Your mother just got out of the hospital after a fall. The doctor says she needs "help at home."
You hire a nice lady to come in 4 hours a day to cook, clean, and help mom bathe.
You assume Medicare will cover it.
A month later, you get a bill for $3,500.
What happened?
You fell into the trap of confusing "Home Health Care" with "Home Care."
They sound the same, but to Medicare, they are opposites.
Disclaimer: Medicare rules are strict. This guide explains general Part A & B coverage. Medicare Advantage (Part C) plans may require pre-authorization. Always verify with your provider.
Hired a Caregiver? Medicare Might Pay $0
1. The Two Worlds of Home Services
Understanding this distinction is the key to saving your wallet.
A. Home Health Care (The "Medical" One)
- Who comes? Registered Nurses (RN), Physical Therapists (PT), Occupational Therapists.
- What do they do? Wound care, injections, rehab exercises, monitoring vitals.
- Medicare Coverage: 100% Covered ($0 cost for services) if eligible.
(Note: Medical equipment like wheelchairs may have a 20% copay.)
B. Home Care (The "Non-Medical" One)
- Who comes? Home Health Aides, Personal Care Assistants.
- What do they do? Bathing, dressing, cooking, cleaning, companionship (Custodial Care).
- Medicare Coverage: $0 Covered (You pay 100%).
2. Comparison Table: Who Pays?
| Feature | Home Health Care | Home Care (Personal) |
|---|---|---|
| Primary Focus | Recovery / Treatment | Daily Living / Safety |
| Prescription? | Required from Doctor | Not Required |
| Cost Source | Medicare Part A/B | Your Pocket / Medicaid |
3. How to Qualify for the "Free" Care (Home Health)
You want the free medical care, right? You must meet these strict criteria to unlock the Medicare benefit:
✅ The "Homebound" Rule
Medicare only pays if leaving home is a "major effort."
- You need a wheelchair or walker to leave.
- You need help from another person to leave.
- Leaving home is medically contraindicated.
PLUS: You must need "Intermittent Skilled Nursing" or Therapy.
(Note: If you just need someone to watch you so you don't fall, Medicare calls that "Custodial Care" and won't pay.)
4. The "Home Health Aide" Loophole
Here is a secret:
If you qualify for Skilled Nursing (Home Health Care), Medicare MAY also pay for a Home Health Aide to help with bathing/dressing on a part-time basis.
Strategy:
If mom has a wound or needs rehab, get the doctor to order Home Health Care immediately. During the period she is receiving skilled care, ask for an Aide to be added to the care plan for bathing assistance (usually 2-3 times a week).
Warning: The Aide is not a sitter. They typically stay only long enough to perform the specific task (bath/dress). Once the skilled need ends, this free service stops.
5. Who Pays for Non-Medical "Home Care"?
Since Medicare won't pay for long-term daily help, look here:
- Medicaid (HCBS Waivers): Pays for home aides for low-income seniors.
- VA Aid & Attendance: For qualified veterans and spouses (up to $2,800/mo in 2025).
- Long-Term Care Insurance: If you bought a policy years ago.
- Life Settlement: Selling a life insurance policy (as discussed in our previous post).
Check the "Order" Before You Hire
Before you let anyone into your home to provide care, ask one question:
"Is this visit covered under Medicare Part A as Skilled Nursing?"
If the answer is "No," get your checkbook ready—or talk to your doctor about whether your condition qualifies for Skilled Care instead.
Action Plan:
- Ask the doctor: "Can you certify my parent as 'Homebound' and order 'Skilled Nursing' or 'PT'?"
- Contact a Medicare-certified Home Health Agency (not a private registry).
- Monitor the care plan. When the "Skilled" portion ends, be ready to pay out-of-pocket or apply for Medicaid.
Helpful Resources:
Medicare.gov: Official Home Health Services Guide
AgingCare: Home Health vs. Non-Medical Home Care
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