Hi Matt,
My father’s Alzheimer’s has become much worse. He can’t be left unsupervised during the day. Everyone in our family works and can’t afford to provide him with round-the-clock care. We’ve looked into what it would cost to hire someone to cook and do some light cleaning and make sure he takes his medication safely, but it’s pretty expensive. My sister heard that Medicare might cover home care. Does it?
Thanks for your help,
Diego
Hi Diego,
That’s a tough situation. My heart goes out to anyone who sees a parent start to go through the mental twilight of Alzheimer’s. Your father is blessed to have you and your sister watching out for his best interests and looking for solutions for him. Let me get straight to the point with an answer to your question, then explain the details and suggest some additional resources:
Medicare covers some in-home medical services and medical equipment, but does not cover 24/7 care, meals, cleaning, or personal care unrelated to a medical condition.
What Home Health Care Services Does Medicare Cover?
The home health care services Medicare will cover must be a medical necessity requiring care from a skilled medical professional on a part-time or occasional basis.
Examples of these types of services could include: physical therapy, occupational therapy, speech-language pathology services, medical social services, or injectable osteoporosis drugs for women. Medicare might also cover the costs of a part-time or occasional home health aide care, but only if you are at the same time getting skilled assistance, such as care from a licensed nurse. Medicare covers some medical equipment and medical supplies for home use.
To receive any of these services, you need to contact a Medicare-certified home health care agency to organize this care. Ask your doctor or your local hospital for recommendations of agencies to contact.
What is Not Covered?
Medicare is not able to cover 24/7 in-home care, only intermittent or part-time assistance. They do not cover the costs of meals, shopping, or cleaning. Personal care such as bathing or assistance using the bathroom is not covered if it is not part of a medical condition that the service provider is treating.
How Can You Be Eligible for Home Health Care Services?
To be eligible for assistance with the expenses of home health care services, you need to have Medicare Part A (hospitalization insurance and/or Medicare Part B (medical insurance). Your doctor or practitioner must certify that that:
- You are homebound (as explained below)
- You need the services that Medicare will cover
- It is safe to provide them in the home
- Providing them requires a skilled medical practitioner
- Your prognosis for improvement or recovery in a reasonable length of time is positive.
The need must be for part-time or occasional care, not full-time, 24/7 care, in which case you would need to look into a hospital or residential care facility.
What Counts as “Homebound?”
For the purposes of Medicare, a person is considered “homebound” when they need a cane, wheelchair, walker, or crutches to get around, or some special kind of transportation, like a specially-equipped vehicle or motorized transport. They might also need help from someone else because leaving the house is such a major effort. And certainly, if a doctor recommends not leaving home because of a medical diagnosis, that counts as being homebound.
Being homebound does not mean the patient can never leave the house without losing their benefits. A homebound person can still take short trips, such as to a religious service or family event. They can even be enrolled in adult day care and still have their qualified homebound medical services covered.
Bottom line, “homebound” does not mean you can’t leave your home or don’t ever leave your home. It means that doing so is difficult and done only when necessary.
What Will I Pay Out-Of-Pocket?
You will not be charged anything for health care services that are covered by Medicare. Medical equipment falls under Plan B. After you meet your deductible, you will be charged 20% of the amount Medicare allows for the equipment.
When you talk with a representative of a home health care agency, ask them to provide in writing an estimate of what Medicare will cover and what it will not, and what your out-of-pocket will be. For example, some providers may charge more than Medicare will cover, and pass that extra cost on to you. Prices may differ between one facility or provider and another.
In addition, your doctor might want you to get some additional treatment or medication that Medicare doesn’t cover. If you have some other insurance that covers part of the cost, this may affect how much you owe. There are too many variables to anticipate them all here; you’ll need to talk to your provider and get a clear understanding of your situation before making a decision.
Find Out More
The government booklet Medicare and Home Health Care explains these things and much more in greater detail than we’ve been able to do here.
The Eldercare Directory is a really useful resource with links to a lot of different governmental and non-governmental services available to help care for the elderly. These include respite care for family caregivers and companion services.
You might also want to look up faith-based organizations in your area that might provide some care services for homebound people in your community.
Did This Help?
Diego, I know this was not entirely the answer you were hoping for. If your father needs a skilled professional to come into the house occasionally for a medical treatment, Medicare might cover that. But it sounds like from your letter you’re needing more of a personal home assistant or adult day care situation, which Medicare would not cover.
It never hurts to contact Medicare and ask, but most likely you will need to explore private or nonprofit organizations to provide for those needs. However, keep Medicare in mind for the future if your father needs other kinds of home medical treatments.
Sincere best wishes to you and your family,
Matt
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Author Bio: Matt Feret is the author of the Prepare for Social Security -The Insider’s Guide and the Prepare for Medicare – The Insider’s Guide book series. He launched PrepareforSocialSecurity.com to help people get objective answers to questions about Social Security and Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.
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