The register of what is covered
Does Medicare Pay for Home Care?
Conditional
The honest answer is narrow, so we will give you the narrow answer first and then show you every door that is still open.
Is a skilled service needed, part-time or intermittent?
Is the person homebound?
Medicare pays for home health care only when someone needs part-time or intermittent skilled services and is homebound, and it never pays for 24-hour-a-day care at home.
Endurance does not accept Medicare, Medicaid or VA benefits as payment. Care is paid for privately, or reimbursed to the household by a long term care insurance policy. This page is here for information.
Two conditions, and both have to be true
Medicare's home health benefit is written as a pair of gates rather than a sliding scale. A skilled service has to be needed on a part-time or intermittent basis, and the person has to be homebound. Clear both and a benefit opens. Miss either one and the answer is no, no matter how much help the household is carrying. Almost every family who reads this page finds themselves outside the second gate, the first gate, or both.
Is a skilled service needed, part-time or intermittent?
YesSkilled nursing, physical therapy, speech-language pathology, or occupational therapy, ordered by a health care provider.
NoIf the only help needed is with bathing, dressing, meals, and company, this gate closes and Medicare's home health benefit does not open.
Is the person homebound?
YesMedicare's home health benefit requires both conditions at once, not either one on its own.
NoWithout the homebound condition the benefit does not apply, however much help the household needs.
What Medicare does cover
Once both gates are cleared, the benefit is real and it is specific. It pays for a skilled service and for a limited number of aide hours attached to that service. What it does not do is turn into general help around the house, because the aide hours exist to support the skilled care and end when the skilled care ends.
The skilled service itself
Skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy, on a part-time or intermittent basis.
Home health aide hours, but only alongside it
Aide care is covered only if one of those skilled services is running at the same time. Aide hours on their own are not a Medicare benefit.
Up to 8 hours a day, 28 hours a week
In most cases Medicare counts skilled nursing and aide services together and caps the combination at 8 hours a day, to a maximum of 28 hours a week.
Ordered, and delivered by a certified agency
A health care provider must order the care, and a Medicare-certified home health agency must be the one providing it.
Read the two numbers together and the shape of the benefit is obvious. Twenty-eight hours a week is four hours a day, and it is attached to a course of skilled care that is meant to end. It was never built to cover a person who needs somebody in the house every afternoon for the next two years.
Two entries in this register are refused outright, and they are the two most families came looking for.
Care around the clock
Medicare's home health benefit does not pay for 24-hour-a-day care at home. Not at a reduced rate, not with a doctor's letter. It is simply outside the benefit.
Custodial care on its own
Help with bathing, dressing, and the ordinary business of a day is custodial care, and Medicare does not pay for it when that is the only care a person needs. This is the sentence that surprises people, because it is the exact help they called about.
Endurance Home Care provides care at home in Connecticut and New Jersey, with companion care only in New York. Skilled nursing, home health aides and physical therapy in Connecticut are provided by Endurance Home Health. Client Support Line (203) 936-6847.
Where an agency like this one sits
Endurance Home Care holds Connecticut License HCA.0002450 as a Homemaker Companion Agency. That is a different category from a Medicare-certified home health agency, and the difference is not a formality. Endurance is not Medicare-certified, does not bill Medicare, and never will under this category. Caregivers support, accompany, remind, supervise, and coordinate. The skilled services Medicare pays for come from somebody else.
Which is why the two frequently run side by side in the same house. The certified agency delivers the visits that were ordered. The daily-living hours are the ones a family arranges around them, including the Endurance Homebound hospital-to-home program program built for the days right after a discharge.
Connecticut License HCA.0002450 · New Jersey License HP0435100 · Connecticut DPH License 9915786 (Endurance Home Health)
If Medicare says no
Because most long-term care is daily-living, Medicare and most health insurance, including Medigap, do not pay for long-term care services. That closes one door, not the corridor. The hub page walks through every way families pay for home care and the four below are the ones that come up most in Connecticut.
Long term care insurance
Endurance's own FAQ puts it plainly: most health insurance does not cover daily-living care, though long term care insurance may. The policy language decides it, so read yours before assuming either way.
long term care insurance rules for home careThe Connecticut state program
Connecticut runs its own program for older adults who want to stay at home. Eligibility is decided by the state, not by an agency.
CHCPE, Connecticut's home care programMedicare Advantage
Whether a Medicare Advantage plan adds anything beyond Original Medicare is a plan-by-plan question, and it is the one to ask before assuming it does.
extra home care benefits in Medicare AdvantagePaying privately
Families typically pay privately or through a qualifying program. It is the most common answer in Fairfield County and New Haven County, and the one worth pricing honestly before the others are exhausted.
Questions families ask
does medicare pay for home care
Only in narrow cases. Medicare covers home health services when you need part-time or intermittent skilled services and you are homebound, with aide help capped in most cases at 8 hours a day and 28 hours a week combined. It does not pay for 24-hour-a-day care, or for custodial personal care like help bathing and dressing when that is the only care you need.
How many hours of home care will Medicare pay for?
In most cases Medicare defines part-time or intermittent care as skilled nursing plus home health aide services up to 8 hours a day combined, for a maximum of 28 hours a week. A health care provider must order the care and a Medicare-certified home health agency must provide it.
Does Medicare pay for home care like Endurance provides?
No. Endurance Home Care is a Connecticut Homemaker Companion Agency providing daily-living care, and Medicare excludes custodial personal care when it is the only care needed. Endurance's own FAQ tells families most health insurance does not cover daily-living care, though long term care insurance may. Families typically pay privately or through a qualifying program.
A narrow no is still worth an hour of somebody's time.
Home care across Fairfield County and New Haven County, Connecticut, from an agency licensed by the state. We will tell you which doors are actually open to you.
Call (203) 936-6847