It's one of the most common questions families ask, and the answer surprises many people: Medicare generally does not pay for ongoing non-medical home care, such as help with bathing, dressing, meals, and supervision, when that's the only help someone needs. It does cover some home health care under specific conditions.
What Medicare does cover at home
Original Medicare (Parts A and B) covers home health services when all of the following are true:
- The person is under the care of a doctor, and services are provided under a plan of care the doctor reviews regularly.
- A doctor certifies that the person needs intermittent skilled nursing care, or physical therapy, speech-language pathology, or continued occupational therapy.
- A doctor certifies that the person is homebound, meaning leaving home takes considerable effort.
- The care is provided by a Medicare-certified home health agency.
When someone qualifies, Medicare can also cover part-time home health aide visits alongside the skilled care. Once the skilled need ends, that coverage usually ends too.
What Medicare doesn't cover
- 24-hour care at home
- Personal care, such as bathing, dressing, and toileting, when it's the only care needed
- Homemaker services, such as shopping, cleaning, and laundry, when they're the only care needed
- Companion care and supervision
- Meals delivered to the home
In other words, the everyday help that lets most older adults stay at home long-term is usually not paid for by Original Medicare. For the difference between the two kinds of care, see home care vs. home health care.
What about Medicare Advantage?
Some Medicare Advantage (Part C) plans offer limited extra benefits, such as a set number of hours of in-home support. Benefits vary widely from plan to plan and year to year, so call the plan and ask exactly what's included.
What about hospice?
For people who qualify for hospice, Medicare's hospice benefit covers the hospice team's care, but it generally doesn't provide a caregiver in the home around the clock. Many families add private caregivers for the remaining hours. Learn about our end-of-life care support.
Other ways to pay
If Medicare doesn't cover the care you need, other options include private pay, long-term care insurance, veterans' benefits, and MassHealth programs for people who qualify. We explain each one in our guide how to pay for home care in Massachusetts.
Medicare rules change and depend on individual circumstances. For your specific situation, check with Medicare at medicare.gov or 1-800-MEDICARE, or talk to a SHINE counselor. SHINE is Massachusetts' free health insurance counseling program for people on Medicare.
Questions about care at home?
Call (978) 479-0499 or request a free consultation. We'll help you understand your options.