Does Medicare Cover 24/7 Home Care Services? 

For most seniors, or caregivers of elderly loved ones, aging in place is an important goal. Living at home allows seniors to maintain their independence in familiar, comfortable surroundings, and to remain close to their friends and family. Also, aging at home has been shown to promote happiness, well-being, and better health.

These days, more and more seniors are finding that aging in place is possible with assistance from home health care providers who come to their homes for short periods during the day. Skilled care providers help patients with wound care, injections, intravenous therapy, nutrition therapy, or health monitoring during a serious illness. 

In certain cases, you might need 24-hour home care services if you or your loved one needs around-the-clock monitoring or more intensive care because of dementia, a physical disability, chronic health conditions like heart disease or diabetes, or more intensive care after surgery or an illness.

If you, or the person you’re caring for is enrolled in Medicare, you might have coverage for some home health care services, but is 24-hour care covered? Here’s a look at what Medicare benefits are available for your home health care needs.  

Does Medicare cover 24/7 home health care services? 

Original Medicare Parts A (hospital insurance) and B (medical insurance) cover home health care services if a health care provider, who accepts Medicare assignment, certifies that you are homebound and skilled health care services, on a part-time or intermittent basis, are deemed medically necessary as part of your treatment plan. 

To certify that you’re homebound and have a medical need for home health care, you must have a face-to-face meeting with the health care provider who orders your care, and a Medicare-affiliated home health care agency must provide these services. 

According to Medicare, you are considered homebound if the following conditions apply:

• You have an illness or injury, and you can’t leave home without assistance from a cane, wheelchair, walker, or crutches; or you require special transportation or assistance from another person. 
• Your health care provider recommends that you don’t leave your home because of an existing medical condition. 
• You can’t leave home because of the effort involved. 

Medicare covers the following home health care services:

• Physical, occupational, and/or speech-language pathology therapy services
• Medical social services
• Home health aide care on a part-time or intermittent basis, but only if you’re getting skilled nursing care simultaneously
• Injectable osteoporosis drugs (only for women)
• Certain medical supplies you need at home
• Durable medical equipment (DME)

Original Medicare pays 100 percent of the cost for covered home health care services and 80 percent of the final approved cost for DME that you use at home. You are responsible for the remaining 20 percent of these expenses after covering your annual Part B deductible. 

Medicare doesn’t cover the following home health care services:

• Around-the-clock home care
• Delivered meals
• Homemaking services like shopping, cleaning, cooking, etc. if they aren’t related to your health care plan
• Custodial care if it’s the only care you require (i.e. bathing, dressing, eating, or using the bathroom)

If you or your loved one needs more than part-time or intermittent skilled nursing care, Medicare doesn’t cover it at home. 

Medicare beneficiaries who are enrolled in a Medicare Advantage (Part C) plan are guaranteed access to all benefits provided by Original Medicare Parts A and B, at minimum. Most Part C plans offer additional coverage and extra benefits to enrollees, so you may have coverage for more home health care services, depending on the type of plan you have. 

Your Medicare Advantage plan might require that you use health care providers, home health care agencies, and medical facilities that are within a set network of providers, so check your policy for details before making arrangements.