Does Medicare or Medicaid Cover Home Care? What You Need to Know
For many families, understanding how to pay for home care can be overwhelming. Does Medicare cover home health care? What about Medicaid? These are common questions, and the answers depend on factors like eligibility, medical necessity, and the type of care required.
In this guide, we’ll break down when Medicare and Medicaid cover home care services, who qualifies, and what alternatives are available.
Medicare and Home Health Care: What’s Covered?
What Home Care Services Does Medicare Cover?
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) cover certain home health care services, but only under specific conditions. Medicare may cover:
✔️ Skilled Nursing Care – Intermittent services provided by a registered nurse, such as wound care, injections, and monitoring of serious health conditions.
✔️ Physical, Occupational, and Speech Therapy – Therapy services aimed at helping individuals regain mobility, speech, or independence in daily tasks.
✔️ Home Health Aide Services – Part-time assistance with activities of daily living (ADLs) like bathing and dressing (only if the patient is also receiving skilled care).
✔️ Medical Social Services – Support services to help patients cope with illness-related social and emotional concerns.
✔️ Durable Medical Equipment (DME) – Items like wheelchairs, walkers, hospital beds, and oxygen equipment.
Medicare Home Health Eligibility Requirements
To qualify for Medicare-covered home health care, patients must:
✅ Be under a doctor’s care with a plan of care reviewed regularly.
✅ Need skilled care (nursing or therapy services).
✅ Be homebound, meaning leaving home requires significant effort.
✅ Receive care from a Medicare-certified home health agency.
Medicare Limitations on Home Care
Medicare does not cover:
❌ 24-hour in-home care.
❌ Homemaker services (like meal prep, cleaning, and laundry) unless tied to skilled care.
❌ Personal care (bathing, dressing, toileting) if it’s the only care needed.
For full details on Medicare’s home health coverage, visit Medicare.gov.
Medicaid and Home Care Services in Michigan
Medicaid is a federal and state program that helps low-income individuals pay for medical care. Unlike Medicare, Medicaid often covers long-term home care services, including personal care assistance and homemaking services.
Key Medicaid Home Care Programs in Michigan
1️⃣ MI Choice Waiver Program
- Provides nursing home-level care at home for eligible seniors.
- Covers personal care, meal services, respite care, and home modifications.
- Eligibility: Must be 65+ or disabled, require nursing home-level care, and meet financial criteria.
- Learn more: Michigan MI Choice Waiver Program.
2️⃣ Home Help Program
- Offers financial assistance for in-home personal care services.
- Covers bathing, dressing, meal prep, and medication reminders.
- Managed by the Michigan Department of Health and Human Services (MDHHS).
- Learn more: Home Help Program.
Medicaid Eligibility Requirements for Home Care
✅ Meet income & asset limits set by the state.
✅ Require assistance with activities of daily living (ADLs).
✅ Approved through a state Medicaid program assessment.
What If You Don’t Qualify for Medicare or Medicaid Home Care?
If you or your loved one doesn’t qualify for government-funded home care, there are other options:
✔️ Private Pay – Paying out-of-pocket for home care services.
✔️ Long-Term Care Insurance – Some policies cover in-home care, so check your coverage.
✔️ Veterans Benefits – The VA Aid & Attendance program helps veterans and their spouses pay for home care.
✔️ State and Local Assistance – Some non-Medicaid programs help with home care costs.
How to Get Started with Home Care
Navigating Medicare and Medicaid home care coverage can be complicated, but you don’t have to do it alone. At AdvisaCare, we help families understand their options and find the best care solutions for their loved ones.
Contact us today to discuss your home care needs and see how we can help.