Surprise! Medicare Doesn’t Pay for Most Home Healthcare

If you’re like most people, you probably think Medicare covers most home healthcare. After all, most people think taking care of our elders is important.

But at best, Medicare Part A helps pay for some home healthcare.

For a limited time.

IFFF your parent’s physician orders skilled home care services.

IFFF your parent is sick enough to need skilled nursing or occupational/physical/speech therapy.

And IFFF Mom or Dad is homebound, which means going somewhere is a major effort for your parent and requires someone to help.

And IFF the home healthcare service is certified by Medicare.

And then Medicare only covers home healthcare provided on a part-time or intermittent basis.

Historically, Medicare’s focus was on providing care for elderly people who are sick enough to need inpatient hospital care or care at skilled nursing facilities (rehab centers, nursing homes). The purpose is to help a person recover at home or in a skilled nursing facility. The expectation is that the patient will improve and discontinue services in a fairly short time. More recently, Medicare began to cover limited home healthcare and long-term hospice care.

Examples of home healthcare Medicare usually covers:

If your Mom has a stroke or your Dad has open-heart surgery, the doctor may order skilled nursing services to help your parent recover at home.

Skilled nursing care

Mom or Dad’s care would be supervised by an R.N., who would assess your parent’s condition and coordinate with a Home Health Aide (HHA) and the Occupational, Physical or Speech Therapists, if they are needed. The R.N. can do things like set up and teach Mom or Dad the proper way to follow a new medication regimen, give medications, change surgical dressings, assess Mom or Dad’s progress and alert the doctor about any problems, and so forth.

Personal care services supervised by an R.N.

The R.N. will also supervise the Home Health Aide, who will help your parent with bathing, toileting, eating, and dressing –whatever non-medical personal care is needed. However, once your parent is improved enough that he or she no longer needs the R.N.’s services, Medicare will stop paying for the Home Health Aide, even though Mom or Dad may not be able to do his or her own personal care. From the Medicare perspective, that is long-term custodial care, and Medicare doesn’t cover it.

That means if your parent still needs the services of a Home Health Aide, the family pays for it or your parent’s private insurance may pay for it (check your policy). Otherwise, you and your parent will need to explore other options including Medicaid, Veterans Benefits, or possibly community services. To learn more about what to expect from Medicare, visit these websites:, and