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Does Medicare Pay for Home Care

  • Synopsis: Published: 2009-03-19 (Rev. 2013-06-12) - The following is a general overview of what Medicare covers in terms of home health care. For further information pertaining to this article contact: Jesse Slome.
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"Long-term care insurance is an option worth considering as an alternative and it's best to start looking into this protection in your 50s and early 60s while you are still healthy enough to qualify."

The following is a general overview of what Medicare covers (currently) in terms of home health care. Care must be temporary and part-time, and you must meet these requirements...

It's increasingly likely that you are going to live a long life, into your 80s, your 90s and quite possibly even into your 100s. When you live a long life, the chances are you'll need some long-term care. And, when you need that care, you'll want to receive it in your own home surrounded by familiar things and the people you know and love.

That's what most people want. Problem is, when that time comes, many people discover that Medicare has very specific rules about what home care is covered and what isn't. The care that isn't covered forces many people to deplete a lifetime of savings or force loved ones to become unpaid caregivers. Long-term care insurance is an option worth considering as an alternative and it's best to start looking into this protection in your 50s and early 60s while you are still healthy enough to qualify. It's certainly worthwhile if you are concerned about Medicare's ability to pay in the distant future.

The following is a general overview of what Medicare covers (currently) in terms of home health care. Care must be temporary and part-time, and you must meet these requirements:

Your doctor must say that you need the care. Your doctor must document that you need care at home and make a plan for that care.

You must need skilled care or therapy (physical, speech or occupational).

You must be homebound. Homebound means that leaving home is a major effort and you cannot do it without help. When you do leave home, it must be to get medical care, or for short, infrequent non-medical reasons such as a trip to get a haircut, or to attend religious services or adult day care.

The home health agency must be Medicare-approved.

If you meet all the requirements for home health care, Medicare will pay for:

Occasional skilled nursing care: This is care that can only be done safely and correctly by a licensed nurse. That's either a registered nurse or a licensed practical nurse.

Physical therapy: Physical therapy includes exercise to regain movement and strength to part of your body, and training on how to use special equipment to take care of yourself.

Occupational therapy: Occupational therapy helps you do daily activities by yourself, such as eating, putting on your clothes or combing your hair.

Speech-language therapy: Speech-language therapy is exercise to help you speak more easily and clearly.

Medical social services: These services can help you with social and emotional concerns related to your illness. For example, you might need counseling or help finding resources in your community.

Some medical supplies such as wound dressings, but not prescription drugs.

Some medical equipment such as a walker or a wheelchair.

Medicare might pay for personal care like bathing, help using the toilet or help with dressing if you are also receiving skilled care such as nursing care or other therapy. But keep in mind that many people need long-term care simply as a result of the frailty that comes about simply because of aging. Medicare doesn't cover this type of need and you'll pay out-of-pocket or have insurance to cover qualifying circumstances. Medicare also does not pay for 24-hour-a-day home care, prescription drugs, meals delivered to your home or homemaker services such as cleaning, laundry and shopping.

Typically, when Medicare does cover home care you do not have to pay for anything except 20 percent on certain kinds of durable medical equipment. There is no time limit on home health care as long as you continue to meet the requirements.

If you are interested in learning more about long-term care insurance as an option to pay for home care costs visit the Consumer Information Center of the American Association. There is a wealth of information and you can access the Associations comprehensive online directory of over 3,000 insurance professionals who can assist with your long-term care insurance needs.

Reference: Jesse Slome is Executive Director of the American Association for Long-Term Care Insurance. The industry trade organization does not sell insurance products but maintains an excellent website for consumers seeking additional information on the subject. If you would like to receive a no-obligation free quote from a member of the Association, visit our Consumer Information Center at www.aaltci.org






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