Does Medicare pay for in-home care

You’re looking for in-home care and, naturally, the first question you ask is, “How do I pay?”.  After sending large chunks of your earnings to the federal government for most of your life, you finally qualify for Medicare. The next logical questions is, “Does Medicare pay for in-home care?”. The answer is mostly yes. Under certain conditions, Medicare does cover the cost of some types of home health care. As you’ll see, that coverage is limited.

The Medicare “Recipe” for Qualifying for In-home Care

In order for Medicare to cover the expense of home care, all of the following requirements must be met. Medicare Part A and Part B can help if:

1. Your prescribing doctor accepts Medicare.

2. You are homebound certified.

Being homebound is defined by Medicare as requiring the help of another person or special equipment (walker, wheelchair, crutches, etc.) to leave your home. Your doctor believes that without assistance, leaving your home would be harmful to your health.

Your doctor must certify that you are homebound in order for you to be eligible for Medicare pay for in-home care. Plus, there must be a specific plan of care that the doctor reviews regularly.

3. You need regular skilled care.

Skilled care includes nursing care or therapeutical services (speed, physical, or occupational therapy). Skilled care is intermittent and predictable. By definition, this means that you need care for as little as once every 60 days to as much as once a day for three weeks. Skilled care must be prescribed by a medical professional on a regularly recurring basis.

4. You have met face-to-face with the prescribing doctor.

The doctor must confirm to meeting with you. The meeting must be within 90 days before starting, or, within 30 days after starting in-home care. And, this meeting must be in regards to the main reason for needing in-home care.

Face-to-face encounters may also be done through the use of teleconferencing.

5. Your in-home care is provided by a Medicare-certified agency.

Does Medicare Pay for In-home Care
if it’s Non-medical, Personal Care?

It does, but the Medicare recipe must still be followed exactly. For example, if you need help bathing or dressing, but you do not need skilled medical care, then Medicare won’t pay. However, if you meet all five conditions listed above, then the following services are also covered:

  • Social services or counseling
  • Companionship/sitter services
  • Bathing, toileting, dressing
  • Small medical supplies (bandages, catheters)
  • Durable medical equipment (wheelchairs, walkers)

Will Medicare Pay for In-home Dementia Care?

A condition that is not explicitly listed in the Medicare recipe can still qualify for Medicare coverage. If the diagnosing doctor works within the parameters, then care for a variety of conditions and illnesses is included. Dementia, for example, is a disease that deems someone homebound. Swallowing disturbances are common in people with dementia and require regular treatment from a speech pathologist. During the time that this person receives speech therapy, Medicare will cover a portion of their non-medical in-home care as well.

Does Medicare pay for in-home care

So… How Long Does In-Home Medicare Coverage Last?

If all five conditions are met, then Medicare will pay for up to 60 days of simultaneous personal and skilled care services. Medicare will pay for in-home care up to seven days a week. This is limited to to eight hours or less per day and 28 hours per week (in some cases up to 35 hours per week). In the best case scenario, Medicare covers a total of 240 hours of in-home care.  Unfortunately, it’s more than likely that your Medicare benefits for in-home care will run out before the need for care runs out. To stretch your benefits, rely on Medicare to pay for the more expensive, in-home skilled care. Secondarily, consider paying out-of-pocket for the less expensive, non-medical in-home care needs.

Alternative, Cost-Saving Options for In-home Care

Medicare is far from limitless. And many seniors find that meeting the requirements for Medicare reimbursement are difficult. The likelihood of needing alternative ways for paying for in-home care is great. Long term care insurance and Veterans benefits can help cover the cost. Reach out to your local Area Agencies on Aging for caregiver support and opportunities for local grants and funding for in-home care.

If you’re forced to pay out-of-pocket, we provide an economical, trustworthy solution. Home Care Assist works like an agency, without the agency prices. This means cost savings for you and increased earnings for the the caregiver. Plus, all caregivers in the Home Care Assist network are thoroughly background-screened and qualified. They’re matched to your specific needs based on skill, availability, and most importantly, personal compatibility. Activate your FREE, introductory 7-day pass to see for yourself!