Medicare and In-Home Care: What's Covered? - Trusted Senior Specialists

If you’re new to Medicare, you may have questions about what’s covered and what isn’t. One of those questions might be about in-home care coverage — which will depend on the kind of care involved and whether it’s precisely “medical” in nature.

Many seniors need in-home care, but the treatment isn’t always medical, by definition. Medicare will often pay the bill for in-home skilled nursing or physical therapy, but it usually won’t cover custodial care.

What Is Custodial Care?

Custodial care refers to services usually provided by nurses’ aides to those who cannot bathe, dress, or feed themselves. Sometimes, Medicare will pay for short-term custodial care — 100 days or less —  if required with the doctor-prescribed in-home care. Otherwise, seniors usually need to pay for this care themselves. However, Medicare will cover other types of in-home care.

Medicare and Skilled Nursing Care

Medicare will cover periodic nursing services, meaning that care is performed either:

• Less than than seven days per week, or
• Daily for less than eight hours per day, for up to 21 days.

Medicare will occasionally expand this window if a doctor can provide an exact estimate for when the care will cease. Skilled nursing services are typically required to treat an illness or help with injury recovery. The nurses are skilled, meaning they are licensed to administer injections, wound dressings, catheter changes, and tube feedings.  

Medicare will pay for a maximum of 28 hours of weekly care (typically) but sometimes will pay for as many as 35 hours. Medicare will not cover around-the-clock care, though.    

Medicare and Physical, Occupational, and Speech Therapy

Medicare will cover physical therapy when needed to help patients get their movement or strength back after an injury or illness. Similarly, it will pay for occupational therapy to renew functionality and speech pathology to help patients reclaim their communication skills. 

But Medicare will only cover these services if:

• the patient’s condition is projected to improve in a reasonable amount of time, and
• the patient really needs a skilled therapist to conduct a maintenance program to treat injury or illness. 

Medicare and Durable Medical Equipment

Medicare Part B will pay for medically necessary equipment that a doctor prescribes to use in your home. This equipment includes wheelchairs, walkers or canes, blood sugar monitors, nebulizers, and hospital beds. Patients usually pay 20% of the Medicare-approved amount for this equipment, plus any remaining deductible under Medicare Part B.    

Medicare and Medical Social Services 

Medicare will cover medically prescribed services that let patients manage the emotional repercussions of an illness or injury. The services may include in-home counseling from a social worker or a licensed therapist. Medicare will only cover these services if the patient is getting skilled nursing care.  

Eligibility for In-Home Care Through Medicare

Medicare users are eligible for in-home care under Parts A and B — given they meet these conditions:

• A doctor has verified that the patient is homebound. 
• The need for skilled nursing care is only intermittent or part-time. 
• The home health care provider is Medicare-approved.
• The patient is under the care of a doctor who regularly reviews his or her treatment plan.
• A doctor has confirmed that the patient needs skilled nursing care or some kind of therapy.
• The patient only needs speech, physical, or occupational therapy for a certain time.

Also, patients don’t typically pay a dime for in-home care (besides durable medical care). 

If you or a loved one needs assistance with daily living activities, consider a long-term care policy to help cover custodial services or assisted living facilities.    

Need Help with Medicare?

At Trusted Seniors Specialists, we want you to get the health care you deserve. Our insurance agents are licensed in all 50 states. Call (844) 325-8710 or contact us online for expert Medicare help.