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When we get older, some of us develop illnesses or injuries that will prevent us from doing daily tasks inside our homes without assistance. If family members need help in caring for loved ones in the home, then we need to bring in outside help from an in-home caregiver.
So a common question many people have is, “does Medicare cover in-home care?” In this article, we answer that question in clear, plain English. You will also find the average costs of home health care and other helpful info.
Does Medicare Cover In-Home Care?
The short answer is yes; Medicare will cover the cost of home health care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home health care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for home health care. However, not all types of home health care are covered by Medicare. Both Medicare Part A and Part B provide coverage for home healthcare, especially if you have an illness or injury that requires in-home caregiver care.
However, there are some conditions that have to be met for Medicare Part A and Part B to provide coverage for your home health care. You must meet at least one of the following conditions:
- You are unable to leave your home unless it is a short outing such as visiting the doctor. (Medicare also provides coverage for home health care even if you visit adult daycare.)
- Your healthcare provider ordered that you need home health care and writes a plan outlining the kind of care you need
- Your healthcare provider must certify that you are homebound.
- You need skilled nursing care. However, Medicare only covers skilled nursing care for 8 hours per day and 28 hours per week for up to three weeks.
- Your healthcare provider believes that your condition will improve in a reasonable amount of time .
- You need assistance from a skilled physical, occupational, or speech therapist to design a program that can help you improve or maintain your current state, or prevent it from getting worse.
- Your home-health agency is Medicare-approved.
Some of the services that you may receive in in-home caregiver care include:
- Physical therapy
- Occupational therapy
- Speech therapy
- Nursing care
- Home-health aides
However, Medicare Part A and Part B do not provide coverage for custodial care. Medicare Part A and Part B will only cover custodial care if you require it for a short amount of time while you are recovering from an injury or illness.
Part C and Part D Coverage for In-Home Care
Medicare Advantage plans (Medicare Part C) also provide coverage for in-home care. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what they cover and what your out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part D provides coverage for prescription drugs that you need during your home healthcare period.
How Much Does Home Caregiver Care Cost?
Having a home caregiver care may cost $20 or more per hour. The average cost is around $400 per month. This cost varies from state to state.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover thyroid blood test?