Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.

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Many families understand the challenges of caring for an aging loved one. While many seniors prefer to age at home, changes in their health may force families to review available in-home care options, including costs and payment options. As an alternative to receiving services on an outpatient basis or in a skilled nursing facility, Medicare can help cover some skilled services for seniors in the comfort of their own homes. However, there are specific eligibility requirements that apply and limitations on what home health care services Medicare will cover.

Key Takeaways

Medicare covers in-home skilled medical services ordered by a doctor. Skilled services include those provided by medical professionals such as a registered nurse or physical therapist.
A senior must have Medicare Part A and/or Part B to receive covered home health services. Their doctor must also create a plan of care and certify they need home health care.
Some personal care and homemaker services may be covered for qualified seniors. Medicare only covers these nonmedical services if they’re included with skilled services in a patient’s plan of care.
Medicare will only cover part-time, intermittent home health care. Medicare-covered home health care is intended to be a temporary solution to help a homebound patient recover from an illness or injury.

What home health care services are covered by Medicare?

Medicare will cover skilled nursing services provided by a health care professional, such as a registered nurse (RN). Skilled therapy services like those provided by a licensed physical therapist are also covered by Medicare.

Examples of skilled nursing services include:

Monitoring of a patient’s vital signs and overall health
Administration of intravenous drugs or nutrition therapy
Wound care for a pressure ulcer or surgical incision
Injections
Catheter changes
Patient and caregiver education

Different types of skilled therapy services include:

Physical therapy, which focuses on restoring optimal physical functioning by improving strength, balance, and range of motion.
Occupational therapy, which assists patients in regaining the ability to independently engage in activities of daily living (ADLs). This may involve adapting daily tasks or the surrounding environment to improve functionality and accessibility.
Speech-language therapy, which helps patients regain the ability to speak and communicate as well as overcome swallowing difficulties (dysphagia).

Keep in mind that Medicare will only cover the above therapies if they’re considered effective treatments for a patient’s condition.

Note that there’s a distinction between medically necessary home health care services and nonmedical personal care services. Medicare will not pay for nonmedical in-home care if it’s the only type of care your parent needs. Personal home care services like assistance with activities of daily living or homemaker services that include light housekeeping and laundry will only be covered if they’re detailed in a patient’s care plan.

How to qualify for home health care under Medicare

To qualify for home health care, your loved one must have Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) in addition to meeting the following criteria:

Eligible recipients must be under the care of a doctor who creates and regularly reviews a medically necessary plan of care. The doctor must also certify that the patient requires at least one of the following services:
- Intermittent skilled nursing care
- Skilled therapy services
Eligible recipients must be certified as homebound by a doctor. A senior is considered homebound if they require help from another person or must use a mobility aid, such as a cane or wheelchair, to leave their home.
A Medicare-certified home health care agency must be used to provide services.

Medicare Advantage

Medicare Advantage plans are health insurance plans offered by private Medicare-approved health insurance companies. These plans must provide the same coverage as Medicare Parts A and B, including home health care services. While the minimum coverage these plans offer must be the same, they may include additional costs and impose conditions that differ from original Medicare.

To receive home health care coverage under a Medicare Advantage plan, a senior may need to:

Get a doctor’s referral beforehand
Use a home health care agency that operates in the plan’s network
Pay a copayment for certain services

Let our care assessment guide you

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What are the costs of in-home care covered by Medicare?

Home health care costs nothing for seniors who have Medicare Part A and/or Part B, meet the eligibility requirements listed above, and receive services from a Medicare-certified home health agency. Patients who have met their Part B deductible are responsible for 20% of the Medicare-approved cost of covered durable medical equipment, such as a wheelchair or oxygen therapy equipment. Additional services not included in a patient’s care plan are not covered by Medicare.

How long will Medicare pay for home health care?

Because home health care is intended to be temporary, Medicare will only cover part-time or intermittent care. Medicare will cover home health care up to eight hours per day for up to 21 consecutive days, or less than seven days per week. Coverage may be extended in some cases, but Medicare does not cover long-term skilled nursing care.

Home health care services covered by Medicare are designed to help a senior recover from an injury or illness. If your loved one’s needs exceed temporary care, then Medicare is not a viable payment option.

What are the costs of nonmedical home care services not covered by Medicare?

If you feel your loved one would benefit from nonmedical home care services not included in their care plan, you should expect to pay between $26 and $27 per hour, according to Genworth’s 2021 Cost of Care Survey.

Common types of nonmedical home care include:

Personal care that provides assistance with performing activities of daily living (ADLs) such as bathing, dressing, and toileting
Homemaker services that help seniors with household chores such as cleaning, laundry, and meal preparation
Companion care that offers social interaction through activities such as games, conversations, and outings

Many of these services are performed by family caregivers, but they can be time-consuming and conflict with other obligations. It’s common to combine family-provided care with paid care. Being realistic about your loved one’s needs, and the time you have to dedicate to their care, can help you create an accurate estimate of in-home care costs.

Talk with a Senior Care Advisor

Our advisors help 300,000 families each year find the right senior care for their loved ones.

How to pay for services not covered by Medicare

Many families are able to supplement Medicare-covered home health care by paying for services out of pocket. Other ways to pay for senior care include cashing in a life insurance policy, using pre-purchased long-term care insurance, or applying for Medicaid or veterans benefits.

How to start receiving Medicare home health care coverage

A doctor will create a plan of care if your parent is in need of home health care services due to an injury or illness. The doctor will then make a referral to a home health agency who will coordinate services. The agency should be Medicare-certified to ensure their services are covered by Medicare. It’s also possible to research and choose your own home health agency using Medicare’s provider search tool, but your loved one will still need their doctor’s referral.

Before services begin, the home health agency should speak with you and your loved one to provide details of their services that Medicare will cover and those it will not. Home health agencies are also required to present patients with a written Advance Beneficiary Notice (ABN) document before providing services and supplies that are not covered by Medicare.

Resources for families navigating Medicare and in-home care

Medicare may help seniors pay for some home health care costs, but coverage is limited. If your loved could benefit from additional nonmedical home care support, our Senior Care Advisors can help you find a home care provider that offers the services your loved one needs.

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References

Medicare.gov. Home health services.
Medicare.gov. Physical therapy services.
Medicare.gov. Occupational therapy services.
Medicare.gov. Speech language pathology services.
Medicare Interactive. Medicare Advantage and home health.
Centers for Medicare and Medicaid Services. Medicare and Home Health.
Genworth. (2022, June 2). Cost of care survey.

Meet the Author

Kevin Ryan

Kevin Ryan is a copywriter at OurParents. He has written about Medicaid and Medicare, and focuses on creating content for caregivers. Previously, Kevin worked as a freelance writer, a special education teacher, and a counselor for adults with developmental disabilities. He earned a bachelor's degree from the University of Colorado Boulder.

Reviewed byLetha Sgritta McDowell

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not recommend or endorse the contents of the third-party sites.

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