Covering the costs of senior care can require creative financing from a range of different areas. While Medicare does not cover the full costs of home care services, you may find that some of your loved one’s home care costs can be temporarily subsidized by Medicare or Medicaid.
This article provides a general overview of when and how Medicare can be used to pay for home care services. However, we recommend contacting Medicare directly and ask plenty of detailed questions, to get accurate information about your specific scenario.
Also, visit our pos Paying For Senior Care: Medicare, Medicaid, and Home Care, which runs through various options and ideas for funding high-quality home care that allows senior loved ones to age-in-place safely and independently.
Medicare Has Stringent Parameters Around Home Care Coverage
If Medicare is willing to cover a portion of home care services, it is only for a temporary amount of time and the very little coverage is dedicated to non-medical home care services.
If you or a loved one qualifies for Medicare or Medicaid reimbursement or home care coverage, pay very close attention to coverage details. Any services that do not meet their qualifications must be paid out-of-pocket.
Again, we highly recommend contacting Medicare through their website, or by phone (1-800-MEDICARE) to get personally-relevant information.
Understanding Medicare-Approved Costs
In addition to understanding the strict parameters Medicare holds around covering home care services, patients and their families should be aware of the term “Medicare-Approved Costs.”
Every service that Medicare covers is assigned a specific cost or allowance. That is the maximum to which Medicare will contribute payment or reimbursement. If your care provider charges more than that, s/he will either have to agree to charge the Medicare-approved price OR the patient is responsible for paying the difference out-of-pocket.
Get Clear With Home Care Providers
Hopefully, you have selected a home care provider who is well-versed in Medicare reimbursement. By doing so, you’ll have more accurate information and estimates about how much you will be charged after Medicare contributions are accounted for.
Your home care agency should also be able to communicate which services are considered part of the home health care arena, and which are encompassed by their non-medical (personal care) offerings, so you can plan accordingly.
Which Services Are Covered By Medicare?
According to the Medicare website, there is a range of both skilled and unskilled services that are partially covered by Medicare. The services are covered by Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) depending on the type of service required. In most cases, Medicare covers up to 70% or 80% of the costs, but there are exceptions.
Also, the majority of the services covered by Medicare fall under the skilled nursing or skilled medical care umbrella, including:
- Part-time or “intermittent” skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Medical social services
- Part-time or intermittent home health aide services (personal hands-on care)
- Injectable osteoporosis drugs for women
If, however, you need skilled nursing care on a short-term basis, you must be under the care of a physician who reviews and approves the plan of care created by the home health agency on a regular basis.
When Is Personal Home Care Covered By Medicare?
Personal care services may qualify for Medicare reimbursement for a short-term basis, assuming they meet Medicare’s strict parameters. In most cases, the coverage encompasses just one or two hours of personal care services per day.
If the patient qualifies, Medicare may cover a portion of personal care services such as:
- Some grocery shopping or meal preparation
Home care services like those are only covered if the client also requires skilled nursing care on a part-time or “intermittent” basis and qualifies as homebound by his/her physician. Additionally, the home care company providing services must be approved by Medicare.
What Is Medicare’s Definition Of Homebound?
To qualify for Medicare reimbursement for a portion of home care costs, the patient must be certified as “homebound” by a physician. Their definition of “homebound” is:
- You need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home, or your doctor believes that your health or illness could get worse if you leave your home.
- And, it is difficult for you to leave your home and you typically cannot do so.
This does not mean you can’t leave your home. According to the Medicare website:
“You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.”
What Home Care Services Are Not Covered By Medicare?
Because Medicare focuses on covering medical- and skilled-nursing care, they also provide a list of services that are not covered. Keep in mind that there are exceptions to this if the patient also qualifies for short-term, intermittent skilled nursing care and requires additional assistance with personal care to support their recovery.
The following services are not covered by Medicare unless they are paired with short-term skilled nursing services:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services (like shopping, cleaning, and laundry), when this is the only care you need
- Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need
Home Care Agencies Should Help Decipher Cost Details
Medicare should always serve as your first and primary resource about what they cover – and what they don’t – in terms of home care services. That said, your home care agency should also be able to help you decipher the cost details so you know what you are responsible for.
Ultimately, only a small portion of home care costs will be covered by Medicare – and these would only be covered for a short- or intermittent period(s) of time. The bulk of non-medical home care services would be paid out-of-pocket or paid for with a combination of other sources such as your private insurance carrier, savings, retirement funds, long-term care insurance, etc.