Medicare pays for in-home care only in limited cases. Original Medicare covers part-time skilled home health care when a doctor orders it and you are homebound. It does not pay for ongoing personal care when that is the only help you need. For some people with dementia, a Medicare program called GUIDE can pay for limited respite care.
Some Medicare Advantage plans also add limited in-home support. The details matter, because “home care” can mean two different things. Open Enrollment for 2027 coverage starts October 15, so now is a good time to sort them out.
What does Original Medicare cover at home?
Original Medicare (Part A and Part B) covers home health services, which are skilled medical services where you live. According to Medicare’s home health coverage page, you must meet all of these conditions:
- You need part-time or intermittent skilled care, such as skilled nursing or therapy.
- You are homebound. Leaving home is not recommended because of your condition, or you have trouble leaving without help.
- A doctor or other provider sees you in person, confirms you need home health care, and orders it.
- A Medicare-certified home health agency provides the services.
If you qualify, you pay nothing for covered home health services. You may owe 20 percent for durable medical equipment after your Part B deductible. A home health aide can help with bathing or dressing, but only while you are also getting skilled nursing or therapy.
What does Medicare not pay for?
Medicare lists these among the things the home health benefit does not cover:
- Care around the clock, 24 hours a day.
- Meals delivered to the home.
- Shopping, cleaning and other homemaker services that are not part of the care plan.
- Personal care, like help bathing, dressing or using the bathroom, when that is the only care you need.
Medicare also states plainly that it does not pay for long-term care. That is the gap. A parent who needs steady help with meals, bathing and errands, but no skilled nursing, will not have that help covered by Original Medicare.
We recently talked with a family about an older man with dementia who had just fallen. His wife was caring for him at home, and the strain was hurting her own health. They expected Medicare to pay for help at home, but his Original Medicare does not cover ongoing personal care. His diagnosis may qualify him for GUIDE, so we pointed them to PocketRN, the GUIDE program we partner with, and offered to help with the paperwork. He is also a veteran who may qualify for VA Aid and Attendance, and the family will likely start with private-pay care in the meantime.
How is home health different from non-medical home care?
Both happen at home, so the names get mixed up. Here is how they compare:
| Medicare home health | Non-medical home care | |
|---|---|---|
| What it is | Skilled nursing and therapy, part-time | Help with bathing, dressing, meals, housekeeping, errands, company |
| Who starts it | A doctor orders it | You and your family |
| Who qualifies | Homebound people who need skilled care | Anyone who wants help at home |
| Who pays | Medicare, for covered services | Private pay; some long-term care insurance policies help |
Do Medicare Advantage plans offer help at home?
Medicare Advantage plans are Medicare-approved plans from private companies. They may offer extra benefits that Original Medicare does not cover, and some include “in-home support services.”
That extra is uncommon. In 2026, about 10 percent of people in individual Medicare Advantage plans had a plan offering in-home support, according to a KFF analysis of 2026 plans. The share was 38 percent in special needs plans. Plans can also limit services or cap dollars each year, and benefits change from year to year.
Open Enrollment runs October 15 through December 7, 2026, and changes take effect January 1, 2027. Your plan should mail an Annual Notice of Change in September listing what is changing. If it never arrived, call the plan.
Is there Medicare help for dementia caregivers?
Yes, for some families. GUIDE (Guiding an Improved Dementia Experience) is a Medicare program that began in July 2024 and is set to run for eight years. It offers care coordination, a 24/7 support line, caregiver training and, for some families, respite care.
To qualify, the person with dementia must:
- Have dementia, confirmed by a GUIDE program clinician.
- Have Original Medicare Parts A and B as their main coverage, not a Medicare Advantage plan or PACE.
- Not be in hospice, a long-term nursing home or a memory care unit.
Enrollment is not automatic. You contact a GUIDE program, which does an assessment and asks Medicare to confirm you qualify. Patients pay nothing for GUIDE services. Switching to a Medicare Advantage plan later would end eligibility.
Respite is for people with moderate or severe dementia who have a family member or other unpaid caregiver. From July 2026 through June 2027, the cap is $2,625 per person, up from $2,500 when GUIDE began. Respite can be in-home care, a stay at an adult day center or a short stay in a 24-hour facility.
Each GUIDE program provides respite itself or through partners that Medicare approves, so you cannot pick just any home care agency. We are an approved respite provider for PocketRN’s GUIDE program, and we can help families start that paperwork.
Programs choose the ZIP codes they serve. The CMS GUIDE Model page links to a list of programs, including several based in San Antonio. You can also ask your doctor whether they take part.
What other ways do families pay for help?
When Medicare does not cover the in-home care a parent needs, look here. Our page on options for paying for care goes further, but here is the short version:
- Private pay. Many older adults pay for long-term care with savings, a pension or retirement fund, or money from selling a home.
- Long-term care insurance. These policies can cover help with daily activities, including care at home. Check what it covers and who it will pay to provide care.
- VA Aid and Attendance. This monthly payment is added to a VA pension for wartime veterans and survivors who need help with daily tasks like bathing, feeding or dressing. Income and net worth limits apply. A veteran can apply for the pension and Aid and Attendance on one application. Paid in-home care can count as a medical expense that lowers the income VA counts. See VA’s Aid and Attendance page.
- Medicaid. For people with limited income who meet state rules, Medicaid covers some long-term care. Eligibility and services vary by state.
What should you ask during Open Enrollment?
Bring these questions to your plan or to your State Health Insurance Assistance Program (SHIP), which offers free Medicare counseling:
- Does this plan offer in-home support services in 2027, and which tasks are included?
- How many hours or visits are covered per year, and is there a dollar cap?
- Do I need a referral or prior approval, and which agencies are in the network?
To compare Medicare in-home care benefits across 2027 plans, use the Plan Finder at Medicare.gov or call 1-800-MEDICARE.
Where does a private-pay caregiver fit in?
Our agency provides the non-medical side: help with bathing, dressing and other personal care, plus companionship, meal preparation, light housekeeping, errands and respite for family caregivers. Apart from GUIDE respite, our services are private pay, which means families pay us directly rather than through Medicare.
Private-pay in-home care can also sit alongside Medicare home health. A nurse or therapist may visit a few times a week, and a caregiver can help with meals, bathing and getting around in between. We also provide help at home after a hospital stay or surgery for families across Bexar, Comal, Guadalupe and Kendall counties, from our office in Bulverde.
Common questions
Does Medicare pay for a caregiver to help with bathing?
Only in a narrow case: a home health aide can help while you are also getting skilled nursing or therapy. If personal care is the only help you need, Original Medicare does not pay for it. People with dementia may have another option, covered next.
Does Medicare help pay for dementia care at home?
Original Medicare does not pay for ongoing personal care, even with dementia. A GUIDE program can add care coordination, caregiver support and, for some families, limited respite.
Does Medicare cover 24-hour care at home?
No. Medicare lists care around the clock at home among the services it does not cover.
When is Medicare Open Enrollment for 2027 coverage?
October 15 through December 7, 2026. Plan changes take effect January 1, 2027.
Can a Medicare Advantage plan pay for non-medical help at home?
Some plans include in-home support as an extra benefit, but most do not, and limits vary. Read the plan’s Evidence of Coverage or call the plan to confirm.
Not sure what kind of help your parent needs? Call (210) 405-4059 or use the chat on this page for a free in-home consultation.
Written by Nancy Wilch, MSN, RN, co-owner of Assisting Hands Home Care of Northeast San Antonio.
