Does Medicare or Medicaid Cover Home Care?

Does Medicare Cover Home Care?

Medicare Part A and/or B (Original Medicare) covers some home care expenses, typically when you cannot or should not leave your home1. These include licensed medical care services such as:

• Skilled nursing care (part-time or intermittent)
• Occupational therapy
• Physical therapy
• Home health aide care (part-time or intermittent)
• Speech-language pathology services
• Medical social services
• Certain injectable osteoporosis medications

Original Medicare does not cover:

• Personal care
• Meal delivery
• Auxiliary care
• Home care services needed 24 hours per day

If you have Medicare Part C (Medicare Advantage) or a supplemental plan, check directly with your plan carrier for information.

Am I Eligible for Home Care with Medicare?

For Medicare to pay for home care, you must meet certain eligibility requirements. These include:

• Doctor’s certification that you require covered home health care services
• Doctor’s certification that you are homebound
• Written plan of care that is regularly reviewed by your doctor
• Care is provided by a Medicare-certified home health agency

How Much Will I Pay for Home Health Care with Medicare?

For the home health services they cover, Medicare coverage is quite complete. You will pay nothing out of pocket for covered home health care services if they are medically necessary.

However, you may require durable medical equipment as part of your care. This includes, but is not limited to, such items as:

• Crutches
• Cane
• Walker
• Wheelchair or scooter
• CPAP machine or oxygen
• Hospital bed
• Nebulizer
• Blood sugar monitor
• Patient lifts
• Commode chairs

Under Original Medicare, you may pay 20 percent of the full cost for any durable medical equipment you need after you meet the deductible. However, both your prescribing doctor and the DME supplier need to be enrolled in Medicare.

How Can I Find Medicare-Certified Home Health Care Near Me?

Your doctor may work with Medicare-certified home health agencies regularly, so he or she may be able to make a recommendation. Alternatively, you can search Medicare’s website for certified agencies near you, along with their quality and patient survey ratings. Ask plenty of questions to ensure the agency provides the type of care you need and that you feel comfortable with those who will care for you.

Does Medicaid Cover Home Care?

Medicaid is less black and white than Medicare because it is administered by the individual states. Therefore, the state you live in determines which home care services are covered and what eligibility requirements you must meet. In general, you can expect that if you qualify for Medicaid in your state, some level of home care will be covered.

To find out whether you are eligible for Medicaid home care and which services are available to you, find your state’s Medicaid profile on Medicaid’s Home & Community Based Services page. Then, contact your state’s Medicaid department directly.

How Can I Find Medicaid Home Health Care Near Me?

Your state’s Medicaid program is the best place to find home health agencies near you that accept Medicaid. Your doctor may also be able to provide a list of agencies with whom he or she has worked in the past.

How Else Can I Pay for Home Care?

Besides Medicare and Medicaid, there are several programs and government aid options that may help cover the costs of home care. Each has its own eligibility requirements and list of services it will cover. In addition, paying out of pocket is always an option, though this may not be feasible for many people.

• VA programs: Low-income veterans with certain disabilities who receive a VA pension may qualify for the Housebound benefit. Other VA benefits that may apply include Homemaker and Home Health Aide Care, Skilled Home Care, Telehealth Care, and Home Based Primary Care. Contact your local VA for more information.
• HCBS Waivers: (Home and Community-Based Services Waivers) These waivers vary from state to state, but may include services not covered by Medicaid.
• Long-term care insurance: This is a type of private insurance you can use to pay for various needs as you age or if you have a chronic illness or disability. Note that you must go through the underwriting process to be eligible, so you may not qualify to obtain this insurance if you already have certain health conditions. However, if you already have long-term care insurance, it may cover some or all of your home care needs. Contact your insurer to learn more.
• State programs: Different states have various programs to help pay for the costs of home care. There may be a single program or a patchwork of state and local-level services, and they might offer complete coverage or cover only a handful of services. The best way to find out what is available to you is to contact your state’s Council on Aging or Department of Aging.
• Private pay options: Most people will be able to find at least some help paying for home care. But you may still have certain out-of-pocket costs. Depending on your personal finances and individual needs, you may have options for raising the money to pay for care. These include a reverse mortgage on your home, converting a whole life insurance policy into cash, or even selling your home and moving into something less expensive. These are big decisions that should not be taken lightly.

While Medicare will cover many of your home care needs, it may not pay for everything. Alternatively, Medicaid coverage varies from one state to the next. Since you may need to dip into private funds, you should always discuss your options with trusted family members or friends, along with your lawyer and accountant, before making a decision.