Staying Home Longer
How Medicare Policy Is (and Isn't) Supporting Aging in Place
Most people, when asked where they want to receive care as they age, say the same thing: at home. Not a nursing facility. Not an assisted living complex. Home. Medicare has always covered some of what that requires, but never all of it, and the gap between what the program covers and what people actually need to stay safely at home has always been significant.
That gap is getting harder to navigate right now. Some of the supplemental benefits that Medicare Advantage plans added over the past several years to help bridge it are being cut. At the same time, policy changes at the federal level are expanding certain home-based services for people who qualify. Understanding what is covered, what is being reduced, and where to find the help that Medicare does not pay for is the core of what this article addresses.
What Medicare Covers at Home#
Original Medicare covers home health care when you meet a specific set of conditions. You must be homebound, meaning that leaving home requires a considerable effort. You must have a skilled care need, meaning you require services that only a licensed professional can provide: wound care, medication management, physical therapy, occupational therapy, or speech therapy. And a doctor must certify that you need these services and establish a plan of care.
When those conditions are met, Medicare covers skilled nursing visits, home health aide visits that are tied to a skilled care need, and physical, occupational, and speech therapy. There is no copayment for home health services under Original Medicare if you receive them from a Medicare-certified agency. There is also no limit on the number of covered visits, provided you continue to meet the homebound and skilled care criteria.
What Medicare does not cover is equally important to understand. Custodial care, meaning help with bathing, dressing, eating, and moving around, is not covered when that is the only care you need. If you no longer require skilled nursing but still need daily assistance with personal activities, Medicare will not pay for a home health aide to provide it. Twenty-four-hour home care is not covered. Most personal assistance and companion care is not covered.
Telehealth coverage has expanded significantly since the pandemic waivers, and many routine follow-up visits, mental health appointments, and chronic disease management visits can now happen by video or phone. This matters for aging in place because it reduces the number of trips to a doctor’s office for people who find travel difficult. Confirm with your doctor’s office and your plan which types of visits qualify for telehealth and whether your technology setup, a smartphone or tablet with a camera, supports the visits they offer.
Remote patient monitoring, where a device at home transmits health data to your care team, is covered by Medicare for an increasing range of conditions. Blood pressure monitors, pulse oximeters, and devices that track blood glucose or cardiac rhythms can be connected to a monitoring program your doctor manages. If you have a chronic condition that produces data your doctor would want to track between visits, ask whether a remote monitoring program is available through your practice.
What Medicare Advantage Supplemental Benefits Are Being Cut#
Medicare Advantage plans can offer benefits beyond what Original Medicare covers, and for several years many plans competed aggressively on these extras. Home modification benefits helped pay for grab bars, ramp installations, and bathroom safety equipment. In-home support benefits paid for personal care aides for limited hours each week. Meal delivery programs provided food after a hospitalization or for homebound members. These were never entitlements, but for beneficiaries who had them and depended on them, they functioned as essential supports for independent living.
These benefits are contracting. The rate environment that has reduced supplemental dental and vision coverage is also reducing home-support benefits. Plans that offered $500 or $1,000 per year for home modifications are lowering those allowances or eliminating the benefit entirely. Meal delivery programs that covered thirty or sixty days per year are being shortened. In-home support hours are being reduced.
If you have a Medicare Advantage plan and have been using any of these benefits, the most important thing you can do right now is read your Annual Notice of Change letter carefully and check whether the benefit you rely on is still available for next year at the same level. If it has been reduced or eliminated, contact your plan to confirm what you read, and then use the Annual Enrollment Period to compare other plans in your area.
When comparing plans specifically for home-support benefits, do not rely on a plan’s marketing materials alone. Ask the plan directly for the specific benefit amount, the eligibility criteria, the documentation required to access the benefit, and any limits on how the funds can be used. Plans are required to provide this information, and the details matter.
FIDE SNP Benefits for Long-Term Care at Home#
If you have both Medicare and Medicaid, a Fully Integrated Dual Eligible Special Needs Plan may offer substantially more home-based support than a standard Medicare Advantage plan. FIDE SNPs are designed to coordinate both programs, and Medicaid’s coverage includes long-term services and supports, the category that covers personal care, home health aides beyond the skilled care threshold, and community-based programs that help people live independently.
A FIDE SNP that manages your Medicaid coverage can authorize personal care aide hours, adult day programs, and home-based support services that Medicare alone would never cover. The care coordination model means a single care team manages your full picture, including your medical care, your medications, your mental health, and your daily living support.
Not every area of the country has FIDE SNPs available. Coverage is more developed in states that have aggressively pursued dual eligible integration, including California, New York, Massachusetts, and several others. If you have both Medicare and Medicaid and you are trying to stay at home with increasing support needs, finding out whether a FIDE SNP operates in your area is one of the highest-value questions you can ask. Your State Health Insurance Assistance Program or your state Medicaid office can tell you what is available where you live.
Community Resources That Medicare Does Not Pay For#
The organizations and programs described in this section are not Medicare benefits. They are community resources that exist independently of insurance coverage and serve people who need support staying at home but do not qualify for or cannot access Medicare-covered services.
Programs of All-Inclusive Care for the Elderly, known as PACE, are comprehensive care programs for people who need nursing-home-level care but want to remain in the community. PACE programs provide medical care, therapy, social services, meals, transportation, and personal care through a dedicated care center, typically on a day-program model. They serve people who are dually eligible for Medicare and Medicaid. If you or a family member meets the eligibility criteria and a PACE program operates nearby, it represents one of the most integrated models of home and community-based care available anywhere in the system. The National PACE Association maintains a locator at npaonline.org.
Area Agencies on Aging are local organizations funded under the Older Americans Act that provide or coordinate a range of services for people 60 and older regardless of income. Services vary by location but commonly include Meals on Wheels and congregate meal programs, transportation assistance, in-home personal care for people who do not qualify for Medicaid, caregiver support and respite services, legal assistance, and benefits counseling. Your local Area Agency on Aging will not charge you for an intake assessment or for many of its services. Find yours at eldercare.acl.gov or by calling the Eldercare Locator at 1-800-677-1116.
Caregiver support is an often-overlooked dimension of aging in place. Most people who stay at home with significant health needs do so with help from a family member or friend who provides unpaid care. That caregiver needs support too. Area Agencies on Aging provide caregiver support groups, training, and respite care, meaning temporary relief for caregivers who need a break. The AARP Caregiver Resource Center and the Family Caregiver Alliance also provide information and guidance at no cost.
State Health Insurance Assistance Program counselors can help you navigate the coverage questions that come with aging at home: whether your plan still covers the services you need, whether a different plan would serve you better, and how to access benefits you may not know you have. They work at no charge and accept no commissions. Reach your state’s SHIP through shiphelp.org.
Related Reading#
MCR-06_05 Aging in Place: The Home Care Industry’s Medicare Policy Moment MCR-06_07 The AI Caregiver Economy: What Medicare Policy Enables and Constrains