Does Medicare Pay for Home Care? A Virginia Beach Guide

Short answer: Medicare generally doesn't pay for the kind of home care most families need, meaning help with bathing, meals, company and supervision. It can pay for some medical care at home for a short time, if strict conditions are met.

Here's where the line falls, and what Virginia Beach families use instead.

What Medicare can pay for at home

Original Medicare covers "home health" services: part-time skilled nursing, physical therapy, occupational therapy and speech therapy, plus some part-time aide help that goes along with them. To qualify, a doctor has to certify that your parent needs skilled care and is homebound, meaning leaving home takes a major effort.

These visits are usually short and set by a care plan. They're often arranged by the hospital or doctor after a stay.

What Medicare generally doesn't pay for

• Care around the clock
• Help with bathing, dressing and the bathroom, when that's the only need
• Companionship and supervision
• Meals, shopping, housekeeping and errands

Medicare calls this "custodial care", and it's exactly what non-medical home care agencies provide.

What about Medicare Advantage?

Some Medicare Advantage plans include limited extra benefits, such as a set number of in-home support hours a year. These vary a lot by plan and by year. Call the number on your parent's card and ask: "Does my plan include any in-home support services, and how many hours?"

How families actually pay

• Private pay. Most families pay out of pocket, usually by the hour.
• Long-term care insurance. Many policies pay toward home care once a waiting period ends. Check the policy's elimination period and daily limit.
• VA benefits. Veterans and surviving spouses may qualify for Aid and Attendance. See veteran care.
• Virginia Medicaid. For people who qualify, the state's long-term care programs can pay for in-home help. Rules and waitlists differ by state.

Using both together

Many families combine them. After a hospital stay, a Medicare-paid nurse or therapist might visit a few times a week, while a private caregiver covers the rest of the day. That's what our post-hospital care is built for.