Does Medicare Cover Caregiver Costs and Services?

In that case, Medicare Part A can cover your first 100 days of home care. Part B covers any days beyond 100. But either way, you don’t have any cost-sharing for covered benefits.

The home health agency sends the bills to Medicare, and the agency must tell you if Medicare won’t cover any items or services its workers provide and the related costs you will incur.

Medicare covers medical supplies and up to 80 percent of the cost of medical equipment, such as a wheelchair or walker, if a doctor certifies it is medically necessary.

How does my loved one qualify for home health care benefits?

To ensure that your loved one can take maximum advantage of Medicare home health benefits, follow these requirements:

1. Follow a plan of care. Patients must be under a doctor’s care, and the doctor must issue a plan of care that certifies the patient needs one or more of the services listed above.

In addition to certifying that need, a plan of care specifies:

• The type of health care professional who should provide the services.
• How often the services will be provided.
• Any needed medical equipment.
• The results the doctor expects.

The doctor and the home health team review and recertify the plan of care at least once every 60 days.

2. Visit a physician. Patients must see their doctor in person less than 90 days before or 30 days after home health services begin.

3. Use a certified agency. A Medicare-certified agency must deliver Medicare home health services. Agency personnel will coordinate the services the doctor orders.

For help finding a certified agency near you, Medicare offers a tool called home health compare on its website. To find out whether an item, service or test is covered under home health benefits, check Medicare’s home health services page and its home care booklet.

“Most family caregivers aren’t familiar with Medicare,” says Amy Goyer, AARP’s family caregiving expert. “It’s important that caregivers learn what it covers and what it does not. Part of our role as caregivers is to advocate for our loved ones.”

Does Medicare Advantage cover home health care?

Private Medicare Advantage plans, also known as Medicare Part C, must provide the same home care benefits as original Medicare. But they may have additional requirements.

For both original Medicare and Medicare Advantage a health care provider, such as a doctor or nurse, must order the plan of care and the beneficiary must need skilled care, Jacobson says. But if you have a Medicare Advantage plan, you may need to use a home care agency in the plan’s network, and you may have additional prior authorization requirements.

Some Medicare Advantage plans provide extra benefits. For example, 17 percent of Medicare Advantage enrollees in standard plans and 31 percent in special needs plans have some coverage for in-home support services in 2023, according to KFF, formerly the Kaiser Family Foundation.

These benefits are separate from Medicare’s home health benefits — providing nonskilled care to help with the activities of daily living without the same requirements as the home health benefit.

However, these benefits may be limited. A Center for Medicare Advocacy study found that some Medicare Advantage plans cover only 12 visits a year or four four-hour shifts after a patient is discharged from the hospital. They may also cover some of the costs of bathroom safety devices, such as handrails.

Some Medicare Advantage plans offer people with chronic conditions extra benefits such as some transportation and meals, and can include a grocery allowance. You may need to use certain service providers, says Jeannie Fuglesten Biniek, associate director with the program on Medicare policy for KFF. Read the plan’s evidence of coverage for details, and find out what type of chronic condition you need to have to qualify.

Editor’s note: This article was originally published Oct. 11, 2019. It has been updated with new information.