Medicare Coverage of In-Home Care


What It Is

Medical and some personal care delivered in a patient's home

What's Covered

Medicare Part A covers part-time skilled nursing or rehabilitation care at home following a patient's hospital stay of at least three days. Medicare Part B covers the same care with no hospital-stay requirement. The care can include skilled nursing care and physical and speech therapy, as needed, along with medical supplies and equipment. Coverage can also include limited visits by a home health aide to help with personal care needs, as well as an occupational therapist to help the patient learn how to safely accomplish daily personal care. Medicare home care coverage is available only while a patient is actually recovering from an illness, condition, or injury. Once the patient's condition has stabilized, Medicare home care coverage ends. Medicare doesn't cover care needed because of a long-term condition or general frailty, and Medicare doesn't cover full-time or daily care.

Medicare Part A or Part B home care coverage is available only under several conditions:

  • The patient must need, and a doctor must prescribe, part-time skilled nursing care or rehabilitative physical or speech therapy to help the patient recover from an illness, injury, or acute condition.

  • At-home care is available only if a patient is "confined to home" (though not necessarily bedridden). This means unable to leave home without difficulty and without the help of another person or a medical device such as a wheelchair.

  • Home care must be provided by a Medicare-certified home healthcare agency. There is no specific limit on how many home care visits Medicare will cover. The home care agency and Medicare regularly evaluate a patient's condition and needs to determine how long the care is medically needed and thus how long Medicare will continue coverage.

If you have a Medicare Part C Medicare Advantage plan: Medicare Part C Medicare Advantage plans, also called Medicare Advantage plans, must cover everything that's included in original Medicare Part A and Part B coverage. But sometimes a Part C plan covers more, with extra services or an expanded amount of coverage. (Co-payments for Part C plans may also be different than those for Part A or Part B.) To find out whether your plan provides extra coverage or requires different co-payments for in-home care, contact the plan directly.

What Medicare Pays

Medicare Part A or Part B pays the full amount of the home care agency's Medicare-approved charges, except for the rental cost of durable medical equipment such as a wheelchair or hospital bed, for which Medicare pays 80 percent.

Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:

  • The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?

  • The care must be performed or delivered by a healthcare provider who participates in Medicare.

Was this medicareinformation helpful?

38 Comments So Far. Add Your Wisdom.

4 months ago

My father recently was released from the hospital, my fathers' heart works less than 10% right now. My daughter lives with her grandparents, she basically is the caretaker for my dad. My daughter fixes all his meals, makes sure he is taking his meds, makes appointments as needed and take him to his appointments and run errands for as needed. Would Medicare pay her for this instead of bringing an outsider in to do this. Bringing a stranger into his home to do all things mentioned above that my daughter does, he very objective to that idea.


6 months ago

my brother has been taking care of my mother in her home but dementia is getting worse and she is believing that he is her husband, she has fallen down about 3 times and I am worried that she may need a female caretaker. I would love for her to come to my home as I have an extra bedroom but she has said she wanted to stay in her own home and the rest of my siblings want her to stay at home since this is what she wants. I am just worried that because of her dementia getting worse and w/my brother being male she made need something else. I really need to know what our options are and what we should do in this case. My brother being the eldest of 7 children is the head of all of the legal issues with my mom and is sometimes hard to talk to.


about 1 year ago

Gruneichtime, Thank you for your kind feedback. I am glad you found us too. Other areas to explore are: Caring.com's Free Senior Directory at http://www.caring.com/local which will help you find in-home care, assisted living, home health agencies in your area. Also our online support groups which are available for support, encouragement, advice, and much more. Online support groups are located at: http://www.caring.com/support-groups . Thanks again!


about 1 year ago

I just signed up for your site today, after finding it completly by accident. All I can say is THANK YOU! There is so many people that have needed a site like yours for years.... Thanks again!


about 1 year ago

Hello, I am a 55 yr old man, disabled with a bad back, leg and emphesema., I am finding it almost impossible to care for myself as far as cooking/cleaning goes, and I have no idea where to start to get help if any is available. I have nobody that is able to help and no savings. I do receive disability pay but that just barely pays the normal bills. Is there any way you can help me??? Thank You, Bill


over 1 year ago

Looking for services for my mom she has dialysis 3 days a week and doesn't qualify for hospice, is there services that can come to the house to help us out. She needs assistance bathing and dressing.


Anonymous said almost 2 years ago

hi i am trying to find out how much Medicare will cover for my sister who has dementia can not remember to take medicine and is really getting worse she is getting to stage she don't remember our names. She is afraid to cook and she don't eat right. Does not want to go to assisted living does not want to leave her home. Son has took her keys to her car and she can't drive very depressed. What is the best answer for her?


about 2 years ago

My sister is 51 and just had a major stroke a couple of months ago. She stayed in the hospital for 4 weeks trying to stabalize her medical condition. She then went to a rehab facility where her medical conditions again flared and she was in and out of the hospital, so she ended up receiving very little rehab. Now the rehab facility is going to discharge her and the only placement for her is going to be a nursing home. It saddens me that the only place she can go is a nursing home. We would like to keep her home however everyone works and we are unable to care for her needs adequately. She needs longterm in home care but we can not afford it. Does anyone have any idea what we can do? I love her dearly and know that living in a nursing home is going to destroy what little spirit she has left.


over 2 years ago

how do i find out if my mom is entitled to get extra help in paying for home care and so that i can stay home to be the caregiver what i do to apply, i've never done any of this befor and it all sounds greek to me is there anyone who can help me i get so flushed and brain knum i dont remember whos what and whens when any help would be very nice thanks God Bless Ruthie


over 2 years ago

how do i go about applying for my spouse who is diabetic had a heart attack 3way by pass


over 2 years ago

I am 87 yrs old, just released from Hospital and rehab., and everything you say is true. I am getting all the services. An RN, occupational therapist for 3 visits, and physical therapist for 3 weeks, twice a week. The nurse will stay on twice a week for I believe increments of 60 days each. It is a great comfort. I moved into a mobile home a short time ago, across the st. and 3 housed down from my son % wife. I came to visit them while in a senior facility in FL last Sept. Had a gall bladder operation, where I was expected to die. Went into Hospice til May 2011 (also for congestive heart failure and a pacemaker). So I bought my mobile home in July 2011, so I could live separately from family who was caregiving me. Started getting scared I couldn't take care of my self and wanted to die and became depressed. I went into the Hospital again for a month, including rehab. Scared to come home from rehab and start life all over again on my own. Medicare put in place the medicall team described above. And I am getting additional Home Care from "Home Instead", Reno, NV 2 times a week, 4 hr shifts. I've been out of Rehab 2 1/2 weeks, and making it very well alone using 2 canes to walk. I highly recomment Home Instead @ $21.00 an hour. They are truly caring here in Reno, and Help in anyway I need - from assisting showering, housekeeping, laundry, picking up groceries and meds, and taking me places like Dr. appointments. This support system has made me feel like living again, and I'm enjoying life again.


almost 3 years ago

Identifying medical condition requirements to be elegible for home health care approved by Medicare.


almost 3 years ago

i want to be my parents caregiver. i don't want someone else to come in and do the cooking cleaning and taking them to drs appt.


almost 3 years ago

The entire article was helpful as I will be having surgery soon that will require assistance and physical therapy at home for a short time following my hospital release. I live alone but I do not want to go to a skilled nursing facility so I'm happy to know that home care is an option.


almost 3 years ago

Hello Anonymous, Thank you very much for your comment. You can, in fact, get paid to be a caregiver! Find out how in this article: ( http://www.caring.com/articles/payment-for-family-caregiver ). Take care -- Emily | Community Manager


Anonymous said almost 3 years ago

I think a family member should get paid to care for parent at home. I QUIT WORK TO TAKE CARE OF MY FATHER i now do not have any income.


almost 3 years ago

MY HUSBAND IS MODERATE TO SEVERE DEMENTIA HE IS 88 MEDICARE WILL COVER SOME PARTS WHICH WILL BE APPRECIATED


almost 3 years ago

Hello puttputt1947­, Thank you for your question. If you'd like to learn more about in-home care, check out our in-home care directory page, here: ( http://www.caring.com/local/in-home-care ). In addition, if you'd like, you can post your question in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


almost 3 years ago

My husband has Alteimers, and sleeps alot, can not feed him self other that cookies, has turned on the stove to heat up a paper cup and a coffee mug. I get no help from his family who turned me into Elder Abuse. I have a son who considered him his father for 30 years and carries his name. Now husband thinks everyone is stealing things from him, including his son and my self. I am getting help from one gal who is a cna at $100.00 per day. we both get ss retired. I am tired of his bad moods and making me out to be the bad guy,since he got his driver license taken away. I would like to know who can I get some in home care, so I can get a week off,without going broke.


about 3 years ago

I am just trying to find a way to get a hour or two break during the week I have so much going on and not being able to take a break is heavy on my health but in the same aspect money is really tight so any idea in my area would be wonderful.


about 3 years ago

Hi momma ruth, Thank you very much for your comment. I am so sorry to hear about your situation. That must be very difficult for you. One great place to share caregiving stories, get advice, or just vent a little if you need to, is in your Stage Group. You can visit your Stage Group, here: ( http://www.caring.com/my/group ). Take care -- Emily | Community Manager


about 3 years ago

i love her so much that i am afraid i am going to start having bad feeling for her for the things she says and does, i know it is her brain but i still hurts to hear her say things and i know daughters are one kund of child that you get and sons are just that sons, cant handle stress like this kind anyways.i watched mom go from this howerling dog the a sweet little gueini pie mean as cat poop she rides my butt like i cant do anything right or good cant cook burps in my face i mean she holds a burp until i have to bend in front of her then right in my face lets me have it when i say anything i get your up tight let your hair down or break wind just as i get to pull up panties or at same time peee in my hand she calls me picky, when i put her in her chair she says boy your cranky then i am she made me that way.can anyone answer me why she has this most ungodlyest smell from bottoms end i scrub that area 3 n 4 times a day and spray and powder but nothing workingthings i cook she tells everyone i deliberatly give her the hardest pieces or tuffest, burnt n so, either to hot or to cool what am i to do, i have 1 girl comes to help me bath her in morn 1 hr 4 days week and 1 girl for wed. 4 full hours so husband n me get out for grocerie shopping and bill paying ,there are days we dont speek he gets up gets coffee shuts his door and i see him no more till supper, somedays i want to run away from home then i stop hay this is my house make them run lol no you know what i mean and she gives me the silent treatment during days so i mostly sit n cry of doing this all by myself.anyone feel like me if so write i write back promise mamma ruth


over 3 years ago

Hi anonymous, thanks for your comment. If you'd like, you can post your question to our Ask & Answer section located here: ( http://www.caring.com/ask ). I hope that helps. Good luck, and take care. -- Emily | Community Manager


Anonymous said over 3 years ago

I have a question, can a family member be the caregiver? Is there training that must be completed first?


over 3 years ago

Hi tin, Thanks for your questions. Sorry to hear your uncle is having a difficult time, that must be hard on him and your family. If you'd like you can post your question in our Ask & Answer section, here: ( http://www.caring.com/ask ). Take care -- Emily | Community Manager


over 3 years ago

I have a disabled uncle who is 68 yrs old and paralyzed from the neck down from a car accident. He is currently in a nursing home and he's experiencing bad treatment there and wants to leave. Do you think he could leave and get a licensed home care provider and have Medicare & medicaid cover it?


over 3 years ago

It made it more clear how Medicare will pay.


over 3 years ago

Limitations on Part A and Part B coverage and general information.


over 3 years ago

Emily, Thank you for your response. I will try the ask and answer section. This whole web site is a great comfort to me; I'm sure it helps many of us!


over 3 years ago

Hi DorisJ, Sorry to hear about your husband's illness. Sounds like you are both is an uncomfortable and difficult situation. One great place to get advice about your situation is in our ask and answer section. You can ask your questions, and one of our experts will give you their expert opinion on your situation (http://www.caring.com/questions/new). I hope that helps! -- Emily | Caring.com Community Manager


over 3 years ago

It basically explained what is and is not covered under medicare. Thanks


over 3 years ago

It seems we can get no help either from Medicare or the VA, as to home health care. We just need occasional checkups by a nurse, since we are 100 miles from the VA where my husband is a patient. He has last stage COPD and is becoming increasingly unable to travel that distance. Nearest hospital or doctor is 21 miles, and he has no suppliment insurence, but does have part B Medicare. He is 78 and we have no relatives within 250 miles. He is not service-related, so VA offers no home care. Neither does Medicare. I am 74 and care for him, but would like someone to stop by and check on him, maybe weekly. Any info or advice would be appreciated.


over 3 years ago

I am so pleased with the various people that are keeping an eye on my wife, and myself ! They are employed by our local hospital. I strongly suggest that one should ask for assistance from from your hospital. We are both retired and living in our home. I am even going to be able to do some part time volunteer work while a volunteer comes to the house to be with my wife who has MDS and dementia and has just had a seizure.


over 3 years ago

i,m trying to find out if there is a way for me to be paied for the full time care of my dad. i have had to move him from tx. to tn. to live with me so i can care for him fulltime. there for i can no longer go to work.. he is 75. he has mediacare and he is a vet. i went to the s.s. office today to ask them thay said tn. s.s. does not have anything. can someone tell me what i need to do,or where to go. thankyou!, debi


almost 4 years ago

I have been looking for this information on in-home healthcare.


almost 4 years ago

I AM LOOKING FOR A HOME HEALTH AID COMPANY THAT WOULD ALLOW US TO INTERVIEW A COUPLE A POTENTIAL CANDIDATES TO CARE FOR MY GRANDMOTHER IN HER HOME.I AM NOT SURE OF HOW MANY DAYS YET , BUT SHE DOES HAVE MEDICARE & OTHER INS. SHE HAS PARKINSON'S AND IS CONFIDED TO THE HOUSE, AND WILL BE COVER MEDICALLY FOR THE COST.WE NEED SOMEONE TO HELP HER BATHE,DRESS,DO LIGHT CLEANING, AND BECOME A FRIEND. THANK YOU...BARBARA


almost 4 years ago

I am looking specifically if cancer is covered, so that would be something that I would like to see mentioned, or at least delve into specific ailments a little more.


Anonymous said almost 4 years ago

This site is totaly what I needed! Thank you!


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