Many people need care in their homes to safely accomplish daily activities. Medicare pays for limited home health care provided by skilled professionals, but does not cover long-term or personal care. A recent tracking poll by the Kaiser Family Foundation shows that one in five adults in the United States is either the recipient or the provider of care that is not covered by health insurance. The need for home care continues to rise with the aging population. Affordability and the toll unpaid caregiving takes on friends and families are major concerns.
What Is Home Health Care vs. Home Care?
Some states use the terms home health care and home care interchangeably. Generally speaking, home health care is professional medical assistance from skilled, licensed professionals while home care is nonclinical help. Both types of care are offered in the home.
Medicare covers limited home health care, which includes services provided by:
- Skilled nurses
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Respiratory therapists if you are on supplemental oxygen
- Medical social workers
- Home health aides―must be supervised by skilled nurses and can only be covered by Medicare if other skilled services are needed too
Federal and state entities regulate home health care, which is provided through Medicare-certified home health agencies. Licensure requirements may vary by state. For instance, home health agencies that provide medical care are licensed under Class A while home care agencies that provide nonclinical care are licensed under Class B. State surveyors ensure that each agency meets and maintains applicable certification and licensure requirements.
Home care is a broad term referring to nonclinical help provided in the home, including:
- Personal and custodial care
- Household chores
- Assistance with remembering medications
- Social support and companionship
Medicare does not cover home care. Home care help through a home care agency is provided by paid, trained staff:
- Home health aides (HHAs)
- Certified nurse aides (CNAs)
- Licensed vocational nurses (LVNs)
You may opt to privately hire home care help or rely on volunteers as unpaid caregivers.
Does Medicare Cover Home Healthcare?
Medicare covers home health care for a limited time if you meet eligibility criteria. Details about what is covered and who is eligible are addressed later in this article.
Here are a few Important terms to help you understand your rights and what Medicare will cover:
- Plan of care: Details what kinds of services and care you should get for your health condition, including:
- Which skilled healthcare professionals will provide these services
- How often you will need the services, including a visit schedule
- What medical equipment you will need
- The goals and anticipated outcomes of your care
- Intermittent: Part-time skilled care that is delivered fewer than seven days per week, less than eight hours per day for three weeks. You must need care at least once every 60 days.
- Durable medical equipment (DME): Certain medical equipment like oxygen, wheelchair, walker, and hospital bed that doctor orders for use in your home.
- Custodial care: Nonmedical care that can safely and reasonably be provided by unlicensed caregivers. Medicare does not pay for custodial care. Custodial care is typically long-term, personal care that includes help with daily activities like bathing, eating, and dressing.
- Nonclinical care: Care that doesn’t require the provision of medical attention or testing.
What Are Your Home Health Care Rights under Medicare?
As a recipient of healthcare, you have the right to privacy, be treated with respect, and participate in developing your plan of care. Your providers must provide communication and education in a language and format that you can understand.
According to the Centers for Medicare and Medicaid Services (CMS), if you are getting home health care from a Medicare-certified home health agency, you have the rights to:
- Get a written notice of your rights before your care starts
- Have your home and property treated with respect
- Be told, in advance, what care you’ll be getting and when your plan of care is going to change
- Participate in your care planning and treatment
- Get written information about your privacy rights and your appeal rights
- Have your personal information kept private
- Get written and verbal information about how much Medicare is expected to pay and how much you’ll have to pay for services
- Make complaints about your care and have the home health agency follow up on them
- Know the phone number of the home health hotline in your state where you can call with complaints or questions about your care
What Parts of Medicare Cover Home Health Care?
Medicare Parts A and/or B cover home health care through Original Medicare or a Medicare Advantage Plan.
| Medicare Type | What Home Health Care It Covers |
| Medicare Part A | 100% of home health care that meets criteria for Medicare coverage |
| Medicare Part B | 80% of Medicare-approved charges for DME and whatever is not covered by Part A |
| Medicare Advantage (Part C) | Same as Part A and B Medicare-covered benefits. Prior authorization, use of network providers, and copays may apply |
| Medicare Supplement Insurance (Medigap) | Coinsurance for Part B at 100% with all types of Medigap plans, except Plan K (50%) and Plan L (75%) |
| Medicare Part D | Outpatient medications covered by your plan |
Who Is Eligible for Medicare Coverage of Home Health Care?
You must have Medicare Part A and/or Part B to be eligible for home health care covered by Medicare. If you have a Medicare Advantage Plan, you will already have both Part A and B and will receive home health care coverage through your plan.
Medicare coverage of home health care depends on specific criteria, including:
- You must be under the care of a physician who routinely reviews and signs off on your plan of care.
- You must be homebound, that is, it is difficult for you to leave your home without help because of your health condition. You may, however, go to doctor’s appointments and adult daycare programs.
- The home health agency caring for you must be Medicare-certified.
- You must have a documented face-to-face visit with your doctor or a health professional who works with a doctor, such as a nurse practitioner, within 90 days prior to the start of care or 30 days after. Your face-to-face visit must relate to the reason you need home health care.
Medicare-covered home health services are provided by licensed professionals, including skilled nurses, physical and occupational therapists, and speech-language pathologists. You must need either intermittent skilled nursing care (other than drawing blood) or therapy within these parameters:
- Services must be complex or provided by a qualified therapist.
- Your therapist must submit documentation as evidence of your initial and ongoing need for therapy.
- You can only receive a reasonable amount of therapy that is ordered on your plan of care in particular frequencies and time intervals for rehabilitation or maintenance. For instance, physical therapy one time per week for four weeks to manage pain.
What Are Home Health Care Services?
Home health care services are provided in your home by skilled medical professionals who are operating in accordance with physicians’ orders. Home health care services are limited in scope and short-term in duration. The goal of these services is to restore you to your previous level of functioning after an illness or injury or at least help maintain your level of functioning or slow your decline.
What Home Health Care Services Does Medicare Cover?
Medicare will only cover services that are included in the plan of care that is developed by you, your home care agency, and your physician, including:
- Part-time or “intermittent” skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Part-time or “intermittent” home health aide services, if you are also getting skilled nursing care at the same time
- Medical social services
- Injectable osteoporosis medications for women
- Medical supplies and DME for use in the home
What Home Health Care Services Does Medicare Not Cover?
Medicare will not pay for:
- 24-hour-a-day care at your home
- Any care or services that are not on your plan of care
- Care received by an agency that is not certified by Medicare
- Meals delivered to your home
- Homemaker services like shopping, cleaning, and laundry that aren’t related to your care plan
- Custodial or personal care that helps you with daily living activities like bathing, dressing, or using the bathroom when this is the only care you need
When Should You Consider Home Health Care for Yourself or a Loved One?
Home health care is often helpful as you transition from hospital or facility to home after being treated for an illness or injury. You can continue your recovery in your home with assistance from trained healthcare staff and hopefully prevent a return trip to the hospital. Here are some examples of how home health care can benefit you:
- If you need wound care or intravenous (into your veins) antibiotics, a skilled nurse can come to your home to provide skilled care.
- An occupational therapist can help you adapt to your home environment by recommending and teaching you how to use equipment, such as a toilet riser or shower chair.
- A physical therapist can teach you exercises to help minimize your pain.
- A speech-language pathologist can help you devise ways to communicate your needs to your caregivers.
- A home health aide, supervised by a nurse, can assist you with bathing and grooming needs until you can safely care for yourself on your own.
- If you need DME
All home health services provided must be on your plan of care signed by your physician.
Medicare-covered home health care is limited. You may consider home care for help with personal care, household chores, getting to doctor’s appointments, preparing medications that you self-administer, or companionship. If you or your loved one struggles with dementia or a health condition that requires constant supervision and help, home care may be needed.
It can be extremely stressful and exhausting to provide care to someone constantly. Providing care can be physically demanding and may lead to a back injury. Caregiver burnout is a major concern for unpaid caregivers. According to a Kaiser Family Foundation poll of caregivers who are providing support to friends or family members, 77% report worry or stress, and 50% experience worsening of their own mental health. Another 42% report financial strain due to inability to work, and more than a third (38%) say their own physical health is worse.
Seeking help from home care providers ― HHA, CNA, LVN ― can be costly but may be a reasonable trade-off for caregiver health and well-being. Think of it like putting your own oxygen mask on first before you help your child or dependent on an airplane.
If you or your loved one doesn’t qualify for home health services, privately hired home care help may be the best alternative to caregiver burnout or needing to move from the home to a facility. There is much to be said for being able to receive care in your own home. It’s a safe and familiar environment. Many people become distressed or disoriented if they need to transfer to a care facility.
What Is the Difference Between Home Health Care Services and an In-home Caregiver With Custodial Care Services?
Home health care services
- Who pays: Medicare
- Services provided: Medical care from skilled, licensed professionals
- Length of time: Short term
- Regulated by: Federal and state agencies
- Reason you may need it: To help you continue to recover or maintain your health status after illness or injury
In-home caregiver with custodial services
- Who pays: Private pay plus subsidies if the care recipient is low-income
- Services provided: Nonclinical custodial care from licensed or unlicensed staff
- Length of time: May be long term
- Regulated by: State agencies, if received from home care agency; U.S. Department of Labor (DOL) if hired privately
- Reason you may need it: You need help with daily activities to remain in your home safely
How Much Does Home Health Care Cost?
If you meet Medicare’s eligibility criteria for home health care, the only costs you are responsible for are your Part B annual deductible ($233 in 2022) and 20% of the Medicare-approved charge for durable medical equipment (DME). This is true if you have Original Medicare. If you also have Medigap, your policy should pay a portion or all of your DME co-insurance.
If you receive your Medicare benefits through a Medicare Advantage Plan, you may have to pay a deductible and copays or coinsurance. Your costs will be lowest if you use in-network home health agencies and suppliers. You may need prior authorization. Find your costs and rules for obtaining services by contacting your plan or by reviewing your Evidence of Coverage (EOC) document.
If you don’t meet Medicare’s eligibility criteria for home health care, but you need help in the home, your costs vary depending on your level of need. Home care agencies that provide nonclinical care charge by the day, shift, or hour. You may pay for privately hired help in the same way. Either way, costs are largely out-of-pocket and can range from $15 per hour to between $200 and $300 per day. According to the Kaiser Family Foundation, 78% of people who need custodial care for themselves or their loved ones say affordability is the biggest hurdle to overcome.
What Are Your Options to Help Pay for Home Healthcare?
Meet eligibility criteria
If you meet eligibility criteria for home health care, Medicare will cover the majority of costs. If you have Original Medicare plus a Medigap policy, Medigap will cover all or a portion of Part B coinsurance charges. If you have a Medicare Advantage Plan, your plan will cover most home health care costs if you follow the rules for how you obtain services.
Long-term care insurance
If you do not meet eligibility criteria for home health care but need home care, you may have benefits from your long-term care insurance policy. Depending on your policy, you may need to get services from a home health agency and only use HHAs, CNAs, or LVNs. Your policy may not cover privately hired help.
Medicaid
A Medicaid program is an option if the care recipient meets your state’s income and resource limit requirements. You may be eligible for In-Home Supportive Services (I-HSS) or Home and Community-Based Services (HCBS) waivers, which provide more in-home services than regular Medicaid. Medicare and Medicaid’s Program of All-Inclusive Care for the Elderly (PACE) is available in some states that offer it under Medicaid. PACE has long-term care benefits and can help you stay in your home instead of needing to move to a facility.
Sliding-scale fees
You may be able to pay for home care on a sliding scale basis if your community has special funding for this. Check with your local Area Agency on Aging to see what is available to you.
VA
The U.S. Department of Veterans Affairs (VA) may pay for at-home care for some veterans. To learn more, call (877) 222-8387, or visit:
- Veterans Health Administration
- VA Caregiver Support page
- Geriatrics and Extended Care: Paying for Long Term Care
Tax deduction
If you hire a caregiver privately, you may be able to receive a tax deduction. Check with your accountant to see if this applies in your situation.
- If you have been hospitalized for an illness or injury and meet Medicare’s criteria for home health care, take advantage of it. Talk with your doctor or facility discharge planner about getting home health care for the remainder of your recovery period. The additional help and education from skilled professionals in your home environment can speed your recovery and, hopefully, prevent readmission to the hospital.
- Whether you are getting short-term home health care or longer-term home care, engage with the plan of care. Communicate your expectations and personal goals.
- You may pay more for home care help if you go through a home care agency. However, agency staff are licensed and insured. If you decide to privately hire nonclinical help, you are the “boss” and assume the responsibilities of conducting background checks, covering insurance and liability costs, and meeting DOL regulations for independent contractors. Weigh the pros and cons of both options carefully.
- If you are providing unpaid care for your loved one, check with your state to see if you can be paid as a caregiver.
- If your loved one is resistant to “strangers” coming into their home to provide care―and many people are―plan to expend some extra time and energy before hired help comes. If possible, involve your loved one in decision-making and plan to be present to help with the adjustment period. Front-end preparation may pay off in the long run.
Find a Home Health Care Facility Near You
Filter Your Search
Distance
Services offered
Quality Rating
Patient Survey Rating
Ownership type
Learn More From Our Sources
- CMS| Home Health Providers: Home Health Agency (HHA) | Last accessed April 2024
- Family Caregiver Alliance | Hiring In-Home Help | Last accessed April 2024
- Family Caregiver Alliance | Can I Get Paid to Care for a Family Member? | Last accessed April 2024
- KFF| Kaiser Family Foundation Health Tracking Poll October 2021 | Last accessed April 2024
- Medicaidplanningassistance.org| Medicaid and In-Home Care | Last accessed April 2024
- Medicare | Costs at a Glance | Last accessed April 2024
- Medicare | Home Health Services Coverage | Last accessed April 2024
- Medicare | Medicare and Home Health Care | Last accessed April 2024
- Medicare | Medicare Part B: DME Coverage | Last accessed April 2024
- Medicare | Program of All-Inclusive Care for the Elderly (PACE) | Last accessed April 2024
- Medicareinteractive.org | Home Health Basics | Last accessed April 2024
- Medicareinteractive.org | Medicare Advantage and Home Health | Last accessed April 2024
- NIA.NIH.org | National Institute on Aging: Paying for Care | Last accessed April 2024