Does Medicare Cover Home Care Services?

If your family is considering hiring home care service for a loved one, there may be financial assistance available to help offset the costs.

For many people over 65, Medicare is a key source of funding for medical benefits. It’s common to ask how much of that might apply for in-home care.

Medicare will only pay for medically necessary care, so there are limited areas of care that may be covered.

What Medicare May Cover

People who are homebound and under a doctor’s care may be eligible for certain home health services. 

Home health care includes services like skilled nursing care, physical therapy, speech-language pathology services and continued occupational services.

Here are the most frequent scenarios: 

1. Short-term care for conditions that will improve

   Medicare may pay for some short-term home health care or a nursing home stay following medical treatment from which the patient is expected to recover.

   To qualify, the patient must have:

• recently stayed in hospital for at least three days
• entered into Medicare-approved care within 30 days of this hospital stay
• a doctor certified requirement for some kind of skilled care; such as physical therapy or skilled nursing
  
  If the patient meets all three criteria, Medicare will pay for 100 percent of the care for 20 days and a portion of the total amount from day 21 to day 100. After 100 days, the patient is responsible for all expenses.

2. Doctor-prescribed care for recovery from an injury

   Medicare may also cover additional care, provided your doctor says it is medically necessary to recover from an injury. This may include:

• part-time nursing care
• physical therapy, occupational therapy or speech/ language therapy for a limited period
• medical social services to help people cope with social, psychological or medical issues that may arise after an illness
• some medical supplies such as wheelchairs, other mobility aids, or an in-home oxygen service
  
  There is no limit to how long Medicare may pay towards these treatments, as long as the patient’s doctor still believes it is required and reorders it every 60 days. The doctor must also certify that the patient is homebound to qualify for these services.

2. Hospice Care

   If the patient has a terminal illness and is not expected to live for more than six months, Medicare will cover hospice and respite care in the patient’s own home, in a nursing home or in a hospice care facility.
   
   In addition to doctor services and nursing care, in a hospice care situation, Medicare may also cover other services that may not usually be covered, including:

• Physical therapy
• Occupational therapy
• Medical equipment and supplies
• Prescription drugs (for pain relief and symptom control)
• Hospice aide or homemaker services
• Grief counselling for the patient and his or her family
• Social work services
• Short-term in-patient care for pain and symptom management
• Short-term in-patient or in home respite care, to allow caregivers time away from caring responsibilities

 

It’s important to note that once Medicare begins to fund hospice or respite care, it will stop funding other areas, including treatment or drugs that are intended to cure the patient’s condition. The patient (or the person’s proxy) must sign a statement confirming the choice of hospice care instead of any other treatment for the illness.

If the patient agrees to this, Medicare will cover all costs, minus a copay for prescription drugs. There may also be a 5 percent copay for inpatient respite care. Medicare will not contribute towards room and board if you receive treatment in your own home or in a nursing home where you live.

Even if your loved one does not meet one of these eligibility criteria for Medicare to meet long-term care costs, there may be other avenues to pursue.

State Medicaid programs, veterans’ affairs benefits, or long-term care insurance may also help you meet the costs of long-term care.

 

Will My Love One Be Covered?

Medicare covers seniors over 65 years old.

Medicare is available for certain people with disabilities who are under the age of 65. That includes people who have received Social Security Disability Insurance for a total of at least 24 months, have end-stage renal disease or permanent kidney failure, or have Lou Gehrig’s disease (ALS).

If you qualify for Medicare, it’s still not certain that your long-term care will be covered. Medicare concentrates on short-term care for conditions which will eventually improve.

This means Medicare will not pay for most long-term home care services or personal services such as help bathing, dressing, or help going to the bathroom.

To help you understand you or your loved one’s ability to finance respite care or home care services, Visiting Angels offers free consultations over the phone and at your home.