Medicare does not pay for most long term care. Specifically, it does not pay for custodial care or personal care, such as help with activities of daily living, which account for most of the cost of long term care. However, Medicare will pay for some nursing home, hospice, and home health care, if you meet certain conditions.
Home Health Care
Traditional Medicare covers skilled home health care, but only if you meet all of the following requirements:
1. You must need skilled services by a licensed nurse or therapist, at home, to treat an illness or injury, as certified by your doctor in a written treatment plan.
2. The care must be provided by a Medicare-certified home health care agency.
3. You must be homebound, or normally unable to leave home without assistance. To be homebound means that leaving home requires considerable effort. You can be homebound even if you leave to go to for medical appointments or treatment, or leave for short, infrequent trips for non-medical reasons, such as attending religious services. You can also attend adult day care and still be considered homebound.
4. The amount of care you receive must meet certain limits:
(a.) You receive skilled nursing care fewer than 7 days per week, or less than 8 hours each day for a period of 21 days, or less, with some exceptions permitted in special cases.
(b.) The combined total of services provided by skilled caregivers, such as nurses and therapists, and non-skilled home health aides, must be less than 8 hours each day, and 28 or fewer hours each week, although this limit may be extended up to 35 hours each week, on a case by case basis.
Medicare does not pay for non-skilled home care or home health care aides to help you with the activities of daily living, unless you are also receiving skilled nursing or therapy services.
Medicare Advantage plans offer varying levels of coverage and limits for skilled home health care services, and also non-skilled care, so you must read your policy benefits carefully to see exactly which services your plan covers, and under what conditions.