Does Medicare Pay For Home Health Care?

By Feliz Selga for Specialized Community Healthcare

Caring for an aging loved one comes with many questions, and one of the biggest is about cost. Many families ask, “Will Medicare help pay for home health care?”

The truth is, it can, but only under certain circumstances.

Understanding these details can make a world of difference when planning the right elderly care services, whether that means staying at home with support or exploring nearby senior living communities for extra care and connection.

What Is Home Health Care?
Home health care provides medical and personal support for seniors in the comfort of their own homes. It’s different from care offered in assisted living homes or nursing care homes, as the focus is often on short-term medical recovery rather than long-term residency.

These services may include:

• Skilled nursing care
• Physical or occupational therapy
• Medical social services
• Assistance with medications or wound care

Home health care is often recommended after surgery, hospitalization, or when a doctor determines that ongoing medical attention is needed at home.

What Does Medicare Cover?
Medicare may cover home health care if specific conditions are met. The senior must:

1. Be under a doctor’s care and have a treatment plan
2. Need skilled nursing care on a part-time or intermittent basis
3. Use a Medicare-certified home health care agency

Covered services typically include:

• Skilled nursing services
• Therapy services (physical, speech, or occupational)
• Medical supplies (like wound dressings)
• Certain medical social services

However, Medicare does not cover:

• 24-hour care at home
• Homemaker services (like cooking or cleaning)

What About Home Care (vs. Home Health Care)?
Here is an important nuance: the difference between home health care and home care (sometimes called non-skilled in-home support).

According to National Council On Aging (NCOA) in their article “Seven Things You Should Know About Medicare’s Home Health Care Benefit”, if you meet the conditions for home health care and you’re also receiving skilled nursing care or other types of therapy, then Medicare will cover home health aide services on a part-time or intermittent basis as part of your overall home care.

Although Medicare typically does not cover large amounts of non-skilled “home care” (like full-time personal care or homemaker services), there is coverage for home health aides when the care is tied to a medically necessary skilled service under the home health benefit.

Medicare can be a tremendous help for short-term senior health care at home, but it’s not a full solution for long-term elderly care. The key takeaways:

• Yes, Medicare covers home health care if eligibility criteria are met.
• Yes, home health aide services can be covered but only when tied to skilled nursing or therapy services under the home health benefit.
• No, Medicare generally does not cover full-time custodial care, homemaker services, or non-skilled personal care when that is all that is needed.
• Families should plan ahead and explore all available elderly care services, from in-home support to retirement homes and long-term care facilities.