Does Medicare Pay for Someone to Sit with the Elderly?

According to a 2024 report by the Kaiser Family Foundation, over half of people who use Medicaid home care are also enrolled in Medicare. For many families, this raises a critical question about financial support: does Medicare pay for someone to sit with the elderly?

Quick Summary

Original Medicare generally does not cover non-medical, custodial care like companionship or supervision. Coverage is typically limited to part-time, medically necessary home health care prescribed by a doctor, though some Medicare Advantage plans may offer additional, limited benefits.

Key Points

• Medicare does not cover custodial care: Original Medicare explicitly excludes coverage for non-medical services like companionship or supervision, categorizing them as 'custodial care'.

• Home health aide requires skilled care: Medicare will only pay for a home health aide (for tasks like bathing) if the patient is also receiving skilled medical services from a Medicare-certified agency.

• Medicare Advantage benefits vary: Some private Medicare Advantage (Part C) plans may offer limited coverage for non-medical benefits, but it depends entirely on the specific plan.

• Medicaid can cover long-term custodial care: State-based Medicaid waivers (HCBS) are a primary source of funding for long-term, non-medical care for low-income seniors.

• Veterans benefits and LTC insurance are options: Benefits from the Department of Veterans Affairs and private long-term care insurance are alternative payment methods for in-home care.

• Private funding is common: Many families rely on personal savings, annuities, or home equity (e.g., reverse mortgages) to cover the cost of custodial care.

Understanding the Types of In-Home Care

To understand Medicare's stance, it is crucial to differentiate between two main types of care: skilled and custodial. Skilled care involves services that can only be safely and effectively performed by licensed medical professionals, such as registered nurses or physical therapists. This can include tasks like wound care, injections, or monitoring an unstable health condition.

Custodial care, in contrast, involves non-medical assistance with Activities of Daily Living (ADLs). These are routine personal tasks that do not require specialized medical training. Examples of ADLs include bathing, dressing, eating, and using the bathroom. The term "someone to sit with the elderly" most often falls into this non-medical, custodial category, as the primary purpose is supervision and companionship, not skilled medical treatment. This is where Medicare's coverage limitations become most apparent.

Original Medicare's Coverage for Home Health Services

For Original Medicare (Part A and Part B) to cover any in-home care services, strict eligibility requirements must be met. These services must be considered medically necessary by a doctor, and the patient must be certified as "homebound". Being homebound means it is a major effort to leave the home, though brief, infrequent absences for medical appointments or religious services are allowed.

If these criteria are met, Medicare will cover specific part-time or intermittent services from a Medicare-certified home health agency. These include intermittent skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services. Critically, Medicare may also cover a home health aide for personal care, but only if the patient is also receiving skilled care. When personal care is the only service needed, Original Medicare does not cover it.

What Is Not Covered by Original Medicare

Original Medicare explicitly does not cover non-medical services on a long-term or stand-alone basis. This includes:

• 24-hour-a-day care at home.
• Full-time skilled nursing care.
• Homemaker services like shopping, cleaning, or laundry (unless they are directly related to the medical care plan).
• Personal care (custodial care) when it is the only care needed.
• Meal delivery services.

Therefore, if the purpose of having "someone to sit with the elderly" is purely for companionship or supervision, Original Medicare will not pay for this service.

The Role of Medicare Advantage (Part C)

Unlike Original Medicare, Medicare Advantage (Part C) plans are offered by private insurance companies and are required to cover all the same benefits as Original Medicare. However, many of these plans also offer additional, non-medical benefits. Some of these extra benefits may include limited coverage for services related to senior companionship or caregiving.

• Varying Benefits: Coverage for non-medical services varies significantly depending on the specific plan and location. Some plans might include a benefit for a certain number of hours of companionship, meal delivery, or transportation to medical appointments.
• Online Platforms: Some Advantage plans have partnered with online platforms that connect seniors with companions who can help with errands, light housekeeping, and offer companionship.
• Review Your Plan: It is essential for beneficiaries or their family members to carefully review the plan's Summary of Benefits or contact the insurance provider directly to understand what, if any, companion services are covered.

Alternative Ways to Pay for Senior Sitting Services

Since Medicare coverage is limited, many families must explore alternative funding sources for non-medical care.

1. Medicaid Home and Community-Based Services (HCBS) Waivers: Medicaid, a state and federal program for low-income individuals, is often the primary payer for long-term custodial care. Many states offer HCBS waivers that provide home-based services, including personal care and homemaker assistance. Some states even allow the care recipient to choose a family member as a paid caregiver through a self-directed program.
2. Long-Term Care Insurance: This type of private insurance is specifically designed to cover the costs of custodial care, either at home or in a facility. Policies must typically be purchased years in advance of needing care.
3. Veterans' Benefits: The U.S. Department of Veterans Affairs offers benefits, such as the Aid and Attendance or Housebound pension, that can help eligible veterans and their spouses pay for in-home care.
4. State and Local Programs: Many states have non-Medicaid programs designed to help low-income seniors remain in their homes. These can offer financial or direct care assistance and serve as an alternative to nursing home placement.
5. Private Pay: Using personal funds, including savings, pensions, or assets like home equity through a reverse mortgage or a collective sibling agreement, is a common approach.

Comparison of In-Home Care Coverage Options

Feature	Original Medicare	Medicare Advantage	Medicaid HCBS Waivers
Custodial/Companion Care	No, unless combined with skilled care and temporary	Possible, but benefits vary significantly by plan	Yes, for eligible, low-income individuals
Homebound Requirement	Yes	No, not for all services	Yes, often a factor in home-based eligibility
Medical Necessity	Yes, required for all covered services	Yes, required for basic benefits	Yes, required based on functional need
Long-Term Care	No	Potentially limited, plan-dependent	Yes, designed for long-term care needs
Eligibility	Age 65+ or certain disabilities, regardless of income	Must be enrolled in Medicare Parts A & B	Low income and limited assets, varies by state

Leveraging Resources for Caregiver Support

Navigating the care system can be overwhelming for families. Fortunately, there are resources to help. Starting in 2025, Original Medicare expanded its coverage for family caregiver training for certain people with dementia. Additionally, programs like the Program of All-Inclusive Care for the Elderly (PACE) can provide a comprehensive package of medical and social services to frail seniors who meet nursing home level of care criteria, allowing them to remain in their communities.

For additional support and to find local resources, families can use trusted services. The National Council on Aging's Benefit CheckUp offers a free, online tool to screen for thousands of federal, state, and private programs that can help with healthcare and other expenses.

Conclusion: Strategic Planning Is Key

In summary, Original Medicare does not cover the cost for someone to sit with the elderly for companionship or non-medical supervision. Coverage for in-home care is strictly reserved for medically necessary, temporary, and intermittent skilled services. While some Medicare Advantage plans offer limited custodial care benefits, and state-funded Medicaid waivers can provide more extensive coverage, families must be proactive in their research and planning. By exploring alternatives like long-term care insurance, veterans' benefits, and personal funds, and by leveraging available support resources, families can build a sustainable care plan for their aging loved ones.

Frequently Asked Questions

What is the key difference between Medicare and Medicaid coverage for in-home care?

Medicare focuses on short-term, medically necessary skilled care, whereas Medicaid often covers long-term, non-medical custodial care for eligible low-income individuals through state-specific waiver programs.

Does Original Medicare cover 24-hour care at home?

No, Original Medicare does not pay for round-the-clock home care. It only covers part-time or intermittent skilled services for a limited duration under specific conditions, such as being homebound.

Can I get paid by Medicare to care for a family member?

No, Original Medicare does not reimburse family members for providing care, even if they are acting as the primary caregiver. Reimbursement for professional caregivers is limited to Medicare-approved home health agencies.

What does being 'homebound' mean in the context of Medicare home health benefits?

To be considered homebound, it must be a major effort for you to leave your home due to an illness or injury, and your departures should be infrequent and brief, primarily for medical care.

Are caregiver expenses tax deductible?

Caregiver expenses may be tax deductible if the care recipient qualifies as a dependent and you pay for more than half of their living expenses. You should consult a tax professional for advice specific to your situation.

What are some practical ways to pay for companion care not covered by Medicare?

Options include state Medicaid waivers, long-term care insurance, veterans' benefits, private payment through savings, or using your home's equity with a reverse mortgage.

How can I find out if my Medicare Advantage plan offers companion services?

You should review your specific plan's Summary of Benefits document. You can also call the plan's customer service number to inquire about any additional, non-medical benefits they may offer, such as companion care.