Original Medicare covers part-time skilled nursing care for medically necessary needs, such as wound care or drug injections, for people who are homebound. Medicare does not cover family or other personal caregivers.
Being responsible for the well-being of someone else is a demanding and important full-time job. Some of the many functions a caregiver provides include:
- Personal care: helping with personal hygiene needs like bathing and dressing
- Medical care: monitoring vital signs and administering medications or oxygen
- Transportation: helping a person move from one location to another in or outside the house, such as going for a walk or going to a doctor’s appointment
- Household tasks: managing daily tasks like laundry, shopping, and cleaning
- Meal prep: preparing daily meals, monitoring food intake, and clearing dishes
- Companionship: providing emotional support such as conversations, playing cards, or watching a movie together
It’s important to be mindful of all these needed caregiving services because Medicare only covers some of them and not full time.
This article reviews the caregiving qualifications and coverage for both Original Medicare and Medicare Advantage (Part C) plans.
Original Medicare does NOT cover the following caregiving services
- a live-in (24-hour) caregiver
- home-delivered meals
- personal care (bathing, dressing, feeding)
- house care (grocery shopping, house cleaning)
- companionship
In order to receive caregiver coverage from Original Medicare (parts A and B), the person in need of care must be “homebound.” This means that they have:
- a disease, injury, or other disability that limits their mobility
- difficulty or an inability to leave home by themselves
- received a doctor’s recommendation to stay at home
Under these circumstances, Medicare will provide coverage for a skilled nurse to provide medically necessary care.
You’ll first need to meet with a doctor who will determine that you or the person you’re caring for needs skilled nursing care. Once you receive a recommendation from a doctor, you can contact a Medicare-certified home health agency to request caregiving service.
Examples of medically necessary nursing care include:
- wound care
- patient and caregiver information
- intravenous or nutrition therapy
- medication injections
- monitoring of serious illnesses or an unstable health status
What are the Medicare limitations for skilled nursing coverage?
Medicare does not cover full-time skilled nursing care. The program only covers part-time skilled nursing care with the following limitations:
- fewer than 8 hours a day
- less than 7 days a week
- no more than 21 days
You can talk with your doctor at your in-person meeting to determine what kind of care you or the person you care for will need and for how long.
Will Medicare pay for me to take care of my parent?
Family members or other personal caretakers are not eligible for Medicare financial assistance. Medicare only covers Medicare-certified nurses who provide medically necessary care as determined by a doctor. Other resources may be available to help.
The qualifications for a caregiver under Medicare Advantage (Part C) plans are the same as Original Medicare. However, some Medicare Advantage plans provide additional adult caregiving services, such as adult day care (drop-off centers), meal delivery, or transportation to medical appointments.
If you are enrolled in a Medicare Advantage plan or are considering enrolling in one, check their summary of benefits to see what caregiving services, if any, they offer.
Medicare Advantage Special Needs Plan (SNP)
The Medicare Advantage Special Needs Plan is available to people with specific disabilities, health conditions, or certain health needs. They’re also available to people on Medicaid.
These plans may also come with extra caregiving benefits. However, you must qualify for these extra benefits based on your diagnosis or income.
If you qualify, Original Medicare will cover hospice care for two 90-day periods, followed by an unlimited number of 60-day benefit periods.
You can receive Medicare-approved hospice care in your home or another facility, such as a nursing home. You and your family will work with your hospice team to set up a plan of care.
How much does Medicare-covered hospice care cost?
Once you qualify for hospice care, Medicare will cover all hospice visits as long as you’re working with a Medicare-approved hospice provider.
You will pay a copayment of up to $5 for outpatient prescription drugs, for example, to manage pain and other symptoms.
How do you qualify for Medicare-covered hospice care?
To qualify for hospice care, your regular doctor must certify that you or the person you care for is terminally ill and has a life expectancy of 6 months or less.
After 6 months, you can continue to receive hospice care if your hospice doctor or regular doctor recertifies (in an in-person meeting) that you are still terminally ill.
In addition to medically necessary, intermittent skilled nursing care, Original Medicare offers a range of in-home healthcare services if you or the family member you’re caring for are unable to leave your home.
Additional services include:
- physical therapy
- occupational therapy
- speech and language services
- medical social services
- injectable medications for osteoporosis for women
- needed medical equipment (such as a cane or walker)
Medicare requires that a doctor or other healthcare professional (such as a nurse practitioner) perform an in-person assessment before certifying that home health services are needed. This same healthcare professional can provide you with a list of Medicare-approved agencies that serve your area.
Contact Medicare if you have any questions
If you have questions about what your Medicare plan does or does not cover, you can talk with a real (not recorded) Medicare person 24 hours a day, 7 days a week (excluding some Federal holidays) by calling:
- 800-633-4227 (800-MEDICARE)
- TTY users can call: 877-486-2048
Federal and state programs are available that provide financial support to assist families needing caregiving.
You can talk with a doctor for resources near you or reach out to the following agencies:
- Medicaid: Medicaid provides programs and financial assistance to family caregivers. Contact your local Medicaid office for more information.
- PACE (program of all-inclusive care for the elderly): This comprehensive care program supports adults over age 55 who qualify for nursing home care but prefer to receive care in their homes. You can find and contact your local PACE program.
- Social Security disability programs: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) can provide financial assistance for people with qualifying disabilities that families can use for caregiving. Learn more and how to apply.
- Veterans Affairs (VA): The VA provides financial assistance to family caregivers of eligible veterans.
- Tax deductions: Depending on what state you live in, you may be able to claim tax credits and deductions if you need to hire caregiving help for dependents. Learn more at this IRS FAQ.
How much do home health services cost?
If Medicare covers the home health service, you pay $0. If you’re purchasing Medicare-covered medical equipment (such as a walker), you pay 20% of the purchase price after you meet your Part B deductible (which is $240 in 2024).
To receive caregiver coverage from Original Medicare, you or the person needing care must be homebound as determined by a doctor. In these circumstances, Medicare will cover a part-time skilled nurse from a Medicare-approved facility to handle medically necessary care.
When deemed medically necessary, Original Medicare may also cover other home health services such as physical or occupational therapy. Some Medicare Advantage plans may cover additional services such as meal delivery, adult day care, or free rides to medical appointments.
If you qualify, Medicare will also cover hospice care either in your home or at a nursing facility for two 90-day periods, followed by an unlimited number of 60-day benefit periods.
You can talk with your doctor about your home healthcare options or call Medicare directly at 800-633-4227.