Paying for home care
Does Medicare Pay for Home Care?
Not for daily help
Medicare doesn’t pay for ongoing daily help at home. It can pay for some skilled care for a while, when two conditions are met. Here’s what it covers, what it doesn’t, and how families pay for everyday help.
Is a skilled service needed, part-time or intermittent?
Is the person homebound?
Medicare doesn't pay for ongoing daily help at home, the kind of company, meals and personal care Endurance Home Care provides. Its home health benefit covers part-time or intermittent skilled care for someone who is homebound, and it doesn't pay for 24-hour-a-day care at home.
Endurance is private pay and doesn’t bill insurance directly. If there’s a long-term care insurance policy, you can use it for care with us, and we’ll help with the policy paperwork.
When Medicare does pay for care at home
Medicare’s home health benefit has two conditions, and both have to be true. The person needs a skilled service on a part-time or intermittent basis, and they’re homebound. If either one is missing, the benefit doesn’t apply. Almost every family asking this question ends up outside one of the two conditions, 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 help needed is with bathing, dressing, meals and company, Medicare's home health benefit doesn't apply.
Is the person homebound?
YesMedicare's home health benefit needs both conditions at the same time, not just one of them.
NoIf the person isn't homebound, the benefit doesn't apply, however much help the household needs.
What Medicare does cover
When both conditions are met, Medicare pays for the skilled care and for a limited number of aide hours alongside it. The aide hours are there to support the skilled care, so they stop when the skilled care stops.
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 while one of those skilled services is going on at the same time. Medicare doesn't pay for aide hours on their own.
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.
So the benefit is help during a course of skilled care, up to 28 hours a week in most cases. It isn’t set up for someone who needs help at home every day for months or years. That everyday help is what families arrange and pay for themselves.
Two kinds of help sit outside Medicare, and they’re often the help a family needs most.
Care around the clock
Medicare’s home health benefit doesn’t pay for 24-hour-a-day care at home. When someone needs help through the day and the night, families arrange that care and pay for it themselves.
Custodial care on its own
Help with bathing, dressing and the everyday business of the day is called custodial care. Medicare doesn’t pay for it when it’s the only care a person needs.
Where Endurance Home Care fits
Our caregivers help with daily life at home: company, meals, the house, errands, getting to appointments and, where it’s needed, hands-on personal care. Endurance Home Care holds Connecticut License HCA.0002450 as a Connecticut Homemaker-Companion Agency, not a Medicare-certified home health agency, so we don’t bill Medicare. In Connecticut, our separate company, Endurance Home Health, can help with skilled nursing, home health aides and physical therapy.
The two kinds of care often work side by side. A home health agency comes for the visits the doctor ordered, and we help with the hours around them. After a hospital stay, the Endurance Homebound hospital-to-home program plans the first days back home.
Connecticut License HCA.0002450 · New Jersey License HP0435100 · Connecticut DPH License 9915786 (Endurance Home Health)
How families pay for daily help at home
Most long-term care is help with daily living, so Medicare and most health insurance, including Medigap, don’t pay for it. Our guide covers every way families pay for home care. These four come up most often.
Long-term care insurance
Most health insurance doesn't cover daily-living care, but a long-term care insurance policy may, depending on its terms. It's worth finding the policy and reading what it says about care at home.
long term care insurance rules for home careConnecticut's home care program
Connecticut runs its own program to help older adults stay at home, and the state decides who qualifies.
CHCPE, Connecticut's home care programMedicare Advantage
Some Medicare Advantage plans offer extra benefits that Original Medicare doesn't. It varies from plan to plan, so check yours before counting on it.
extra home care benefits in Medicare AdvantagePaying for care yourselves
Families can pay for daily help themselves, on its own or alongside one of the options above. It's the most common answer in Fairfield County and New Haven County, and worth pricing early, before the others are exhausted. Once we know what's needed, we can tell you what a plan would cost.
what home care costs and how families payQuestions families ask
Does medicare pay for home care?
Medicare doesn't pay for ongoing daily help at home. It covers home health services when you need part-time or intermittent skilled services and you're homebound, with aide help capped in most cases at 8 hours a day and 28 hours a week combined. It doesn't pay for 24-hour-a-day care, or for custodial personal care like help bathing and dressing when that's 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 has to order the care, and a Medicare-certified home health agency has to provide it.
Does Medicare pay for home care like Endurance provides?
No. Endurance Home Care is a Connecticut Homemaker-Companion Agency that helps with daily life at home, and Medicare doesn't pay for custodial personal care when it's the only care someone needs. Most health insurance doesn't cover daily-living care either, though long-term care insurance may, depending on the policy. Families typically pay privately or through a qualifying program. If there's a policy, have it handy when you call.
Let’s talk about the help at home and how to pay for it.
Home care across Connecticut and New Jersey, and companion care in New York, from an agency licensed by the state. Tell us what’s needed and whether there’s a long-term care policy, and we’ll tell you which doors are open to you and what care would cost. The first conversation is free, and nothing starts until you say so.