Home Health Care Coverage: Recover in the Comfort of Home

For most seniors, the goal is to age in place—to stay in your own home for as long as possible. However, understanding what Medicare covers (and what it doesn’t) regarding home health is one of the most confusing aspects of retirement planning.

In 2027, Medicare regulations regarding Home Health Agencies (HHAs) are tightening, making it more important than ever to have a backup plan.

What Medicare Covers vs. What It Doesn’t

It is vital to distinguish between “Skilled Care” and “Custodial Care,” because Medicare draws a strict line between them.

Medicare COVERS (Skilled Care):

Medicare Part A and B will pay for home health services only if they are temporary and medically necessary. This includes:

• Intermittent skilled nursing care (changing dressings, administering IVs).
• Physical, speech, or occupational therapy to restore function after an injury or illness.
• Requirement: You must be considered “homebound” by a doctor to qualify.

Medicare DOES NOT COVER (Custodial Care):

Medicare provides zero coverage for 24-hour care or personal assistance, such as:

• Help with bathing, dressing, or using the bathroom.
• Meal preparation and housekeeping.
• Shopping or transportation.

These “activities of daily living” are often what seniors need most to stay independent, but paying for them out of pocket can drain a retirement account rapidly.

2027 Market Changes

CMS finalized an estimated 1.3% decrease in aggregate Medicare payments to home health agencies for 2026. For 2027, CMS has proposed additional payment adjustments, but the rule is not yet final. Under the proposal as a whole, CMS estimates that aggregate payments to agencies would increase by 2.4% compared with 2026.cms+1

These payment changes do not expand Medicare’s home health coverage. Medicare generally covers qualifying part-time or intermittent skilled care, but it does not cover ongoing personal care—such as help with bathing or dressing—when that is the only care needed. A private insurance policy with home-care benefits may help pay for eligible services Medicare does not cover, subject to the policy’s eligibility requirements and benefit limits.

Short-Term Home Health Care Insurance

At Trusted SR Solutions, we offer Short-Term Home Health Care policies. These are affordable plans designed to pay you benefits for up to a year specifically for home recovery.

• Rx Prescription Drug Benefit: Many of these plans include a reimbursement rider for prescription drugs, helping to offset the deductibles in your Part D plan.
• Simple Qualification: These plans are often easier to qualify for than comprehensive Long-Term Care insurance.
• Flexibility: Pays for aides to help with recovery so you don’t have to burden family members.

Planning to age at home? Contact us to discuss Home Health Care insurance options that fit your budget.