Does Medicare pay for home care? What families need to know

By Teresa Sajkowski, RN, BSN, Founder of Always Responsive Home Care

I have been a nurse for many years, and I founded Always Responsive Home Care in 2010. This is one of the questions I hear most from families, usually right after a loved one comes home from the hospital and everyone is trying to figure out what comes next. Here is what you need to know.

What Medicare does cover at home

Medicare covers what is called home health care. This is medical care at home for a short period of time, provided by a Medicare certified home health agency. It can include:

• Part time skilled nursing care
• Physical, occupational and speech therapy
• Some part time home health aide help, but only while your loved one is also receiving skilled care
• Medical social services

To qualify, your loved one generally needs to be considered homebound, meaning leaving home takes a major effort. A doctor also needs to certify that they need skilled care and create a plan for it. The care is part time and short term. Once your loved one no longer needs skilled care, the Medicare coverage stops, even if they still need help with daily life.

What Medicare does not cover

This is where many families are surprised. Medicare generally does not pay for:

• 24 hour care at home
• Personal care on its own, like help with bathing, dressing, toileting or getting around, when that is the only help someone needs
• Homemaker services, like cooking, light housekeeping, laundry and errands
• Companionship and supervision, including for someone living with dementia
• Overnight or live-in care

This type of help is often called non-medical home care or custodial care. It is exactly the kind of care that keeps someone safe and independent at home, and it is what Always Responsive Home Care provides.

What about Medicare Advantage?

Some Medicare Advantage plans now offer limited in home support benefits, such as a small number of hours of help each year. These benefits vary a lot from plan to plan, and they are usually not enough to cover ongoing care. If your loved one has a Medicare Advantage plan, it is worth calling the plan to ask what is included.

When Medicare home health ends, what happens next?

This is the moment so many families find themselves in. A loved one comes home from the hospital or rehab. A home health nurse and therapist visit for a few weeks. Then the visits stop, and the family realizes Mom still needs help getting showered, making meals and moving around the house safely.

That gap is where private home care comes in. Many families start non-medical home care alongside Medicare home health, or right as it ends, so their loved one never goes without support during recovery. Our hospital to home care is built for exactly that stretch.

How families pay for home care

Most families use one or more of these options:

• Private pay. Most families pay for non-medical home care out of pocket. With the right plan and schedule, it can be more affordable than people expect, and it lets your loved one stay home instead of moving to a facility.
• Long term care insurance. If your loved one has a long term care insurance policy, it may help pay for home care. At Always Responsive Home Care, we work with all long term care insurance policies and take care of the administrative work for you. Our payment options page explains how it works.
• Veterans benefits. Some veterans and surviving spouses may qualify for VA benefits like Aid and Attendance, which can help with the cost of care. We are happy to help you look into eligibility or point you in the right direction. See our page on home care for veterans.
• Medicaid. Some state Medicaid programs help pay for in home care for people who qualify. Always Responsive Home Care is a private pay agency, but if Medicaid is the right path for your family, we will gladly refer you to trusted providers.

How Always Responsive Home Care helps

We provide non-medical home care that picks up where Medicare leaves off. Families choose us because:

• We help you figure it out. Every client starts with a free in home assessment. We meet your loved one, learn what they need and work with you to find the most affordable way to get them the right care.
• We can start fast. Care can often start the very same day, which is one reason hospital discharge planners count on us.
• We offer every level of care. Hourly care, overnight care, 24/7 care, live-in care in select locations, and 24/7 Virtual Care.
• Our caregivers are our employees. Every caregiver is screened, background checked and trained, and our care team supervises and supports them every step of the way.
• No surprises. No long term contracts, no large deposits and nothing billed in advance. Our pricing is clear and upfront.
• We are always here. Our team is available 24/7, and we have been caring for families since 2010.

Get answers for your family

Figuring out how to pay for care can feel overwhelming, especially when a loved one has just come home from the hospital. You don't have to sort it out alone. Call Always Responsive Home Care today or fill out the form below for a free in home assessment. We will answer your questions, walk you through your options and help you find the care your loved one needs.

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About the author

Teresa Sajkowski, RN, BSN, is the founder of Always Responsive Home Care. She started the company in 2010 in New Jersey and has grown it into a home care franchise serving families in multiple states.

This article is for general information. Medicare rules and plan benefits can change, so check with Medicare or your plan for details about your own coverage.