Medicare coverage of at-home care

Medicare provides some coverage for medically necessary at-home care. It does not cover what is known as custodial care, which is the kind that most frail and Alzheimers patients require.

To find out if you qualify for home care coverage, speak with your doctor(s) about whether they believe you require medically necessary care at home. If they say you do, and they are willing to formally prescribe such care, the next step would be to contact your Medicare insurer.

If you have traditional Medicare, this would be a Medicare administrative contractor (MAC). Here is an online guide to the MACs that service different parts of the country. Someone at the appropriate MAC should be able to tell you how to apply for an at-home benefit.

If you have a Medicare Advantage plan, you should contact the private MA insurer and find out how to proceed with your benefit application.

In either case, Medicare’s permissible home-care benefits must be provided by an at-home caregiver that has been certified by Medicare. Medicare has an online tool to help you find such agencies. Some readers have told me that they have had trouble finding a caregiver who would agree to care for their loved-one, so you may need to work this list very hard to find someone.

If a person’s income is low enough, they might qualify for Medicaid, which does provide at-home care. Medicaid eligibility rules are set at the state level. The State Health Insurance Assistance Program (SHIP) provides free counseling and should have someone familiar with the rules in your state.