Medicare covers home care services if the following conditions are met:
- The Medicare recipient's doctor must decide that the patient needs medical care at home and must initiate the plan.
- The patient must need at least one of the following: intermittent skilled nursing care, physical therapy, speech-language therapy or occupational therapy.
- The home health agency caring for the patient must be a Medicare-certified agency.
- The patient must be homebound or normally unable to leave home unassisted. (A need for adult day care doesn't stop the patient from getting home health care.)
Under Medicare, home health aide services are only covered on a part-time or intermittent basis, not long term. Medicare limits the number of hours a day and days a week you can receive skilled nursing or home health aide services. Therapy services are covered for as long as your doctor determines that you need them.
Medicare will not cover the following services as part of a home care plan:
- 24-hour-a-day home care
- Prescription drugs (although they may be covered by Medicare part B or D)
- Meals delivered at home
- Homemaker services such as shopping, cleaning and laundry
- Personal care provided by home health aides such as bathing, dressing and toileting when this is the only care the patient needs
For a list of certified home healthcare agencies, contact Medicare.
States are mandated to provide home health services only to individuals who receive federally assisted income maintenance payments, such as Social Security, or who are considered "categorically needy." Categorically needy recipients include certain disabled individuals whose incomes are too high to qualify for mandatory coverage but are below federal poverty levels.
Under federal Medicaid rules, home health services coverage must include:
- Part-time nursing
- Home care aide services
- Medical supplies and equipment
However, at the state's discretion, Medicaid may also cover:
- Physical, occupational and speech therapies
- Medical social services
For more information about your Medicare and Medicaid entitlements, contact The Centers for Medicare and Medicaid Services.
Community Health Insurance Companies
Community health insurance companies generally pay for skilled professional home care services. They often cover some home health services for acute needs, though benefits vary from one plan to another.
Managed Care Organizations
Managed care organizations and other group health plans sometimes include coverage for home care services as well. However, these organizations only pay for pre-approved services.
The Veterans Administration (VA) covers home healthcare services for veterans who are at least 50 percent disabled because of a service-related condition. For more information, contact the VA at (800) 827-1000.
State Health Insurance Assistance Program
Every state and territory has a state health insurance assistance program (SHIP) whose counselors can provide free health insurance information and help. This includes answering questions about home care services and what Medicare, Medicaid and other types of insurance pay for. To find out more about your state's program, visit the SHIP website.
Other Helpful Resources
You may want to look into state and local social service programs that may cover the costs related to services such as home care aids; personal care, chore and shopping assistance; escorts; and meal deliveries to persons 60 years and older.