Caring for a loved one as they age or recover from an illness can be challenging, especially when they require round-the-clock assistance. Many families turn to Medicare to help cover in-home care costs, only to find that Medicare’s coverage is limited when it comes to 24-hour care. Understanding what Medicare covers, what it does not, and the available alternatives can help families plan effectively for long-term care.
This guide will walk you through everything you need to know about Medicare’s in-home care benefits, eligibility requirements, and financial assistance options to ensure your loved one gets the support they need.
Understanding Medicare and Home Health Care Coverage
What Is Medicare and How Does It Work?
Medicare is a federal health insurance program primarily designed for individuals aged 65 and older and certain younger people with disabilities. It is divided into several parts:
- Medicare Part A – Covers hospital stays, skilled nursing facility care, and some home health services.
- Medicare Part B – Covers doctor visits, outpatient care, preventive services, and some home health services.
- Medicare Part C (Medicare Advantage) – Offered by private insurers, these plans provide additional coverage beyond Original Medicare.
- Medicare Part D – Covers prescription drugs.
While Medicare covers some home health services, it does not fully cover long-term or 24-hour in-home care. Instead, it primarily provides short-term, medically necessary care for individuals recovering from an illness, surgery, or injury.
What Type of In-Home Care Does Medicare Cover?
Medicare will only cover in-home care if it is medically necessary and prescribed by a doctor. The care must be provided by a Medicare-certified home health agency and typically includes:
✅ Skilled nursing care (wound care, injections, monitoring vital signs)
✅ Physical, occupational, and speech therapy
✅ Medical social services
✅ Home health aide services (only if skilled care is also needed)
Medicare does not cover:
❌ 24-hour home care
❌ Personal care (bathing, dressing, eating) without skilled care
❌ Homemaker services (cooking, cleaning, shopping)
❌ Custodial care for daily activities
The Difference Between Short-Term and Long-Term Home Care
Many people confuse short-term home health care with long-term in-home care.
- Short-term home care (covered by Medicare) – Temporary care for recovery after surgery, injury, or illness.
- Long-term home care (not covered by Medicare) – Ongoing assistance with daily living, often required by individuals with chronic conditions or disabilities.
Since Medicare only covers short-term, skilled care, families needing long-term, 24-hour support must explore alternative options.
Does Medicare Cover 24-Hour In-Home Care?
The short answer is no—Medicare does not cover 24-hour, around-the-clock in-home care. However, there are specific circumstances where some home health care services may be covered.
What Medicare Covers vs. What It Does Not Cover
Medicare will only cover in-home care if the following conditions are met:
✔ Doctor-ordered care for a medically necessary condition
✔ Part-time or intermittent care (less than 8 hours a day, up to 28 hours per week)
✔ Services provided by a Medicare-approved home health agency
However, Medicare does not cover:
❌ 24-hour or round-the-clock care
❌ Live-in caregivers
❌ Long-term custodial care for help with daily activities (unless skilled care is also required)
Exceptions and Special Circumstances
In rare cases, Medicare may provide more extensive coverage if the individual is eligible for Medicare-certified hospice care or a specialized home health program.
- Hospice care – If a patient has a terminal illness and qualifies for Medicare’s hospice benefit, Medicare may cover certain home care services.
- Medicare Advantage plans – Some private Medicare Advantage plans (Part C) offer expanded home care benefits, though they typically do not cover 24-hour care.
What About Medicare Advantage Plans?
Medicare Advantage (Part C) plans are offered by private insurers and may include additional home health care benefits beyond Original Medicare. Some plans offer:
✅ Limited personal care services
✅ Expanded home health benefits
✅ Transportation assistance
However, Medicare Advantage does not guarantee 24-hour home care coverage. Plan benefits vary, so it’s important to review each policy carefully.
Who Qualifies for Medicare Home Health Benefits?
To qualify for Medicare-covered home health care, you must meet specific eligibility criteria.
Medical Eligibility Requirements
A person must:
✔ Be under the care of a doctor who prescribes home health services
✔ Require intermittent skilled nursing care or therapy
✔ Be homebound (unable to leave home without help)
✔ Receive care from a Medicare-approved home health agency
Services Covered by Medicare (Physical Therapy, Skilled Nursing, etc.)
Medicare will cover part-time home health services, including:
✅ Skilled nursing care (medication management, wound care)
✅ Physical, occupational, and speech therapy
✅ Medical social services
✅ Home health aides (only when skilled care is also needed)
How to Apply for Medicare Home Health Coverage
- Get a doctor’s order – A physician must prescribe home health care.
- Choose a Medicare-approved home health agency – You can find one on Medicare’s website.
- Ensure eligibility requirements are met – The home health agency will assess and confirm eligibility.
- Start receiving services – Covered services will begin, but note that 24-hour care will not be included.
If Medicare denies coverage, you have the right to appeal the decision.
Alternative Options for 24-Hour In-Home Care
Since Medicare does not cover 24-hour in-home care, families must explore alternative funding options to provide continuous support for their loved ones.
Medicaid vs. Medicare – What’s the Difference?
Medicaid is a state and federally funded program that provides healthcare coverage for low-income individuals, including some long-term care services that Medicare does not cover.
Key Differences Between Medicare and Medicaid for Home Care:
| Feature | Medicare | Medicaid |
| Who qualifies? | Seniors (65+) and disabled individuals | Low-income individuals, regardless of age |
| Covers 24-hour in-home care? | ❌ No | ✅ Yes, in some cases |
| Covers custodial care? | ❌ No | ✅ Yes |
| Income restrictions? | ❌ No | ✅ Yes (varies by state) |
| State-run programs? | ❌ No | ✅ Yes (varies by location) |
Since Medicaid is administered at the state level, eligibility and benefits vary. Many states offer Home and Community-Based Services (HCBS) waivers, which can help cover in-home care costs, including personal care aides and 24-hour assistance.
If your loved one has a low income and limited assets, applying for Medicaid may be a good option to cover long-term in-home care.
Long-Term Care Insurance and Private Pay Options
If Medicaid is not an option, families may need to explore long-term care insurance and private pay methods to cover 24-hour in-home care.
Long-Term Care Insurance:
✅ Covers custodial and home care services
✅ May include coverage for 24-hour care
✅ Policies vary—some cover only nursing homes
Tip: If your loved one is still in good health, purchasing a long-term care insurance policy early can help reduce future care costs.
Private Pay and Out-of-Pocket Options:
If insurance isn’t available, families often rely on:
- Personal savings and retirement funds
- Reverse mortgages (home equity conversion)
- Life insurance policies with cash value
- Family contributions
Some non-profit organizations and state assistance programs may also provide financial support for seniors needing long-term care.
VA Benefits for Veterans Seeking Home Care
If your loved one is a veteran, they may qualify for VA home care benefits, including:
- Aid and Attendance (A&A) Pension – Provides extra funds for veterans who need help with daily activities.
- Veteran-Directed Care – Allows veterans to hire their own caregivers, including family members.
- Homemaker & Home Health Aide Services – Helps veterans who need personal care assistance at home.
The VA offers some of the most comprehensive home care benefits for seniors, so if your loved one is a veteran, it’s worth exploring these options.
How to Reduce the Cost of In-Home Care
Long-term in-home care can be expensive, especially if 24-hour care is needed. Fortunately, there are ways to lower costs and find financial assistance.
Financial Assistance Programs
There are several programs that can help offset the cost of home care services, including:
✅ PACE (Program of All-Inclusive Care for the Elderly) – Helps seniors receive home-based care instead of moving into a nursing home.
✅ State-funded programs – Many states offer home care assistance beyond Medicaid.
✅ Nonprofit organizations – Groups like the Alzheimer’s Association and Area Agencies on Aging (AAA) provide financial aid.
Tip: Contact your local Area Agency on Aging (AAA) to explore affordable care options in your area.
Non-Profit and State Assistance Options
In addition to federal programs, many nonprofits and state-funded initiatives help seniors afford home care services:
✔ Meals on Wheels – Provides meal delivery and safety check-ins for seniors at home.
✔ Family Caregiver Support Programs – Offers financial relief for family caregivers.
✔ State-based respite care programs – Provides temporary home care assistance for families needing a break.
Family Caregiver Support and Respite Care
If hiring a professional caregiver is too costly, family members often take on caregiving roles. However, this can lead to burnout.
To help, some programs offer respite care services, allowing family caregivers to take breaks while professionals provide short-term care.
Options for respite care include:
- Adult day care programs
- Short-term in-home respite services
- Volunteer companion programs
If your loved one does not need full-time medical assistance, combining family caregiving and part-time professional care can be a cost-effective solution.
Common Misconceptions About Medicare and Home Care
There are many misunderstandings about what Medicare covers when it comes to in-home care.
Medicare vs. Medicaid: What People Get Wrong
Many seniors assume Medicare and Medicaid are the same, but they serve different purposes:
🚫 Medicare does NOT cover long-term home care.
✅ Medicaid can cover 24-hour home care for those who qualify.
Understanding this difference can help prevent financial surprises when planning for care.
Myths About What Medicare Will Pay For
❌ Medicare covers any type of home care.
✔ Medicare only covers medically necessary skilled care, not 24-hour assistance.
❌ Home health aides are covered for all seniors.
✔ Aides are only covered when skilled nursing or therapy is also required.
❌ Medicare will pay for a live-in caregiver.
✔ Medicare does not cover live-in caregivers, even for seniors with severe disabilities.
The Role of Supplemental Insurance in Home Care
Some seniors purchase Medicare Supplement Insurance (Medigap) to cover additional costs. However, Medigap does NOT cover long-term home care.
Instead, seniors may need:
✔ Medicare Advantage plans (some offer limited in-home care benefits)
✔ Long-term care insurance
✔ State Medicaid programs (if eligible)
Understanding these coverage limitations is crucial when planning for home care expenses.
Final Thoughts: Planning for Senior Care Costs
Because Medicare does not cover 24-hour in-home care, it’s important to explore alternative options and create a financial plan early.
Steps to Take When Medicare Won’t Cover 24-Hour Care
- Check Medicaid eligibility – If income and asset levels qualify, Medicaid may help cover costs.
- Explore VA benefits – Veterans may receive assistance through the VA.
- Consider long-term care insurance – If still available, this can help offset costs.
- Look into nonprofit support – Many charities and state programs provide aid.
- Hire part-time caregivers – Combining professional help with family caregiving can reduce costs.
Finding the Right Home Care Provider
When choosing an in-home care provider, consider:
✅ Licensed and Medicare-approved agencies
✅ Caregivers with experience in senior care
✅ Flexible service options that fit your loved one’s needs
Many private home care agencies offer customizable care plans, but costs vary. Always compare multiple providers before making a decision.
The Cassagnol Agency Can Help You
By understanding Medicare’s limitations and planning for alternative options, families can ensure their loved ones receive the best possible care without unexpected financial burdens.
The Cassagnol Agency specializes in helping families navigate home care options, Medicaid planning, and insurance coverage. Their expert team can guide you through the process and connect you with the best solutions for your loved one’s needs.
For personalized assistance, contact The Cassagnol Agency today to explore how they can help you secure quality in-home care.