In this guide 4 sections
This is the question families ask most, and the one they most often get a misleading answer to, in both directions. Some are told Medicare covers nothing at home and pay privately for help they could have had. Others are told Medicare covers home care and discover, when the aide’s invoice arrives, that it does not cover the help they actually needed. Here is the whole picture.
What Medicare covers at home
- Home health services: skilled nursing, physical therapy, occupational therapy, speech-language pathology and medical social work, delivered by a Medicare-certified agency to a homebound patient who needs skilled care, certified by a doctor. No deductible, no coinsurance. Typically a few visits a week for several weeks, in 60-day certification periods that can renew while she qualifies.
- Home health aide services: bathing, dressing, personal care, but only while she is also receiving skilled nursing or therapy from the agency, and typically a few short visits a week.
- Durable medical equipment: walkers, wheelchairs, hospital beds, oxygen, commodes and similar, prescribed by a doctor from a Medicare-enrolled supplier. Part B deductible, then 20% coinsurance.
- Medical supplies related to home health care, such as wound dressings and catheters, through the agency.
- Hospice care at home for people with a terminal prognosis who choose comfort care, including nursing, aide services, equipment, medications for comfort and short inpatient respite.
- Doctor visits at home, including home-based primary care where offered, and telehealth.
What Medicare does not cover at home
- Custodial care: help with bathing, dressing, toileting, eating, moving around, when that is the only care needed. This is what most families mean by “help at home”, and it is the biggest gap.
- 24-hour care or live-in care.
- Meal preparation or delivery.
- Housekeeping, laundry, shopping, errands.
- Companionship or supervision.
- Home modifications: grab bars, ramps, stair lifts, walk-in showers.
- Personal emergency response systems (medical alert buttons).
- Adult day care.
Where the non-medical help comes from
Who pays for help with daily living at home
Medicaid home and community-based services (HCBS)
- What it covers
- Personal care aides, homemaker services, respite, adult day, sometimes home modifications; hours vary by state and assessed need
- Who qualifies
- Income and asset limits (state-specific); functional need, often nursing-home level
- How to start
- State Medicaid office or Area Agency on Aging; many states have waiting lists
Medicaid self-directed care
- What it covers
- Lets the person hire and pay their own caregiver, sometimes a family member
- Who qualifies
- Medicaid-eligible; program varies by state
- How to start
- Ask the Medicaid agency about consumer-directed or self-directed options
PACE (Program of All-Inclusive Care for the Elderly)
- What it covers
- Comprehensive medical and social services, adult day center, home care, transportation
- Who qualifies
- 55+, nursing-home eligible, living in a PACE service area; free for dual-eligible
- How to start
- npaonline.org to find a program
Veterans’ programs
- What it covers
- Homemaker/home health aide, respite, Aid & Attendance pension supplement, caregiver support program
- Who qualifies
- Veterans and some surviving spouses; varies by program
- How to start
- VA social worker or local Veterans Service Officer
Area Agency on Aging
- What it covers
- Meals, rides, respite, some in-home services, caregiver support, benefits screening
- Who qualifies
- Age 60+; some services means-tested
- How to start
- Eldercare Locator 1-800-677-1116
Long-term care insurance
- What it covers
- Home care per the policy’s terms, after an elimination period
- Who qualifies
- Policyholders meeting the policy’s trigger (usually help with 2+ daily activities)
- How to start
- Call the insurer; ask about the claims process early
Some Medicare Advantage plans
- What it covers
- Limited in-home support, meals after hospitalization, rides, OTC allowances
- Who qualifies
- Plan members; benefits vary widely
- How to start
- Call the plan; check the Evidence of Coverage
Private pay
- What it covers
- Anything, at $25–$40+ an hour through agencies
- Who qualifies
- Anyone who can pay
- How to start
- Home care agencies; ask about minimum hours
| Source | What it covers | Who qualifies | How to start |
|---|---|---|---|
| Medicaid home and community-based services (HCBS) | Personal care aides, homemaker services, respite, adult day, sometimes home modifications; hours vary by state and assessed need | Income and asset limits (state-specific); functional need, often nursing-home level | State Medicaid office or Area Agency on Aging; many states have waiting lists |
| Medicaid self-directed care | Lets the person hire and pay their own caregiver, sometimes a family member | Medicaid-eligible; program varies by state | Ask the Medicaid agency about consumer-directed or self-directed options |
| PACE (Program of All-Inclusive Care for the Elderly) | Comprehensive medical and social services, adult day center, home care, transportation | 55+, nursing-home eligible, living in a PACE service area; free for dual-eligible | npaonline.org to find a program |
| Veterans’ programs | Homemaker/home health aide, respite, Aid & Attendance pension supplement, caregiver support program | Veterans and some surviving spouses; varies by program | VA social worker or local Veterans Service Officer |
| Area Agency on Aging | Meals, rides, respite, some in-home services, caregiver support, benefits screening | Age 60+; some services means-tested | Eldercare Locator 1-800-677-1116 |
| Long-term care insurance | Home care per the policy’s terms, after an elimination period | Policyholders meeting the policy’s trigger (usually help with 2+ daily activities) | Call the insurer; ask about the claims process early |
| Some Medicare Advantage plans | Limited in-home support, meals after hospitalization, rides, OTC allowances | Plan members; benefits vary widely | Call the plan; check the Evidence of Coverage |
| Private pay | Anything, at $25–$40+ an hour through agencies | Anyone who can pay | Home care agencies; ask about minimum hours |
How to put it together
- 1.Get every Medicare-covered service you can. After any hospital stay or change in condition, ask the doctor about home health. It is $0 and it brings professionals into the house.
- 2.Screen for Medicaid, even if you think she will not qualify. Rules for home care are often more generous than for nursing homes, and many states let a spouse keep significant assets. A SHIP counselor or Area Agency on Aging can do a benefits check.
- 3.Ask about veterans’ benefits if either parent served. Many eligible families never apply.
- 4.Use the Area Agency on Aging for meals, rides and respite. Free or low-cost, and the daily meal delivery is a safety check.
- 5.Fill the remaining gap with family and, where affordable, private-duty help. Be realistic about hours: a few hours of paid help at the hardest times of day often prevents the crisis that would cost far more.
- 6.Plan for change. Needs grow. A plan that works today should have a next step built in.
Questions families ask
Will Medicare pay for a caregiver to come to the house?
Only in the form of home health: skilled nursing and therapy visits, with limited aide help for personal care while skilled services continue, for homebound patients with a doctor’s order. Medicare does not pay for ongoing custodial care, an aide alone, or 24-hour care.
How many hours of home care does Medicare cover?
Medicare home health is intermittent: typically a few visits a week, each under an hour, per discipline, for several weeks. It is not measured in hours of care and cannot be expanded into daily or all-day coverage. Continuous care at home is not a Medicare benefit outside of very limited hospice circumstances.
Does Medicaid pay for help at home?
Yes, for eligible people, through home and community-based services that vary by state: personal care aides, homemaker help, respite, adult day care and sometimes home modifications. Income and asset limits apply, and many states have waiting lists. Some states let the recipient hire a family member as the paid caregiver.
Can Medicare pay a family member to be the caregiver?
No. Medicare does not pay family caregivers. Some state Medicaid self-directed programs, the VA caregiver program and some long-term care insurance policies do, under specific conditions.
How can a navigator help with home care?
By getting every Medicare-covered service in place, screening for Medicaid, veterans’ and community programs, coordinating with the Area Agency on Aging, helping the family find and trial private help for the gap, and adjusting the plan as needs change.
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