If you are helping a parent age at home, or if you are planning for your own future care, one of your first questions might be about Medicare. Specifically, you may wonder whether Medicare will pay for in-home care services like help with bathing, dressing, or preparing meals.
It is a common elder law question with an answer that depends on the type of care, how long it is needed, and whether certain conditions are met. Understanding what Medicare does and doesn’t cover can help you make smarter, more affordable choices as you plan for long-term support.
What Medicare Covers in the Home
Medicare does pay for some in-home care, but only under limited circumstances. It must be considered medically necessary, and you must meet all of Medicare’s eligibility rules.
To qualify for Medicare-covered home health care, all of the following must apply:
- You are under the care of a doctor who certifies you need skilled care at home.
- You need part-time or intermittent skilled nursing care or therapy services (physical, speech, or occupational).
- You are homebound, meaning leaving home is a challenge due to illness or injury.
- A Medicare-certified home health agency provides the care.
Under these conditions, Medicare may pay for visits from a nurse or therapist, medical supplies, and part-time help from a home health aide. However, the aide’s services are only covered if you are already receiving skilled care.
This means Medicare does not cover long-term personal care, companion services, or housekeeping, even if they are essential for your daily life.
What Medicare Does Not Cover
Medicare does not pay for custodial care. If you need help with non-medical tasks such as bathing, using the toilet, eating, or dressing, Medicare will not cover these services.
It also does not pay for:
- Full-time home care
- Meal delivery
- Homemaker services like shopping, cleaning, or laundry
- 24-hour supervision
For many seniors in Oklahoma City, Tulsa, and throughout the state, this can be a frustrating gap. You or your loved one may need daily help, but without a medical need that qualifies under Medicare, the costs will fall to you.
The Elder Law Solution: Medicaid
Medicaid is often the program that fills the gap when Medicare stops short. In Oklahoma, Medicaid may cover long-term in-home care through the ADvantage Waiver.
This program offers case management and personal care services to qualified seniors who want to stay at home rather than move into a nursing facility. However, to receive these benefits, you must meet strict income and asset limits.
Income-Only Medicaid Trust
To create a financial profile that will lead to future Medicaid eligibility with long-term care in mind, you can create a Medicaid trust. This is an irrevocable trust and does have some restrictions on your access to assets owned by the trust.
In this case, that’s a good thing because the principal amount of assts owned by the trust for more than 60 months will not be subject to spend-down if and when you apply for Medicaid. Meanwhile, you’re free to accept distributions of the trust’s earnings prior to submitting your Medicaid application.
Medicaid Estate Recovery
Your home is not looked upon as a countable asset for Medicaid eligibility purposes. However, if you qualify as a homeowner, the program will seek reimbursement from your estate after your death, and your home would be fair game.
To protect the property, you could transfer it to the trust. Nothing would change about your day-to-day situation because you could live in the home as usual. After your passing, it would go to the beneficiary that you named in the trust, and it would be out of the reach of Medicaid.
Timing Is Key
As mentioned, there is a 60-month (five-year) look-back period. You are penalized and your eligibility is delayed if you give away assets within five years of your application for Medicaid. For this reason, you have to plan well in advance of the need for a nursing home to successfully execute this strategy.
We Are Here to Help!
We can help you create a plan that protects your legacy from potentially devastating nursing home costs. To get started, call our Oklahoma City elder law office at 405-843-6100.
Our Tulsa location can be reached at 918-615-2700, and you can use our contact form to send us a message.
Since founding Parman & Easterday in 1985, Larry has led over 1,000 free, community-service education programs and helped more than 10,000 Oklahoma families go from putting off their estate plan to getting it done. His goal for every client is the same: to become the person their family calls "the one who took care of everything."
Larry is the author of three books: The Straight Shooter's Guide to Estate Planning; Estate Planning Basics; and Guiding Those Left Behind in Oklahoma. He served as Oklahoma's Secretary of State and Secretary of Commerce, and his firm is the only member of the American Academy of Estate Planning Attorneys in the state.
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