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Does Medicare Cover Home Care After Surgery?
Date Updated: December 20, 2024
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
Reviewed by:
Kristi Bickmann, a licensed Long-Term Care Specialist, represents top-rated "Traditional" & "Hybrid" LTC companies. Serving associations such as the American Nurses Association, she's a licensed insurance agent in 27 states. Specializing in insurance products for seniors, Kristi helps hundreds of families every year protect assets, retirement, and loved ones. She understands aging concerns firsthand, having assisted her own parents. Kristi ensures accuracy on topics about senior long-term care and its consequences.
No, Medicare doesn’t cover home care after surgery. However, the national health insurance program funds limited personal care assistance for individuals who also receive skilled home health care services. Following surgery, seniors may qualify for funding for nonmedical home care through other financial assistance programs.
Main Differences Between Home Care and Home Health Care
Home care includes nonmedical support around the house, such as housework, laundry and light yard work. Aides also help individuals with personal care, such as bathing, brushing their teeth and using the toilet. Care plans include companionship hours, too, for those at risk of social isolation.
Conversely, home health care helps those with temporary or ongoing medical or therapeutic needs. Health care professionals, such as nurses, nursing assistants and therapists, visit patients at home to deliver medically essential services that aid their recovery. Such care includes:
- Skilled nursing
- Physical therapy
- Occupational therapy
- Speech-language therapy
- Dietitian guidance
- Medical social services
- Home health aide support
Medicare Coverage of Care at Home
Medicare covers intermittent home health care services under both Part A and Part B as long as Medicare-certified agencies deliver the care. Eligibility criteria include:
- Patients being homebound
- Doctors prescribing home health care attention
- Doctors considering home health care as medically necessary
The program funds up to 28 hours of weekly care for most individuals, although it pays for up to 35 hours in exceptional situations. Doctors must review care plans regularly and recertify that care continues to be necessary for an individual’s condition. Medicare coverage only includes personal care, such as bathing and dressing assistance, for those who also receive skilled care at home.
Pay Options for Nonmedical Home Care
Following surgery, seniors need practical help alongside medical care. Sometimes, family caregivers complete domestic chores and help their aging loved ones with hands-on care. In some locations, seniors with lower incomes can secure funding that pays their relatives to help. Alternatively, state Medicaid plans or waiver programs cover nonmedical home care services that certified agencies deliver. Although rules vary among states, seniors must typically satisfy criteria related to the following:
- Citizenship or permanent residency
- In-state residency
- Age
- Financial resources
- Functional need
People who hold long-term care insurance policies should discuss their circumstances with their providers; many plans cover home care support for those who need assistance with several activities of daily living. Likewise, veterans need to contact their local VA center to find out if they qualify for VA-funded home care services. Other ways to pay for home care include:
- Income, such as Social Security, and pensions
- Savings
- Loans
- Reverse mortgages