Does Medicare Pay for Live-in Caregivers?

The financial considerations surrounding long-term care present challenges for many. Understanding how federal health insurance programs contribute to care costs is important when planning for future needs.

Understanding Live-in Care and Medicare’s General Stance

A live-in caregiver provides continuous non-medical assistance with daily personal needs and household support within an individual’s home. This care involves around-the-clock presence for routine activities and safety. It is sought for ongoing, long-term support rather than short-term medical recovery.

Medicare, the federal health insurance program, does not cover live-in caregiver costs for non-medical, long-term personal care. Its primary focus is on acute medical conditions and skilled services for recovery or managing specific health issues. Medicare explicitly states it does not pay for 24-hour-a-day care in one’s home.

Medicare’s Home Health Benefits

While Medicare does not cover continuous live-in care, it provides coverage for specific home health services under certain conditions. These medically necessary services include part-time or intermittent skilled nursing care, physical, occupational, and speech-language pathology therapies. Medical social services and intermittent home health aide care are also covered, but home health aide services require concurrent skilled nursing or therapy.

To qualify for Medicare home health benefits, an individual must be under a physician’s care, who must certify the need and plan of care. A face-to-face encounter with a healthcare provider is required within 90 days before or 30 days after the start of care. The services must be provided by a Medicare-certified home health agency.

A key requirement for home health coverage is being “homebound,” meaning leaving home requires significant effort, often needing assistance or a supportive device. Being homebound does not mean being bedridden; individuals can still leave home for medical appointments, religious services, or short, infrequent non-medical events without jeopardizing their homebound status. Skilled nursing care and home health aide services are limited to fewer than 8 hours a day and a maximum of 28 to 35 hours per week, depending on medical necessity.

Care Not Covered by Medicare

Medicare generally does not cover services considered “custodial care” as standalone services. Custodial care involves non-medical assistance with activities of daily living (ADLs), such as bathing, dressing, eating, using the bathroom, and moving around. These personal care tasks can be performed without professional medical skills.

Medicare’s coverage policies distinguish between skilled medical care and non-medical personal care. Medicare focuses on treating illnesses or injuries and providing rehabilitation, not on ongoing support for daily living that does not require a medical professional. Therefore, services like 24-hour care, meal delivery, or homemaker services unrelated to a medical care plan are not covered.

Alternative Funding for Live-in Care

Given Medicare’s limitations, other options exist for funding live-in care. Medicaid, a joint federal and state program, can fund long-term care, including custodial care, for individuals who meet specific income and asset eligibility requirements. Medicaid programs often cover a broader range of long-term services and supports than Medicare.

Long-term care insurance is a private option covering various long-term care services, including in-home care, assisted living, and nursing home care. For eligible veterans and their surviving spouses, the Department of Veterans Affairs (VA) offers the Aid and Attendance benefit, which provides financial assistance for in-home care. Finally, private pay, using personal savings or family contributions, is a common method for covering live-in caregiver costs when other funding sources are unavailable or insufficient.