Does Medicare Cover In-Home Care?

As a caregiver, you might be exploring how to pay for your loved one’s in-home care. You might have asked, “Does Medicare cover in-home care?” There are many cases in which Medicare provides partial coverage of care provided at home for a short period. This article breaks down the circumstances in which Medicare will cover those expenses. We’ll also explain what to look for so that you don’t get hit with unexpected costs in cases where Medicare won’t cover certain things.

Eligibility

There are three basic criteria your loved one must meet to be eligible for in-home care Medicare coverage. Coverage is available under Medicare Part A, Part B, or both. Here are the basic guidelines to see if your loved one meets the requirements for Medicare support:

• Your loved one needs to be homebound. This means a doctor has signed a piece of paper indicating your loved one needs special help moving from one place to another. For example, they might need a cane, a scooter, a walker, or someone by their side. They should also stay primarily at home. 

It’s OK if they occasionally go to church services or doctor’s appointments. If your loved one regularly goes outside of the house, they likely will not be eligible. 

• Your loved one gets regular help from a doctor. Most people who get in-home care paid in part by Medicare have a plan of care in place. A doctor should help design the plan and review it often.

• Your loved one needs occasional help from a skilled nurse, some type of therapy, or both. Sometimes Medicare calls this “intermittent” care. It means a professionally trained nurse is needed to check on your loved one off and on. For example, they might check vitals, administer medicine, care for a wound, etc. 

They must do more than just draw blood for your loved one to qualify. Or your loved one might need some type of therapy, for example, physical therapy to recover from hip, knee, or shoulder surgery; speech therapy to improve their ability to communicate with others; or occupational therapy. 

This should not be a permanent situation. Medicare wants to ensure your loved one will recover to the point that a skilled nurse is no longer needed. You should be able to demonstrate that this is the case. Or you can show how the nurse is helping put a plan in place that your loved one can follow in the future to keep healing. You can also demonstrate a nurse is necessary to maintain your loved one’s well-being.

If your loved one attends an adult daycare, that’s OK. Depending on their circumstances, they can still be eligible for in-home care Medicare coverage. 

Medicare In-Home Nursing Coverage

Medicare home nursing covers several types of activities, including occasional care from certified nurses, various forms of therapy, and support with medical supplies. Here are some other types of support Medicare will cover if your loved one qualifies:

• Social services focused on meeting your loved one’s health care needs

• Care from a home health aide, in certain cases

• Osteoporosis medication injections for women

• Support with certain types of equipment for medical purposes

• Help using specific kinds of medical supplies

Types of Medical Professionals Covered 

Medicare coverage includes home care provided by a licensed practical nurse (LPN) or a registered nurse (LPN). In cases where you are assigned an LPN, they will be guided by an RN. As a result, you can have confidence that your loved one will get high-quality care from a trained professional. 

Trained nurses not only provide occasional help but also provide coaching. This way, you can learn about care best practices. This can help provide a greater quality of life for your loved one. It also gives you greater confidence to help put your loved one’s care plan into action. 

In-Home Care Costs Not Covered By Medicare 

Several costs your loved one might incur at home aren’t covered under Medicare, including around-the-clock care. If your loved one needs help more than eight hours a day, or more than 28 hours a week, you will likely need to pay for their care out of pocket. 

Additional expenses Medicare won’t cover include:

• At-home meal delivery

• Cleaning, laundry, shopping, and other services that aren’t directly authorized in a doctor’s home care plan

• Support only for daily activities such as taking a bath, getting dressed, or going to the bathroom

• Help from unskilled caregivers without the required medical training

Talk with your loved one and their doctors and nurses to align on the best care plan and clearly understand which pieces Medicare will cover. 

How to Tell What’s Covered

When you seek in-home care Medicare coverage, there might be expenses the program won’t cover. In these cases, your loved one’s care provider will provide a written document called an advance beneficiary notice of non-coverage. It’s also called an ABN. 

This document lists the planned services Medicare will not pay for. If you see these kinds of services listed, there are several steps you can take:

• You can pay for these extra services and ask the care provider to file a Medicare claim. If Medicare comes back and says it won’t pay, you will pay out of pocket. If you wish, you may appeal the denial. On the other hand, if Medicare does pay for a portion of those services, your caregiver can refund payments less any copay or deductibles. 

• You can pay for the services out of pocket. In this case, you are responsible for the cost of the non-Medicare services. You can’t appeal this because you have not filed a Medicare claim.

• You can skip the services. There might be services that are nice to have but not a must for your loved one. In these cases, you can tell your loved one’s service provider that you are no longer interested in receiving those services. It’s best to put this in writing so you have a record of your loved one’s request to skip these services. 

Takeaways

Medicare can be a great option for covering certain at-home care expenses for a limited time. It’s essential to understand ahead of time if your loved one is eligible and what types of services are covered so you don’t have to pay for unexpected costs. 

Need Some Help?

Have questions about caregiving or care products? Our Caregiving Specialists are here to support you 24 hours a day, seven days a week. Call (800) 696-CARE or send an email to support@carewell.com.