Updated: Oct 3
Many clients are curious if Medicare will pay for senior home care. The answer is fairly straightforward, but there can be exceptions. Typically Medicare does not pay for in home senior care, or a private caregiver at home for seniors. Some Medicare Advantage plans may cover some in home services, but those will depend on your individual plan benefits.
Medicare does not cover 24 hour care in your home, meals delivered to your home, home care services such as personal care, assistance with activities of daily living, meal preparation, home health aides, or housekeeping services. However, Medicare does cover skilled nursing and additional services in the home including physical therapy, occupational therapy, and medical social services. However, there are some strict criteria to meet the eligibility for these services. They include the need to be under the care of a physician, you must be homebound, and you must have the need of intermittent nursing care, physical therapy, occupational therapy, and your condition is expected to improve. The home health agency will coordinate the care and re-evaluate your eligibility every thirty days.
What do I do if I need nursing care but am not homebound?
This is where a private duty nurse agency can support your care. Often, insurance companies and Medicare will not qualify you as eligible for home care services, but you can pay for these services privately through a private duty nursing agency. In Sarasota, Florida Nestcare is a private duty caregiver agency where we employ private registered nurses and private caregivers to support your health and wellness goals.
What does Medicare cover?
Medicare does cover home health care which is different than home care services. Home health care can be the care that you receive after a hospital discharge, after a fall, or an acute illness. Home healthcare services are authorized for a specific amount of time. These services will need to be delivered by a Medicare certified home health agency.
What is the difference between home care and home health care?
The main difference between home care and home health care is that home care covers non-medical needs and home health care covers medical and skilled nursing needs. Home health care requires a short term need to provide you the medical care in your home. You will most likely qualify for home health care if you have a medical need, but you are stable enough to be discharged from a hospital. This usually means that you do not require 24 hour nursing care. If you do require 24 hour nursing care then Medicare will likely cover either your hospital stay or your rehabilitation facility stay or your skilled nursing facility stay. All of these also require additional eligibility requirements. The skilled nursing facility coverage requires that you have a hospital related condition that required a minimum of a three day hospital stay. They also will only cover these services for a specific amount of time.
Private duty nursing care is care that is paid for privately by the client choosing to receive the care. Private duty nursing services can be utilized for the care that is not covered by Medicare. These services in Sarasota include senior companion care, senior personal care, senior dementia care, private caregiver, private nursing care, private case management and more.
For more information on what services may be covered by your insurance, or how you can get some support at home for yourself or your loved one contact us at Nestcare to learn more.