Is Home Care Covered by Medicare?

Getting set up with home care can be a bit of a journey.

For starters, you want to make sure you find the right caregiver who matches your values and preferences. You deserve to continue to feel like you while you age at home — don’t forget that!

You also need to figure out how to pay for home care, which can vary widely depending on where you live and what type of care you require. During this process, you might find yourself asking: does Medicare cover any of this?

The short answer: no, Medicare does not cover home care.

However, Medicare does cover some home health care services for short periods of time. To help you navigate this journey, and understand what is and isn’t covered by Medicare, we’ve broken down the most important details below.

You’re probably already familiar with Medicare, but for the sake of this article we’ll break it down from a top-level perspective.  

In short, Medicare is the government program in the United States that covers all individuals who are 65 and older. It’s essentially acute care, which means it covers major medical things like hospital or physician expenses. 

There are two primary types of Medicare: Original Medicare and Medicare Advantage. If you’re eligible for Medicare, you’ll need to choose one or the other, but there are annual enrollment periods where you can switch between the two. 

Original Medicare is comprised of Parts A and B. Part A covers any in-patient expenses, like hospital stays; Part B covers out-patient expenses, like physician visits, lab work, x-rays — things like that. With Original Medicare, you can go to any doctor or hospital in the United States that takes Medicare, but there’s no yearly limit of what you’ll pay out of pocket. 

Medicare Advantage operates more like a group health insurance plan, meaning you’ll need to receive your primary care services from a provider who’s in the network of your plan and service area (for non-emergency care). These plans do have a yearly limit, which means you’ll pay nothing for the types of services Part A and B cover once you reach your deductible. 

At the moment, there’s about a 50-50 split of enrollment between the two types of Medicare options.

As we mentioned, Medicare will not cover home care, but it will cover some home health care services. Before you begin any research, it’s important to understand the differences between the two:  

Home care refers to any type of non-medical assistance at your home that helps you with activities of daily living — things like bathing, dressing, light housekeeping, transportation, and basic companionship. Again, Medicare will not cover this. 

Home health care refers to in-home services like skilled nursing or physical therapy — anything that requires a trained clinician. Medicare will cover some of this, assuming it’s short-term.  

These are the primary home health care services Medicare will cover: 

Home health aide services 

Medicare will pay for part-time home health aide services if you need them to treat an illness or injury. These services include: 

• Skilled nursing care 

• Physical therapy 

• Speech-language pathology services 

• Continuing occupational therapy 

Medical social services 

These types of services include counseling or help finding mental health resources in your community. One important note, though: Medicare won’t cover social services unless you’re also receiving skilled care (any of the services mentioned above). 

Medical supplies 

Medicare will also cover supplies, like wound dressings, if your doctor orders them as part of your treatment. 

All of these services are covered under both Original Medicare and Medicare Advantage. However, Medicare Advantage may additionally provide ancillary services like home-delivered meals or transportation, which Original Medicare won’t provide.  

To be eligible for any of the benefits we just walked through, you’ll need to meet the following two criteria: 

Require 30 Days (or Fewer) of Help 

Both Original Medicare and Medicare Advantage will only cover the home health care services above if it’s for a short period of time — usually 30 days or less.  

Be Homebound 

Under both plans, you’ll also typically need to meet Medicare’s definition of being “homebound,” which means it’s either very difficult or impossible for you to leave your home. 

If you’re eligible, it’s worth noting that you’ll need to receive these care services from a Medicare-certified agency. Any type of agency that’s only providing home care services, not medical services, is unlikely to be certified.  

On a related note, Medicaid does cover home and some types of home health care — beyond just 30 days — under a waiver program. However, you need to meet the income requirements of Medicaid to qualify.

Each state has slightly different requirements, which you can research here.  

Overall, Medicare will not cover home care, but it will cover some select home health care services for 30 days or less.  

This can be helpful if you’re recovering at home from a minor illness or surgery, and only need a month or less of care, but for anything longer you would need either long-term care insurance or to pay out of pocket. 

The most important thing to remember: information is power. Take a look through our resources for planning for long-term care here so you can be better equipped when you begin your search.