Does medicare pay for home health care by family member

Q: Will Social Security pay me for taking care of my mother?

Although Social Security typically doesnt pay for caregivers, financial support is available through other national programs. Depending on where you live, a caregiver may also be eligible for payments through state and local services.

Table of Contents Show

Home health covered services
Care can’t be full time
How to qualify for benefits
Types of services provided
Does Medicare Part B cover caregivers?
Will SSI pay you to take care of a family member?
Will Social Security pay me for taking care of my mother?
Which is generally covered by Medicare for the homebound patient?

Home health covered services

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If you qualify for the home health benefit, Medicare covers the following:

Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
- Services you may receive include injections (and teaching you to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
- Provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week.
Skilled therapy services: Physical, speech, and occupational therapy services that are reasonable and necessary for treating your illness or injury, and performed by or under the supervision of a licensed therapist.
- Physical therapy includes gait training and supervision of and training for exercises to regain movement and strength in a body area.
- Speech-language pathology services include exercises to regain and strengthen speech and language skills.
- Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
Home health aide: Medicare pays in full for an aide if you require skilled care (skilled nursing or therapy services). A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you only require personal care and do not need skilled care.
Medical social services: Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or help finding resources in your community.
Medical supplies: Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency (HHA).
Durable medical equipment (DME): Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker. You pay 20% coinsurance (plus up to 15% more if your home health agency does not take assignment).

Medicare should pay for these services regardless of whether your condition is temporary or chronic.

Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

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Medicare, the government's medical insurance for people age 65 and older and younger people receiving Social Security disability benefits, isn't designed to pay for 24-hour care for a loved one at home.

But with a doctor's orders and plan of care, you can get costs covered for several necessary services if you are caring for a loved one who is homebound because of a chronic illness or injury.

Covered services include:

Home health services, part-time or intermittent, provided by home health aides.
Medical social workers, who help with emotional concerns and with understanding a disability or illness.
Occupational therapists, who help people do the daily activities they need to live life more easily.
Physical therapists, who help restore movement in those who might have weakened while being hospitalized.
Speech-language pathologists, often used after strokes to help restore communication and swallowing.
Skilled nursing care.

What 'homebound' is

• A person has trouble leaving home without help because of an illness or injury.

• Or a patient's medical condition means that leaving home is not recommended.

Attending adult day care or religious services, or infrequently going out for medical treatment or special occasions, is OK under Medicare rules.

Care can’t be full time

These services are limited to fewer than seven days a week or less than eight hours a day for up to 21 days.

Medicare also covers medical supplies and up to 80 percent of the cost of medical equipment, such as a wheelchair or walker, if a doctor certifies that it is medically necessary.

Home health care has many benefits: It is usually less expensive and more convenient for patients and can shorten their stay in a hospital or skilled nursing facility. It also can help them recuperate faster. Medicare beneficiaries have no copayments for approved services.

"Not only can home health care help to avoid accidents and falls, but it can increase your loved one's happiness,” says Gretchen Jacobson, associate director at the Kaiser Family Foundation.

It's a popular benefit: From 2002 to 2019, the number of Medicare beneficiaries using home health grew by more than 30 percent, according to a Commonwealth Fund report. There was a 6 percent decline in 2020 as the COVID-19 pandemic took hold, but even that year, there were nearly 2.9 million home health users among beneficiaries, and about 8.9 million home health claims.

How to qualify for benefits

To ensure that your loved one can take maximum advantage of Medicare home health benefits, review these important requirements:

Patients must be under a doctor's care, and the doctor must issue a plan of care that certifies the patient needs one or more of the services listed above. In addition to certifying that need, a plan of care specifies the type of health care professional who should provide the services, how often the services will be provided, any needed medical equipment, and the results the doctor expects. The doctor and the home health team review and recertify the plan of care at least once every 60 days.

Patients must see their doctor in person less than 90 days before or 30 days after home health services begin.

A Medicare-certified agency must deliver Medicare home health services. Agency personnel will coordinate the services the doctor orders. For help finding a certified agency near you, Medicare offers a tool called Home Health Compare on its website.

Types of services provided

Different kinds of home health care professionals deliver different services.

Registered nurses or licensed practical nurses under the supervision of a registered nurse deliver skilled nursing care.

This includes:

Changing wound dressings
Giving injections, intravenous drugs or tube feedings
Teaching about prescription drugs and diabetes care

Some of the tasks home health aides do include:

Assessing pain
Checking blood pressure, breathing, heart rate and temperature
Checking the safety of the home
Ensuring medications are being taken correctly
Monitoring food and drink intake
Teaching patients and caregivers about the plan of care and how to carry it out

Professional therapists provide specific kinds of services, including physical therapy, speech therapy and occupational therapy.

Social workers provide medical social services.

"Your doctor or other health care provider may recommend you get services more often than Medicare covers," Medicare's website says. “Or they may recommend services that Medicare doesn't cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and whether Medicare will pay for them.”

Medicare home health benefits do not cover full-time skilled nursing care. They also do not cover drugs, housekeeping, meal delivery or transportation.

To find out whether an item, service or test is covered under home health benefits, check Medicare's home health services page or download its What's Covered app from the Apple App Store or Google Play.

"Most family caregivers aren't familiar with Medicare,” says Amy Goyer, AARP family caregiving expert. “It's important that caregivers learn what it covers and what it does not. Part of our role as caregivers is to advocate for our loved ones."

Editor's note: This article was originally publised Oct. 11, 2019. It has been updated with more recent information on home health use by Medicare beneficiaries.

Jennifer J. Salopek has been a health care writer and communications strategist for more than 20 years. Her health care pieces have appeared in major outlets including TheWashington Post. Follow her on Twitter @jsalopek.

Learn More about Caregiving Help

Resources that can help pay for caregiving
Hiring and affording a home care worker
How to get paid as a caregiver for a family member

Does Medicare Part B cover caregivers?

Medicare Part B benefits help pay for home healthcare services, including caregivers. It does not cover 24-hour care, meal delivery, and personal care when personal care is all that is needed. If a person expects to use an item, such as a walker, for at least 3 years, Medicare may cover it as DME.

Will SSI pay you to take care of a family member?

Neither SSI nor SSDI will pay a caregiver directly. A beneficiary can use their Social Security payments to help pay for care from a home health care service or another party. In many cases, they can choose to pay a friend or family member if desired.

Although Social Security typically doesn't pay for caregivers, financial support is available through other national programs. Depending on where you live, a caregiver may also be eligible for payments through state and local services.

Which is generally covered by Medicare for the homebound patient?

Medicare considers you homebound if: You need the help of another person or medical equipment such as crutches, a walker, or a wheelchair to leave your home, or your doctor believes that your health or illness could get worse if you leave your home.