Does Medicare cover in-home care?
A plain answer for families in Woodbury and the East Metro who are counting on Medicare to pay for help at home.
Why this article exists
Nearly every family that contacts us about care at home asks the same thing in the first few minutes: will Medicare pay for this? Your mother has had Medicare since she turned 65. It paid for her knee, it paid for the hospital stay in March, and it pays for the doctor visits. Now she needs someone to help her shower and get through the afternoon safely, and it seems reasonable that Medicare would cover that too.
Most of the time it does not, and you have not missed something obvious. The two kinds of care have nearly the same name, the rules were written for insurers rather than for families, and a lot of people only find out where the line is after a hospital discharge, when the nurse visits stop and nobody had arranged the daily help because everyone assumed it was covered.
A note on what this is. This article is general information from a care provider. It is not legal, financial, or medical advice. Medicare, Medical Assistance, and VA rules change, so confirm the details of your parent's coverage with Medicare, Minnesota Aging Pathways, the county, or the insurer before you make decisions.
Two kinds of care with almost the same name
Home health care is medical. A doctor or another provider orders it after an illness, an injury, or a hospital stay, and a Medicare-certified agency sends people out in visits: a nurse to check a wound or sort out new medications, a physical therapist after a hip repair, a speech therapist after a stroke. Two or three visits a week is typical. It ends when the person has recovered as far as they are going to, or no longer needs skilled care.
Home care, which you will also hear called personal care, custodial care, or non-medical care, is help with the ordinary business of the day: bathing, dressing, getting to the toilet, meals, medication reminders, and someone in the house so a person with dementia is not alone at four in the afternoon. It goes on for as long as it is needed. When a daughter calls and says her mother needs help at home, this is nearly always what she means.
Medicare covers the first kind, with conditions. It does not cover the second kind on its own. If you are not sure which one you are looking at, our comparison of home care and home health goes through it with examples.
What Medicare does pay for at home
Original Medicare covers home health services when all of the following are true. A health care provider orders the care and certifies that it is needed, after seeing the person face to face. A Medicare-certified home health agency delivers it. The person is homebound, which Medicare describes as normally being unable to leave home, or needing help or a great deal of effort to do so; leaving for a doctor's appointment, adult day care, or a short trip to church does not count against anyone. And the person needs skilled care on a part-time or intermittent basis: skilled nursing, physical therapy, occupational therapy, or speech-language pathology.
When those conditions are met, Medicare pays for the nursing and therapy visits, for medical social services, and for a home health aide to help with bathing and dressing, as long as the person is also getting the skilled care. Medicare's coverage page describes "part-time or intermittent" as up to 8 hours a day of nursing and aide services combined, up to 28 hours a week, and up to 35 hours a week for a short period if the provider decides it is necessary. There is no copay for the home health services themselves. Equipment ordered as part of the plan, such as a hospital bed or a walker, comes under Part B, so the deductible applies and the person pays 20 percent of the approved amount.
This is real help and you should take it. If your father is coming home after a fall, ask the discharge planner about a home health referral before he leaves the building. Our page on returning home after a hospital stay has the rest of that conversation.
What Medicare will not pay for
Medicare's coverage page is plain about this. It does not pay for 24-hour-a-day care at home. It does not pay for meal delivery. It does not pay for homemaker services such as shopping and cleaning unless they are part of the care plan. And it does not pay for custodial or personal care, meaning help with bathing, dressing, and using the bathroom, when that is the only care the person needs.
The last one is where families get caught. The aide who comes three mornings a week while the physical therapist is visiting is covered. When the therapy ends, the aide's visits end with it, even though your mother still cannot get into the shower on her own, because the aide was only ever covered as part of the skilled care.
The same thing happens more slowly with dementia. Home health is built around a skilled need and a period of recovery, and once someone is stable the visits taper off. A parent who needs someone in the house every afternoon so she does not wander or leave a burner on has a serious, ongoing need, but in Medicare's terms that is supervision, and supervision is custodial.
A Medigap supplement does not fill the gap either. Medicare's page on what Medigap covers lists long-term care and private-duty nursing among the things those policies generally leave out. Some Medicare Advantage plans offer extra benefits that Original Medicare does not, and a few of them include a small number of in-home support hours a year. Read the plan's Evidence of Coverage or call the number on the card, but a benefit measured in hours per year will not carry a person who needs help every day.
Medicare's own long-term care page says the same thing: Medicare does not pay for long-term care.
How families in the East Metro pay for the rest
Once you know where Medicare stops, the question becomes what pays for the hours on the other side of it. In Washington County it is usually one of these, or a combination. Our paying for care page goes into each one in more depth, and the journal post on how families pay for care at home works through the hours and the monthly arithmetic.
Paying out of pocket. This is how most families pay for ongoing personal care, and it is the most flexible way. You pay the agency directly, you set the schedule around your parent rather than around a program's rules, and care can usually start within days. The cost is the hard part, and the hours matter more than the rate. A good agency will help you put the hours where the risk is: the morning routine, the hour before supper, the weekday afternoons when you are at work. Ask for the rate card in writing before you sign anything.
Long-term care insurance. If your parent bought a policy years ago, find it now. Most policies pay for care at home once the person needs help with a set number of daily activities or has a cognitive impairment, after a waiting period the policy calls the elimination period. The agency's care plan and invoices are what the insurer uses to approve the claim, so it helps to choose an agency that has handled these before.
VA Aid and Attendance. If there is a veteran or a surviving spouse in the household who already qualifies for a VA pension, Aid and Attendance adds a monthly amount when the person needs another person's help with daily activities such as bathing, feeding, and dressing. The money goes to the veteran or survivor, not to the agency, and the agency's invoices are part of how the family documents unreimbursed medical expenses for the claim. Your county veterans service officer will walk through it with you at no charge.
Medical Assistance and the Elderly Waiver. Minnesota's Medicaid program is called Medical Assistance, and it can pay for in-home services through the Elderly Waiver for people 65 and older who qualify financially, have been assessed as needing a nursing-home level of care, and need more support than the standard benefit covers. The road starts with a MnCHOICES assessment. A certified assessor from the county does it, it is free, and anyone can ask for one: your parent, you, or the social worker at the hospital or transitional care unit. In Washington County the request goes to Community Services, and Minnesota Aging Pathways can help you start. Not every agency takes waiver funding, so ask before you get attached to one. Abloom Senior Living, for example, delivers in-home care on a private-pay basis and does not accept waivers or Medical Assistance for in-home services; a family that needs waiver-funded care at home hears that on the first call, along with the names of agencies that do.
What this looks like for one family
Say your father is 84, lives in Oakdale, and is coming home from a transitional care unit after a fractured pelvis. Medicare home health will very likely cover a nurse and a physical therapist for a few weeks, and an aide on the days they come. Get that referral arranged before he leaves. What Medicare will not cover is the person who helps him wash and dress every morning, or the four hours each weekday afternoon when you are at work and he should not be alone on the stairs. Those hours are paid out of pocket, or by his long-term care policy if he has one, or, if his income and assets are low enough, through the Elderly Waiver once the county assessment is done.
It is much easier to work all of that out before the discharge meeting than three weeks after it, when the therapy ends and the aide stops coming.
Where to go from here
If you want somebody to look at your parent's actual coverage with you, Minnesota Aging Pathways at 800-333-2433 offers free Medicare counseling, and its staff can explain how the Elderly Waiver works in Washington County. Nothing here has to be settled today.
If care at home is going to be private pay and you would like a straight read on what would help and what it would cost, tell us about your parent's week and we will read it before we reply. We are glad to come to your parent's home in Woodbury or anywhere in the East Metro to talk it through, and you are welcome to come and see the house in Woodbury as well. If we are not the right fit for your family, we will say so and point you toward someone who is.
Frequently asked questions
Does Medicare pay for a caregiver to come to the house every day? Not for ongoing personal care. Medicare covers home health aide visits only while the person is also receiving skilled nursing or therapy under a provider's plan of care, and it excludes custodial care when that is the only care needed. Daily help with bathing, dressing, meals, and supervision is generally paid out of pocket, through long-term care insurance, with VA pension benefits, or through Medical Assistance.
How many hours of home health will Medicare cover? Medicare describes "part-time or intermittent" as up to 8 hours a day of combined skilled nursing and home health aide services, up to 28 hours a week, with a short-term allowance of up to 35 hours a week if the provider decides it is necessary. In practice most people receive a few visits a week for a limited period.
Does Medicare cover in-home care for someone with dementia? Only to the extent the person also has a skilled need, such as nursing or therapy after an illness or injury. Supervision, cueing, and personal care for dementia on their own count as custodial care and are not covered by Medicare or by Medigap supplements. Some Medicare Advantage plans offer limited in-home support benefits; check the plan documents.
What is the difference between home health and home care in Minnesota? Home health is skilled, short-term, provider-ordered medical care delivered in visits by a Medicare-certified agency. Home care is ongoing help with daily living, delivered by an agency licensed by the Minnesota Department of Health under chapter 144A. Medicare covers the first under conditions and does not cover the second on its own.
Can Medical Assistance pay for in-home care in Washington County? Yes, for people who qualify. The Elderly Waiver funds home and community-based services for Minnesotans 65 and older who are eligible for Medical Assistance and assessed as needing a nursing-home level of care. The process begins with a free MnCHOICES assessment done by a certified assessor from the county; anyone can request one, including a family member or a facility social worker, and Minnesota Aging Pathways can help you start.
Sources
- Medicare.gov, Home health services: https://www.medicare.gov/coverage/home-health-services
- Medicare.gov, Long-term care: https://www.medicare.gov/coverage/long-term-care
- Medicare.gov, What Medigap covers: https://www.medicare.gov/health-drug-plans/medigap/basics/coverage
- Medicare.gov, Compare Original Medicare and Medicare Advantage: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/your-coverage-options/compare-original-medicare-medicare-advantage
- Minnesota Statutes 144A.471, Home care provider and home care services: https://www.revisor.mn.gov/statutes/cite/144A.471
- Minnesota Department of Human Services, Elderly Waiver (Health Care Programs Eligibility Policy Manual 03.40.25): https://hcopub.dhs.state.mn.us/hcpmstd/03_40_25.htm
- Minnesota Department of Human Services, Elderly Waiver program page: https://mn.gov/dhs/disability-aging/home-and-community-services/programs-and-services/elderly-waiver/
- Minnesota Statutes 256B.0911, Long-term care consultation services: https://www.revisor.mn.gov/statutes/cite/256B.0911
- Minnesota Aging Pathways (formerly the Senior LinkAge Line): https://mn.gov/aging-pathways/
- Washington County Community Services, MnCHOICES Assessment: https://www.washingtoncountymn.gov/3758/MnCHOICES-Assessment
- U.S. Department of Veterans Affairs, VA Aid and Attendance benefits and Housebound allowance: https://www.va.gov/pension/aid-attendance-housebound/