Medicare Home Health vs. Home Care
Understanding what Medicare covers starts with distinguishing between home health care and home care (or custodial care). Home health care involves skilled medical services for a short-term illness or injury, while home care provides non-medical assistance for daily living over a longer period. Original Medicare primarily covers medically necessary home health care, not long-term custodial care.
What Medicare Will Cover
Original Medicare (Part A and/or B) covers home caregiver services under strict conditions. These services must be intermittent and prescribed by a doctor as part of a care plan. The care must be from a Medicare-certified home health agency, and the patient must be certified as homebound.
Covered services include:
- Skilled nursing care: Part-time or intermittent care from a licensed nurse.
- Therapy services: Physical, occupational, and speech-language therapy for an illness or injury.
- Home health aide services: Assistance with daily tasks like bathing if also receiving skilled nursing or therapy. Not covered if it's the only service needed.
- Medical social services: Counseling for social concerns related to the illness, if skilled care is also provided.
- Medical supplies: Certain supplies from the home health agency.
What Medicare Will Not Cover
Medicare does not cover:
- 24-hour care.
- Full-time nursing care.
- Custodial care only.
- Homemaker services.
- Meal delivery.
- Family caregivers.
Coverage Differences in Medicare Plans
| Feature | Original Medicare (Part A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Home Health Services | Covers short-term, medically necessary services from a Medicare-certified agency. | Must cover all benefits of Original Medicare, but may have different costs and network rules. |
| Custodial Care | Generally does not cover assistance with daily living activities if it's the only care needed. | Some plans may offer additional, non-skilled benefits like meal delivery, transportation, or limited home care assistance. |
| Flexibility | Use any Medicare-certified home health agency that accepts Medicare. | Often requires using an agency within the plan's specific network. |
| Eligibility | Requires being homebound and a doctor's order for skilled, intermittent care. | Must meet Original Medicare's criteria for home health, but may have expanded benefits based on the plan. |
| Costs | $0 for covered home health services. 20% coinsurance for durable medical equipment. | May vary by plan, but often has predictable out-of-pocket costs and annual limits. |
Other Options for Home Caregiving Costs
Due to Medicare's limitations, other options for long-term home care costs are often necessary.
Medicaid: State programs may cover long-term, non-medical services through Home and Community-Based Services (HCBS) waivers.
Veteran's Benefits: The VA offers programs like the Aid and Attendance benefit for financial support.
Long-Term Care Insurance: Private policies designed for extended care services, including non-medical home help.
Private Pay: Paying out-of-pocket for flexibility in choosing agencies and services.
State and Local Programs: Many programs offer home care assistance. The Eldercare Locator can help find these.
How to Proceed with a Home Caregiver
Start by discussing eligibility with your doctor. If eligible, they will certify you are homebound and create a care plan. Choose a Medicare-certified home health agency. The official Medicare website helps find agencies for Original Medicare, while Medicare Advantage plans require checking network providers. The agency must inform you of non-covered services. For non-covered care, explore other options early; a financial advisor or elder care advocate can help.
Conclusion
Medicare covers some in-home care, but it is limited to specific, medically necessary skilled services and does not cover long-term, non-medical home care. Eligibility requires a doctor's certification of homebound status and a need for intermittent skilled care from a Medicare-certified agency. For long-term or purely custodial care, consider alternative funding like Medicaid, veterans' benefits, long-term care insurance, or some Medicare Advantage plans. Understanding these distinctions is crucial for care planning.
