Let's face it. For most of us, nothing beats the comfort of our home. Luckily, there are plenty of options for professional in-home care, so you can continue to live at home as you age and enter new stages of life. You might receive temporary home care while recovering from a surgery or hospitalization. Or you may need ongoing home care when aging in place or living with a disability or chronic illness.
No matter your reason for needing home care, it can be downright expensive. If you have Medicare or Medicaid, you might wonder whether home care services are covered. Here's everything you need to know about home care coverage.
Does Medicare Cover Home Care?
Medicare Part A and/or B (Original Medicare) covers some home care expenses.1 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
More Tips from the Pros: Read through this year's complete guide to enrolling in Medicare. Our experts break down everything you need to know to get started with Medicare.
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.
However, you may require durable medical equipment as part of your care. This includes, but is not limited to, such items as:
- Wheelchair or scooter
- CPAP machine
- Hospital bed
- Blood sugar monitor
Under Original Medicare, you may pay 20 percent of the full cost for any durable medical equipment you need. If you have Medicare Advantage or a Medigap plan, contact your plan carrier for details.
Pro Tip: Deciding between assisted living or home care? Our experts have taken a deep dive into the difference between assisted living and home care so you can decide what is best for you or your loved one.
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.
Did You Know: In some states, Medicaid pays family members for providing personal care to their aging loved one.2
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 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.
- 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 for more information.
- 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.
- Private pay options: Most people will be able to find at least some help paying for home care. But you may still have some out of pocket costs. Depending on your personal finances and individual needs, you 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. Discuss the possibilities with your trusted family members or friends, along with your lawyer and accountant, before making a decision.
Quick Tip: To learn more about the costs of in-home care, visit our home care cost guide.