Most families hope Medicare will cover a helper who cooks meals, assists with bathing, and stays with a loved one so they’re never alone. That’s a reasonable hope—but it’s not how Medicare works. Medicare is built to pay for medical care, not day‑to‑day help. Understanding this difference early prevents costly surprises and helps you design a plan that actually fits real life. The All Seniors Foundation supports families at no cost, explaining options in plain language and mapping out funding pathways that match each situation.
Myth vs. Reality
- Myth: Medicare will pay for someone to come every day and help Mom with meals, bathing, and companionship.
- Reality: Original Medicare does not pay for ongoing, non‑medical “custodial” care. It pays for short‑term, intermittent medical services at home when they are medically necessary and ordered by a doctor.
A 2‑Minute Decision Path
- Is the need medical and short‑term? (e.g., wound care, therapy after surgery, injections) → Explore Medicare Home Health.
- Is the need daily, ongoing help? (e.g., bathing, meals, supervision, companionship) → That’s non‑medical home care and Medicare doesn’t cover it.
- Is the person nearing end of life? → Medicare Hospice may provide aides and homemaker services related to the terminal diagnosis (not 24/7 care).
- On a Medicare Advantage plan? Some plans include limited, supplemental in‑home support services. Check the plan’s Evidence of Coverage.
What Original Medicare Covers at Home (Medical)
When ordered by a physician and provided by a Medicare‑certified agency, home health may include:
- Skilled Nursing (intermittent): injections, IVs, wound care, medication management, health assessments.
- Therapy: physical, occupational, and speech therapy to regain function and safety.
- Medical Social Services: counseling, resource coordination during recovery.
- Home Health Aide (limited): personal care such as bathing—only while skilled nursing or therapy is also active and under clinical supervision.
- Durable Medical Equipment: items like walkers or hospital beds may be covered separately under Part B rules.
These visits are intermittent (a few times per week) and temporary (end when goals are met). They do not replace a full‑time caregiver.
What Original Medicare Does Not Cover (Non‑Medical)
Medicare will not pay for:
- Ongoing help with bathing, dressing, toileting, or meal preparation (beyond limited aide visits tied to skilled care)
- Housekeeping, laundry, errands, grocery shopping, transportation
- Companionship and routine supervision
- Live‑in or 24/7 caregivers
These supports are called custodial care. They keep people safe and comfortable at home, but Medicare doesn’t fund them.
Edge Cases & Important Exceptions
- Medicare Advantage (Part C): Some plans offer limited supplemental in‑home support (e.g., a few hours per week) for certain conditions. Availability, hours, and eligibility vary by plan. Review the plan’s Evidence of Coverage.
- Medicare Hospice Benefit: If your loved one elects hospice for a terminal illness, Medicare may provide hospice aides, homemaker services, and short‑term respite—focused on comfort, not continuous 24‑hour care.
- PACE (Program of All‑Inclusive Care for the Elderly): In participating areas, PACE can deliver a comprehensive package of medical and supportive services at home for frail adults, often combining Medicare and Medicaid.
Five Real‑World Scenarios & How Coverage Works
| Scenario | What You Need | Will Medicare Pay? | What to Add |
|---|---|---|---|
| Post‑surgery at home (hip repair) | Wound care + PT 3x/week | Yes — Home Health (temporary) | Private caregiver for meals, bathing, mobility between visits |
| Moderate dementia, no acute illness | Daily supervision, cueing, personal care | No — Custodial care | Private home care or Medi‑Cal IHSS if eligible |
| Advanced COPD flare | Oxygen mgmt, nursing checks | Yes — Home Health (short‑term) | Non‑medical support for energy conservation, meal prep |
| Enrolled in hospice | Comfort‑focused care | Yes — Hospice aides/homemaker (not 24/7) | Private aides or family rotation for additional hours |
| On a Medicare Advantage plan | Light in‑home help | Maybe — Plan‑specific benefit | Check plan details; supplement with private hours as needed |
What It Costs When You Need a Caregiver (Budget Benchmarks—Encino 2025)
| Service | Typical Rate | How It’s Used |
|---|---|---|
| Hourly caregiver (non‑medical) | $32 – $38/hour | 4–8 hour blocks for ADLs, meals, rides, companionship |
| Live‑in caregiver (sleeping at night) | $350 – $450/day | Daytime help + night presence (not awake throughout) |
| 24‑hour awake care | $700 – $900/day | Two or three rotating caregivers for continuous supervision |
Tip: Ask agencies for an itemized quote: base rate, holiday premiums, mileage, minimum hours, and cancellation policy.
Funding Sources Matrix (Beyond Medicare)
| Program / Source | Who It Helps | What It Can Pay For | Notes |
|---|---|---|---|
| Medi‑Cal IHSS (California) | Low‑income seniors who meet functional criteria | Non‑medical in‑home support hours | County‑assessed hours; family can often be paid caregivers. IHSS Info |
| Long‑Term Care Insurance | Policyholders meeting ADL/cognitive triggers | Home care (hourly or live‑in), sometimes adult day care | Check elimination period, daily max, covered providers |
| VA Aid & Attendance | Qualifying veterans & surviving spouses | Monthly stipend toward caregiver costs | Benefit details |
| Medicare Advantage (supplemental) | Members of specific plans | Limited in‑home support hours | Plan‑by‑plan, not guaranteed; verify annually |
| PACE | Frail adults in participating ZIP codes | Comprehensive medical + supportive services | Often combines Medicare & Medicaid; may include home support |
| Private Pay / Family | All who can budget funds | Any non‑medical hours needed | Consider tax planning, caregiver contracts, and backups |
Blended Care Plans That Work (Case Snapshots)
1) Post‑Hospital Recovery, Then Support
A nurse and physical therapist visit under Medicare home health for three weeks. Family supplements with a four‑hour afternoon caregiver block for meals, bathing, and safe walking practice. As recovery progresses, home health ends and caregiver hours taper to twice weekly for rides and housekeeping.
2) Moderate Dementia, Living Alone
No active medical need, so Medicare coverage is minimal. Family applies for Medi‑Cal IHSS to fund daily morning help (bathing, breakfast, meds set‑up), adds private evening companionship three days per week, and installs a fall‑alert device. Regular care conferences adjust hours as cognition changes.
3) Hospice at Home
Medicare hospice provides nursing oversight, symptom management, and aides several days per week. Family schedules private night coverage to prevent wandering and to support comfort. Hospice offers short respite so family caregivers can rest.
Common Pitfalls (and How to Avoid Them)
- Assuming Medicare = full‑time caregiver: Build a non‑medical plan early (agency quotes, IHSS screening, LTC insurance claim).
- Waiting for a crisis: Start safety upgrades and paperwork (POA, advance directive) before the first fall.
- Under‑estimating night needs: Many accidents happen after dark. Budget for awake overnight care during high‑risk periods.
- Forgetting backup coverage: Ask agencies about replacements, sick‑day policies, and emergency staffing.
- Not documenting tasks: A clear task list improves quality and helps justify insurance claims.
Your 7‑Day Action Plan
- Day 1: Write two lists—medical tasks (nurse/therapist) and daily tasks (caregiver).
- Day 2: Call the primary doctor to discuss home health eligibility and orders if there’s a medical need.
- Day 3: Pull insurance documents (Medicare card, Advantage plan EOC, LTC policy) and note benefits.
- Day 4: Request three quotes from licensed home care agencies (hourly, live‑in, 24‑hour awake).
- Day 5: If appropriate, begin Medi‑Cal IHSS pre‑screening; start a simple care binder (meds, contacts, preferences).
- Day 6: Make the home safer: remove rugs, add grab bars, improve lighting, set up medication reminders.
- Day 7: Hold a family huddle to pick a start date, confirm a backup caregiver, and establish a weekly check‑in.
How All Seniors Foundation Helps — Free
The All Seniors Foundation guides families through this exact question every day. We:
- Clarify what Medicare will (and won’t) cover at home in simple terms
- Review Advantage plan summaries to spot any in‑home support benefits
- Identify funding routes like IHSS, VA Aid & Attendance, PACE, and long‑term care insurance
- Shortlist reputable local agencies and compare quotes side‑by‑side
- Build a blended care plan that balances safety, dignity, and budget
There’s no fee for our help. Our role is to reduce stress, organize options, and support better decisions.
Conclusion
Does Medicare pay for a caregiver at home? Not for day‑to‑day, non‑medical help. Medicare covers short‑term, medically necessary services through home health—and hospice adds comfort‑focused supports near end of life—but neither provides a full‑time helper for meals, bathing, and companionship. The right strategy blends what Medicare does pay for with practical funding sources for custodial care. With informed planning—and guidance from the All Seniors Foundation—families in Encino can keep loved ones safe at home without losing clarity or control over costs.
