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What Percentage of Home Care Costs Does Medicare Pay?
Date Updated: December 13, 2024
Written by:
Lauren Thomas is a seasoned writer that specializes in long-term care, with a special focus on dementia-related topics. She holds a degree in counseling and uses her knowledge and experience to create insightful content that gives seniors and families the information they need to make important care decisions.
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Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.
Medicare pays 100% of home care costs for those who need skilled nursing services and meet eligibility requirements. However, it doesn't provide coverage for nonmedical custodial services. For qualified durable medical equipment, including wheelchairs and walkers, Medicare covers 80% of costs after you meet your deductible. To be eligible for care, you must need services only for short-term or intermittent periods.
What Type of Home Care Services Does Medicare Cover?
Medicare pays for medically necessary home health care services. For many people, this type of care is more affordable and convenient, yet just as effective, as the services they receive in an inpatient hospital setting or skilled nursing facility. Some services Medicare may cover include:
- Rehabilitative therapies
- Feeding tube maintenance
- Nutrition therapy
- Wound care
- Catheter care
- Medication administration
- Diabetes management
- Vitals monitoring
Medicare doesn’t pay for nonmedical custodial services such as help with dressing or bathing, meal preparation or companionship. For those who need nonmedical support, alternative payment methods such as long-term care insurance or Medicaid waivers may be options.
How Much Do Medicare Beneficiaries Pay for Home Care?
To have Medicare pay for home care, you must first meet your annual deductible, which comes in at $240 in 2024. After you meet your deductible, Medicare covers qualified home health care services in full, with no copays or coinsurance. However, if you need durable medical equipment at home, such as an adjustable bed, wheelchair or walker, you can expect to pay 20% of the Medicare-approved amount.
Medicare only covers medically necessary home health care services. If your doctor recommends services such as physical or occupational therapy, but services aren’t medically required, Medicare won’t provide coverage.
What Qualifies You for Home Care under Medicare?
To be eligible for home care services under Medicare, you must meet certain criteria:
- You must be under the care of a doctor and have a plan of care that includes regular review.
- Your doctor must certify that you’re homebound, meaning leaving your home is inadvisable or very difficult due to your condition.
- Your doctor must certify that you need skilled nursing services at home.
- You must only need short-term or intermittent services, which Medicare defines as no more than eight hours per day and 21 days per 30-day period.