Can I Get Medicare Coverage for In-Home Caregivers?

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 09/10/2018

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As people age, many choose to stay in their homes rather than move to an assisted living community or other facility. According to a 2012 survey by AARP, about 90% of people 60 or older plan to live in their current homes for the next five to ten years. This is a phenomenon AARP calls “aging in place.” However, as many people experience declining health, they may want in-home caregiving to help with medical needs, household functions, and personal care. Read on for situations where a Medicare beneficiary may want in-home caregiving and see what Medicare covers.

In-home caregiving: Skilled nursing care

Some people may want to be home after undergoing surgery or experiencing a health event such as a heart attack or stroke. They may need skilled nursing care.

Skilled nursing care could include:

  • Changing sterile dressings
  • Intravenous injections

Medicare Part A generally covers skilled nursing care in a skilled nursing facility under certain conditions for a limited time. Medicare also may cover intermittent skilled nursing care at home. If you need in-home caregiving, Medicare Part A and Part B may also cover other home health services such as:

  • Physical therapy
  • Speech-language pathology services
  • Continued occupational services

To qualify for home health services for in-home caregiving, you generally must:

  • Have Medicare Part A and Part B
  • Be under the care of a doctor and getting services under a plan of care regularly reviewed by a doctor
  • Have a doctor certify that you need intermittent skilled nursing care or physical therapy, speech-language pathology or continued occupational services
  • Receive care from a home health agency that is Medicare-certified
  • Be homebound, which means you have difficulty leaving home without help or leaving home isn’t recommended because of your condition

If you need more than intermittent skilled nursing care (less than 7 days a week and less than 8 hours a day you generally are not eligible for a the home health benefit and must receive care in a skilled nursing facility. You might have to pay for in-home caregiving on your own in this situation.

Medicare generally doesn’t cover round-the-clock day care at home.

I need in-home caregiver help with daily tasks

As you age and possibly experience trouble with muscle weakness, balance, and vision you could increase your risk of a fall, according to the National Institutes of Health. These physical limitations could also make basic household tasks more difficult. Household tasks you might find challenging could include:

  • Cooking/preparing food
  • Cleaning up
  • Washing dishes/putting dishes in the dishwasher
  • Doing laundry

Medicare generally doesn’t cover “homemaker services” such as shopping, cleaning, and laundry when this is the only care you need and when the services aren’t related to a plan of care. If you are not able to afford a full-time in-home caregiver to help you with these tasks, you may be able to find a meal-delivery service or a part-time cleaning service that you will need to pay for out-of-pocket. Medicare generally doesn’t cover meals delivered to your home.

You might want to look into the Meals on Wheels program, which delivers free meals to older people in many communities.

Especially if you’ve had a stroke and resulting paralysis, some personal care may also be difficult to do alone such as:

  • Dressing
  • Bathing
  • Eating
  • Using the restroom

Medicare considers help with dressing, bath, eating and using the restroom “custodial care” and generally won’t cover it if that’s the only help you need.

I have dementia and I need in-home caregiving

The Alzheimer’s association (ALZ) defines dementia as a decline in mental ability severe enough to interfere with daily life. According to ALZ, 60% of people with dementia will wander, not remembering his name or address and becoming disoriented in familiar places. If you’re a loved one of someone with dementia who wanders, you may feel that they need 24-hour supervision by an in-home caregiver. Unfortunately Medicare doesn’t generally cover 24-hour care at home. To cover in-home caregivers you may want to consider long-term care insurance, available from private insurance companies.

If you would like to know more about Medicare coverage of in-home caregivers, please feel free to reach out to me. If you prefer, you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about plan options in your area by clicking the Compare Plans button.

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