Does Medicare Pay for In-Home Care? What Michigan Families Should Know Before Open Enrollment

One of the first questions families ask me, often in the first five minutes of a phone call, is whether Medicare will pay for the care their parent needs at home. They ask it hopefully, because their parent has paid into Medicare for a whole working life, and it seems reasonable that it would cover this.

I always answer it as clearly and kindly as I can, because a family that plans around the wrong answer can end up in a very hard place a few months later. Many families are afraid to ask what care will cost. I would much rather they hear the truth from me early, while there is still time to plan, than discover it in the middle of a crisis.

The short answer is that Medicare pays for some kinds of care at home, under specific conditions, for limited periods of time. It does not pay for the ongoing, everyday help most families are picturing when they call me. Below is what it does cover, what it does not, what to look at during this fall’s open enrollment, and the other ways Michigan families pay for care.

What Medicare does cover at home

Medicare covers home health care, which is different from what most people mean by home care. Our guide to home care, home health and hospice explains the three in more depth, but here is the Medicare piece.

To qualify for home health under Medicare, according to Medicare’s own coverage rules:

• Your parent must need part-time or intermittent skilled services, such as skilled nursing, physical therapy, occupational therapy or speech therapy.
• Your parent must be homebound, meaning leaving home is not recommended because of their condition, or they have trouble leaving without help, and leaving normally takes a great deal of effort.
• A doctor or other qualified provider must see your parent in person and confirm that home health care is needed.

When those conditions are met, Medicare pays for the covered home health services, and your parent pays nothing for them. Home health can include skilled nursing visits, therapy, medical social services, and a home health aide for some personal care while the skilled care is going on. Medical equipment used at home is covered under Part B with a 20% coinsurance after the deductible.

In practice, home health most often follows a hospital stay or a new diagnosis. A nurse comes to check a wound or adjust medications, a therapist comes a few times a week to rebuild strength, and an aide may help with a bath. Visits are usually an hour or less, and the care ends when your parent stops improving or no longer needs the skilled service. If your parent is coming home from Michigan Medicine or St. Joe’s, our guide to bringing Mom or Dad home after the hospital walks through that stretch.

Medicare also covers hospice for people with a terminal illness who choose comfort care. The hospice team comes to the home, and Medicare covers short stays of inpatient respite care so family caregivers can rest. I served as a hospice chaplain before opening this agency, and I still call hospice the most underutilized benefit in America. Our piece on hospice at home says more about it.

What Medicare does not cover

Medicare’s own list of what it will not pay for under home health is short and important. It does not cover:

• 24-hour-a-day care at home
• Meal delivery
• Homemaker services, like shopping and cleaning, that aren’t part of the care plan
• Custodial or personal care, such as help with bathing, dressing or using the bathroom, when that is the only care your parent needs

If your mother needs help getting safely in and out of the shower, someone to make sure she eats lunch, and company through a long afternoon, but she has no skilled medical need, Medicare will not pay for that help.

Hospice has a similar boundary. It brings a nurse, a social worker, an aide for short visits and a chaplain, but Medicare does not cover room and board, and the hospice team does not stay in the home around the clock. Families caring for someone on hospice often still need a caregiver for the long hours in between visits.

Most of the care that lets an older person stay at home, day after day and month after month, is not medical care. It is help with the ordinary tasks of living, and a watchful, kind presence. That is what in-home care provides, and it is mostly paid for some other way.

If you’re trying to sort out what your parent needs and what might pay for it, you can schedule a free in-home assessment. We’ll look at your parent’s situation together, including what Medicare may cover. There’s no cost and no pressure to decide that day.

Medicare Advantage plans and in-home support

Many people on Medicare are enrolled in Medicare Advantage plans, which are offered by private insurers in place of Original Medicare. Some of these plans have begun offering extra benefits beyond what Original Medicare covers, and a few include limited in-home support, such as a set number of hours of help with daily tasks.

This is worth knowing about, and it is also worth keeping in perspective. In an analysis of 2022 plan data, KFF found that only 12% of Medicare Advantage enrollees were in plans offering in-home support services at all, with wide variation between insurance companies. Where the benefit exists, it is often limited to a certain number of hours a year, and some supplemental benefits are available only to a subset of members with particular conditions.

If your parent has a Medicare Advantage plan, or is considering one, the plan’s Evidence of Coverage document is where the real answer lives. Some questions to ask the plan directly:

• Does the plan cover any in-home support or personal care services, and how many hours per year?
• Does my parent qualify, or is the benefit limited to members with certain conditions?
• Does the benefit require a referral, a care manager’s approval, or using a specific agency?
• What home health agencies and hospices are in the plan’s network?

Open enrollment: October 15 to December 7

Medicare’s open enrollment period runs from October 15 through December 7 each year. During that window your parent can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, or change drug plans, and the new coverage begins on January 1. People already in a Medicare Advantage plan also have a second window, from January 1 through March 31, to change plans or return to Original Medicare.

Plans change their benefits every year, so this fall is a good time to sit down with your parent’s plan materials, especially if their health has changed this year. A few things I would look at alongside the usual questions about premiums, doctors and prescriptions:

• Whether your parent’s doctors, and the hospital they would most likely use, are in the network
• Which home health agencies and hospices the plan works with
• Whether any in-home support benefit exists, and what its limits are
• What your parent would pay for a skilled nursing facility stay after a hospitalization

Free, unbiased help is available in Michigan. The Michigan Medicare/Medicaid Assistance Program (MMAP) offers free counseling on Medicare choices, and it does not sell insurance. You can reach it at 1-800-803-7174. I recommend it to families every fall, because it is much easier to compare plans with someone who has no stake in which one you choose.

How Michigan families pay for the rest

If Medicare will not pay for the everyday care your parent needs, here is where most families in Washtenaw County turn. Our guide to what in-home care costs in Ann Arbor covers each of these in more detail.

Private pay. Most in-home care in our area is paid for out of savings, retirement income or family contributions. Standard in-home care in the Ann Arbor area generally runs about $30 to $36 an hour, and most agencies have a shift minimum of three or four hours.

Long-term care insurance. If your parent bought a long-term care policy years ago, find it. These policies often cover in-home care once certain conditions are met, frequently after an elimination period. Look for the policy in the file cabinet, in old tax records, or ask their insurance agent.

Veterans benefits. Wartime veterans and surviving spouses may qualify for VA Aid and Attendance, a monthly benefit that can help pay for in-home care. Our guide to VA Aid and Attendance for Michigan veterans walks through eligibility.

Medicaid and the MI Choice Waiver. For older adults who meet Michigan Medicaid’s financial limits and need a nursing-home level of care, the MI Choice Waiver can pay for services at home. In Washtenaw County it is administered through AgeWays Non-Profit Senior Services (248-357-2255). There is often a waitlist, sometimes many months long, so families who might qualify should ask early rather than waiting until the need is urgent.

PACE. Huron Valley PACE, based in Ypsilanti, serves adults 55 and older with ongoing health care needs who live in its service area. PACE coordinates medical care, therapy, transportation and home care through one team. It is worth a phone call to see whether your parent’s address and needs fit.

Frequently asked questions

Does Medicare pay for a caregiver to come to the house?

Medicare pays for a home health aide only as part of home health care, which requires that your parent be homebound and need part-time skilled care ordered by a provider. It does not pay for a caregiver whose main role is help with bathing, dressing, meals, companionship or supervision when that is the only care needed.

Does Medicare cover 24-hour care at home?

No. Medicare lists 24-hour-a-day care at home among the services it does not cover. Families who need round-the-clock care usually combine private pay, long-term care insurance, veterans benefits, or Medicaid programs such as the MI Choice Waiver.

Will Medicare pay for home care after a hospital stay?

Often, yes, for a limited time. If your parent leaves the hospital needing skilled nursing or therapy and meets Medicare’s homebound requirement, home health visits are covered. That care is part-time, and it ends when the skilled need ends. Many families add private in-home care during the first weeks home to cover the hours in between visits.

Do Medicare Advantage plans cover in-home care?

Some do, in a limited way. A minority of plans offer in-home support services as an extra benefit, usually with a cap on hours and sometimes only for certain members. Check the plan’s Evidence of Coverage, call the plan directly, or talk with a Michigan MMAP counselor at 1-800-803-7174.

When can my parent change Medicare plans?

During Medicare open enrollment, October 15 through December 7, with new coverage starting January 1. Medicare Advantage members can also make a change from January 1 through March 31.

Does Medicaid pay for home care in Michigan?

For people who qualify financially and medically, yes. The MI Choice Waiver pays for home and community-based services for older adults who need a nursing-home level of care, and PACE is another option where available. AgeWays (248-357-2255) is the place to start in Washtenaw County.

If you’re sitting with this now

If you came here hoping Medicare would solve this, I’m sorry the answer is more complicated. Many families feel discouraged at this point, and I understand why. I would ask you to remember that most families do find a way, often by combining two or three of the sources above, and that you don’t have to work it out alone.

There is help out there, whether it comes from my company or not. If you’d like to think it through together, you can schedule a free in-home assessment whenever you’re ready. There’s no cost and no pressure to decide that day, and if what your parent needs is a home health referral, a MMAP counselor or a MI Choice application rather than anything we provide, I’ll tell you that and point you there.

About the author

Elizabeth Snyder Corman is the owner of Home Helpers Home Care of Ann Arbor, serving families in Ann Arbor, Saline, Dexter, Chelsea, Pinckney, and Whitmore Lake. Before opening the agency, she served as a hospital chaplain through the COVID-19 pandemic and as a hospice chaplain, walking with families through some of the hardest transitions of their lives. She holds an M.Div.