Practical Guides
Understanding Medicare and Home Care
What's Covered, What Isn't
THE SHORT ANSWER
Original Medicare covers short-term skilled home health (nursing, PT, OT) when ordered by a doctor. It does NOT cover ongoing non-medical home care — bathing, meals, supervision, transportation. Some Medicare Advantage plans now cover limited non-medical hours. Know the difference before you call.
Home health vs. home care — they are not the same
Home health is skilled medical care delivered at home: nursing visits, physical therapy, occupational therapy, speech therapy, sometimes a home health aide for limited hours. It's ordered by a doctor and time-limited.
Home care (also called personal care, custodial care, or non-medical home care) is help with daily living: bathing, dressing, meals, supervision, transportation, companionship.
Medicare and most insurers cover the first. They generally don't cover the second.
What Original Medicare covers
Under Medicare Part A or B, you can receive home health if you:
- Are under the care of a doctor with a written plan of care.
- Need part-time skilled nursing, PT, OT, or speech therapy.
- Are certified as 'homebound.'
- Receive services from a Medicare-certified home health agency.
What Original Medicare does NOT cover
- 24-hour care at home.
- Meals delivered to your home.
- Homemaker services (laundry, shopping, cleaning) when that's the only need.
- Personal care (bathing, dressing) when that's the only need.
Medicare Advantage — the partial exception
Starting in 2019, some Medicare Advantage plans began offering limited non-medical home care benefits — typically 20–40 hours per year, sometimes more. Coverage varies wildly by plan and year.
If your loved one has a Medicare Advantage plan in Alabama, check the Evidence of Coverage document or call member services. Don't assume — confirm.
What to do when Medicare runs out
Most families discover the gap after a hospital discharge: home health covers the first few weeks, then ends, and the need is still there. That's where private-pay home care, long-term care insurance, VA Aid & Attendance, and Alabama Medicaid's E&D Waiver come in. We can walk through all four on a free consultation.
KEY TAKEAWAYS
- ◆Home health and home care are different services with different funding.
- ◆Original Medicare doesn't cover ongoing non-medical care.
- ◆Some Medicare Advantage plans offer limited non-medical hours — check yours.
- ◆Plan for the gap after home health ends, not when it ends.
FREQUENTLY ASKED
Quick answers for families
Will Medicare pay for a caregiver to come to the house?
Only as part of skilled home health, and only for short, intermittent visits — not for ongoing companionship, personal care, or supervision.
How long does Medicare-covered home health last?
Typically 4–8 weeks after a qualifying event, recertified in 60-day episodes if medically necessary. Once skilled need ends, coverage ends.
Can SevynCare work alongside a Medicare home health agency?
Yes, regularly. We coordinate with home health teams across Huntsville so families get both medical and non-medical care without overlap.
SERVING HUNTSVILLE & MADISON COUNTY, AL
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