To help you better understand the different types of in-home care and how they differ from one another, we’ve broken the varieties of in-home care into three categories below.

Types of In-Home Care

Companion Care

At one end of the home care spectrum is companion care, which involves no medical assistance whatsoever. Companion care aides, also referred to as elder care companions, provide company for seniors in their homes and out on errands. You may consider companion care if you worry about your loved one spending too much time by themselves at home and becoming lonely or isolated. A companion care aide can spend time with a senior in their home, play games or engage in the senior’s favorite hobbies, and accompany them to the grocery store or on other errands. Because companion care doesn’t involve any medical care, it falls under the umbrella of standard in-home care.

Personal Care 

Personal care aides help seniors with their activities of daily living (ADLs), which include bathing, dressing, eating, and transferring (getting up from a seated position). Personal care aides can help seniors who are starting to have some difficulty living entirely independently and need assistance with some ADLs but who do not yet need or want to transition to an assisted living community. You may also decide to seek the help of a personal care aide to solve a specific problem you’re facing aging in place; for example, a wife may need help assisting her husband get in and out of bed.

In addition to assisting with the ADLs, personal care assistants can provide housekeeping services, transportation, and help with chores like grocery shopping. Like companion care, personal care does not involve any medical care beyond basic first aid, so it too is under the umbrella of standard in-home care.

Home Health Care 

Home health care stands out from standard in-home care in one fundamental way: it involves medical or rehabilitative care from a certified practitioner, nurse, or physician. This level of home care is the only one that focuses on actual medical care rather than personal care. Home health care practitioners must undergo extensive training to meet clients’ needs, and most hold nursing or medical degrees and/or certification.

Home health care can be beneficial in various situations, including assistance managing and monitoring chronic health conditions, short-term care and monitoring following a surgery or injury, or for rehabilitative services like physical, occupational, or speech therapy. Because it involves medical services, home health care is typically covered by Medicare.

When considering what type of senior care is best for yourself or a loved one, the cost is often a significant factor. In-home care costs can vary dramatically depending on the specific client and how much and what type of care they need. Prices also fluctuate based on location.

Below, we discuss the cost of basic in-home care and home health care. To represent the market variations, we present several scenarios during which someone may use in-home care and how much the care will cost.

Home Care Costs

According to Genworth Financial, Inc, in-home care (such as companion and personal care) costs an average of just over $25 an hour in the United States. Keep in mind that this is the national average, and your costs will depend on the general cost of living in your area. Even national home care agency chains have different prices in different regions to reflect the local cost of living.

The map below shows the average cost of in-home care throughout the United States. The prices shown are based on 20 hours of care per week.

While costs can still vary within states, the map above can give you an idea of fluctuations in the cost of home care in different areas of the U.S. As you may notice, not only does the cost of living come into play, but the availability of providers. For instance, even though the cost of living in Nebraska is lower than in Florida, in-home care is more expensive in Nebraska because Florida’s large elderly population means that it has more providers available to meet market demands.

Another factor that can greatly affect home care costs is the severity of your or your loved one’s needs. Home care providers can scale their services to an individual’s care needs, so those with fewer needs receive fewer hours of care, and vice versa. Below, we present a few different care scenarios to help you understand how varying care needs impact home care costs.

Home Health Care Costs

According to Genworth Financial, the average cost of home health care in the United States is approximately $26 per month. As we discussed above, costs can deviate from this average, sometimes significantly, in your area. The real cost will depend on the cost of living and how many medical professionals are in the area.

Additionally, the amount of home health care that one needs will have a significant impact on costs. Take note of the three scenarios below to see how different care needs can lead to vastly different home health care costs.

When it comes to Medicare coverage of in-home care, it is crucial to distinguish between standard home care and home health care. Medicare does not cover any standard in-home care because it is considered custodial care rather than health care. However, Medicare does cover eligible home health care services, which we explore in more detail below. Furthermore, in some cases, Medicare may actually cover custodial in-home care if delivered with home health care services from the same provider. Ultimately, seniors and their families should be aware that they’re unlikely to get help from Medicare paying for regular in-home care, but may have at least some home health care services covered by Medicare.

Home Health Care Services Covered by Medicare

As opposed to standard in-home care, home health care is considered skilled nursing care and thus is covered by Medicare. A range of home care services falls under the benefit. Some of the covered home health care services include:

• Skilled Nursing Care: This includes all care services that must be carried out by registered or licensed nurses, such as medication administration (including injections) and monitoring of your vital signs. Medicare only covers “intermittent nursing services,” which means part-time. There are time limits on how many hours per week and/or days per month of care that Medicare will cover.
• Therapy Services: Often needed when recovering from an illness or injury, this includesrehabilitation services such as physical and occupational therapy and speech-language pathology.
• Medical Social Services: Medical social services involve counseling to help seniors deal with the emotional and social impact of their illness or injury.
• Medical Supplies: Any medical supplies related to the condition for which you’re being treated, such as catheters and wound dressings, are covered by Medicare. Durable medical equipment like wheelchairs may be partially covered.

Medicare also covers personal care assistance if you’re also receiving one of the above services; personal care assistance is only covered when delivered in tandem with home health care services. In all cases, Medicare will only cover home health care services if you’re under the care of a doctor who regularly reviews your care plan and who can certify the home health care services as medically-necessary. You must also be homebound, but are allowed to leave home for medical treatments or short, infrequent non-medical errands, like attending religious services.

It’s important to note that even when the above criteria are met, Medicare never covers full-time home health care. If you need around-the-clock care and cannot financially support full-time, in-home health care without Medicare, a skilled nursing community may be a better option.

Other Ways to Pay for In-Home Care

Because Medicare does not cover in-home care, many seniors and their families seek alternative financial assistance options. Some of the most common sources of financial assistance for in-home care are explained below.

• Medicaid: Medicaid does cover home health care for seniors, and in some cases, may also cover personal care assistance. Though standard Medicaid does not cover in-home personal care, many states offer Medicaid waiver programs that expand Medicaid coverage in that state. In many cases, personal care services are covered under these Medicaid waiver programs.
• PACE: Programs of All-Inclusive Care for the Elderly (PACE) is a joint Medicare and Medicaid program designed to help seniors get the care they need in their own communities rather than transition to nursing homes. Home care is a covered benefit under PACE. All seniors who qualify for Medicare or Medicaid may be eligible for PACE, but it is not available in all states, and there are additional eligibility requirements. You can learn more on the official Medicare website.
• Long-Term Care Insurance: Many long-term care insurance (LTC insurance) policies have an in-home care benefit. However, the type and amount of services they cover can vary significantly between different policies, so be sure to check the details of yours when looking into home care. Typically, LTC insurance policies limit the number of hours per day of care the policy will cover. There may also be eligibility criteria for in-home care coverage, such as needing a certain level of assistance.
• Reverse Mortgages: Reverse mortgages are a type of loan that you can take against the equity you have in your home, allowing you to access some of your equity in cash while continuing to live in the house. This can be a great short-term solution in paying for home care if your home is entirely or almost paid off. The loan does need to be repaid with interest once you move out of the residence.
• VA Aid and Attendance: Some veterans are eligible for the Aid and Attendance (A&A) benefit, which provides an extra monthly payment made in addition to the standard VA pension. The purpose of A&A is to provide financial assistance for veterans who need help with their ADLs and/or are housebound. There are other eligibility requirements, so Veterans in need of home care who think they may be eligible should visit the VA website to learn more.
• Life Insurance: You may be able to use an existing life insurance policy to pay for long-term care. Some policies allow you to receive an “accelerated death benefit,” or receive your policy’s benefit amount while you’re still alive. This can make sense when in a financial bind, but the payment amount will always be less than the total death benefit. You can also sell the policy to a third-party company that will pay you a settlement amount. It’s essential to consider both the pros and cons of accessing your life insurance benefit early, especially if you were hoping the life insurance benefit would help your family after you pass.

Medicare is a federal program that provides health insurance for most Americans over the age of 65, and younger adults with qualifying conditions. Like most health insurance programs, Medicare covers some, but not all, health care expenses. As discussed above, Medicare does not cover in-home care for those who need personal care assistance, but it may cover home health care in qualifying situations.

Read on if you’re unsure if you’re eligible for Medicare or how to sign up for Medicare.

Medicare Eligibility

Most, but not all, seniors are eligible for Medicare. The program is designed to help elderly Americans, and the main qualifying factor is age. Except in special circumstances for young people with qualifying conditions, you become eligible for Medicare when you turn 65.

If you’re 65 or older, you simply need to meet the following criteria to be eligible for Medicare:

• You must be a U.S. citizen or a permanent legal resident.
• You or your spouse must be receiving or eligible for Social Security or railroad retirement benefits (you must have worked long enough to be eligible for these benefits).

If you’re unsure whether you’re eligible for Medicare, use the Medicare Eligibility Tool to determine if you qualify.

How to Sign Up for Medicare

Many people are automatically enrolled in Medicare parts A and B when they turn 65 and start getting Social Security benefits. If you want extra coverage, you also have the option of signing up for a Medicare Supplement or Medicare Advantage plan. You can sign up for those plans directly with the insurance provider (these aren’t government-run plans). Note that while Medicare Supplements and Medicare Advantage offer more coverage, you’ll have to pay an additional monthly premium.

If you weren’t automatically enrolled in Medicare upon turning 65, you can sign up during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after. Each year, there is also a General Enrollment Period from January 1st to March 31st, when all eligible adults can enroll in Medicare.

If you’re eligible for Medicare but not currently enrolled, you can easily sign up online via the Social Security Administration website during an enrollment period. You can learn more about the process on the official Medicare website.

Medicare and Home Care Resources for Seniors

The resource below can help you better understand Medicare coverage of in-home care, as well as the Medicare program as a whole.

What is the difference between home health and home care?

The difference between home care and home health care is that home health care involves skilled nursing care from trained medical professionals. On the other hand, standard home care focuses on companion care, personal care and assistance with ADLs, and household assistance. Standard home care aides do not need any nursing or medical certification, while home health aides do.

Will Medicare pay for in-home care for the elderly?

Medicare will pay for in-home care for the elderly under certain circumstances. In general only home health care, not personal or companion care, is covered. Home health care includes skilled nursing care, therapy services, and other medical services. If you need personal care and home health care and receive them both from the same Medicare-approved provider, in-home personal care should be covered.

What home health care is covered by Medicare?

Medicare covers several home health care services, including intermittent skilled nursing care (medication administration, monitoring of vitals, etc.), therapy services like physical and occupational therapy, and medical social services. Medicare does not cover companion care, transportation, and meal delivery.

How much does home care cost? 

According to Genworth Financial, home care costs an average of $25 an hour for personal or companion care and $26 an hour for home health care. This comes out to an average of $4,481 and $4,576 per month, respectively, for 44 hours of care per week.

What insurance covers home health care?

Several types of insurance cover home health care. The most common is Medicare, which does cover home health care services under qualifying circumstances, but not standard in-home care. Long-term care insurance typically covers both in-home personal care assistance and home health care, but policy details vary. Additionally, Medicare Advantage of Medicare Supplement plans may provide coverage for home health care.