Understanding What Medicare Covers and How to Access Benefits

When a loved one needs support at home due to illness, injury, or recovery from surgery, families often ask the same question: Will Medicare help cover the cost?

The answer is yes, but only under specific conditions.

At 24 Hour Caregivers, we help families across California navigate their options with clarity and confidence. This guide breaks down what Medicare does and does not cover when it comes to home health care, and how to take the next steps if your loved one qualifies.

What Is Considered Home Health Care?

Home health care is medical care delivered in the home for individuals who are homebound and require skilled services. This is different from non-medical home care, which includes help with daily activities like bathing, dressing, and companionship.

Services that may be covered by Medicare include:

• Skilled nursing care

• Physical therapy

• Occupational therapy

• Speech-language pathology

• Medical social services

• Part-time home health aide services (for personal care needs)

Learn more about the difference between home care and medical chronic condition care on our services page.

What Are the Medicare Requirements for Home Health Coverage?

Medicare Part A and/or Part B will typically cover home health care if all of the following conditions are met:

1. The patient is under the care of a doctor and receiving services under a written plan of care.
2. A doctor certifies that the patient is homebound.
3. The care is medically necessary and includes intermittent skilled nursing or therapy services.
4. The home health agency providing the services is Medicare-certified.
5. Medicare does not pay for 24 hour in-home care, meal delivery, personal care not tied to skilled services, or custodial care alone.

How Much Will Medicare Cover?

If the individual qualifies:

• Medicare covers 100 percent of approved home health services, including skilled nursing, therapy, and medical supplies.

• For durable medical equipment (such as wheelchairs or walkers), Medicare covers 80 percent, and the patient is responsible for the remaining 20 percent.
  
  

There are no copayments or deductibles for eligible home health services under Medicare Part A and/or Part B, unless durable equipment is involved.

What Medicare Will Not Cover

Medicare does not cover:

• 24-hour in-home care

• Meal delivery services

• Homemaker services like cleaning or laundry

• Personal care (bathing, dressing) when it is not part of skilled medical care

• Long-term custodial care

For these needs, families often turn to private pay, long-term care insurance, or supplemental services like our Home Care & Companionship.

How to Get Started with Medicare-Covered Home Health

If you believe your loved one may qualify, here is what to do:

1. Get a referral from a doctor who will oversee the plan of care.

2. Choose a Medicare-certified home health agency.

3. Work with the provider to set up a care plan that includes frequency and type of services.

4. Confirm eligibility and coverage through Medicare.gov or by calling 1-800-MEDICARE.

You can also speak with your loved one’s hospital discharge planner or primary care provider for help coordinating care.

Combining Medical and Non-Medical In-Home Support

In many cases, Medicare will cover intermittent medical care, while families pay privately for non-medical services such as:

• Daily hygiene and grooming

• Meal prep and light housekeeping

• Transportation and errands

• Companionship and overnight supervision

At 24 Hour Caregivers, we help bridge the gap between what Medicare covers and what your loved one truly needs to live safely and comfortably at home.

Why Families Choose 24 Hour Caregivers

• We work alongside Medicare-approved providers to support your care plan

• Our caregivers are trained employees; not contractors

• We customize care based on your family’s needs and budget

• We serve all of Southern California, including Pasadena, Thousand Oaks, Palm Desert, and the greater Los Angeles area

• We offer both short-term respite care and long-term 24-hour support
  

We are not a Medicare provider, but we are a trusted partner to families navigating in-home care across all stages of life and health.

Have Questions About Paying for Home Health Care?

We understand how confusing coverage options can be. Our team is here to help you make sense of it all. Whether you need medical services, personal care, or both.

Contact us today for guidance on coordinating care and exploring your options. No pressure. Just compassionate, knowledgeable support to help you move forward with confidence.