Does Medicare or Medicaid Cover Companion Care?

What Is Companion Care?

As we age, it’s common to need additional social and emotional support or assistance with nonmedical care such as housekeeping and errands. It may be challenging to find when family or friends aren’t near, or busy schedules get in the way. That’s why companion care is an excellent option for older adults who want to remain independent but need a helping hand.

According to Pew Research Center,1 27 percent of adults aged 60 or older live alone in the United States, and 46 percent share their home with only a spouse or partner.This can lead to isolation and depression. Companion care helps create an engaging and supportive environment. From conversations to keep your brain healthy and active to helping with challenging activities of daily living, the benefits of companion care are abundant!

Does Medicare Cover Companion Care?

Medicare provides health insurance coverage for over 55 million beneficiaries aged 65 or over. Some home health services are eligible under Medicare Part A or Part B, but many older adults are surprised that Medicare doesn’t pay for a homemaker or home health care when it is the only care you need.

That means Medicare does not pay for:2

• 24-hour care at home
• Stand-alone homemaker services such as shopping, cleaning, and laundry that are not related to your care plan
• Stand-alone personal care to assist with daily living activities such as bathing, using the toilet, and getting dressed if this is the only care you require
• Meals delivered to your residential address

Expert Insights

From Jason Milz, Medicare and Social Security Expert

Throughout my years working with seniors, one of the biggest surprises to many is that Medicare restricts skilled care. It also does not allow an individual or family member to determine when it’s time to return home after an in-patient treatment. This can put an immense burden on the family when it comes to satisfying an individual’s needs for daily care, such as cooking, cleaning, bathing, etc., making the need for advance planning more important than ever.

What Are the Requirements for Medicare to Cover Companion Care?

Medicare may cover part-time or occasional home health aide services such as personal care if the services are needed to maintain your health (or treat an illness or injury).3 Medicare won’t cover home health aide services unless you’re also getting skilled care, such as:

• Skilled nursing care
• Physical therapy
• Speech therapy
• Continued occupational therapy (if any of the previously listed services are no longer required)

Does Medicaid Cover Companion Care?

Medicaid provides health coverage to over 7 million low-income seniors also enrolled in Medicare. Through Medicaid’s Home and Community-Based Services (HCBS) programs, people have access to in-home care benefits not covered by Medicare, such as:4

• Home health services
• Personal care
• Caregiver and client training
• Transportation to medical care

What Are the Requirements for Medicaid to Cover Companion Care?

The first step in exploring companion care through Medicaid is to ensure you or a loved one qualify for Medicaid benefits. Unsure if you are eligible? Requirements and income levels vary from state to state, so complete your application by contacting your state Medicaid office.

Medicaid’s HCBS programs also vary by state — as do some in-home care benefits — so it’s important to confirm eligibility before starting companion care.

Where Can I Find Medicaid and Medicare Companion Care Near Me?

If a home health agency accepts Medicare or Medicaid, it must be certified by the Centers for Medicare and Medicaid Services. Medicare’s Find and Compare tool allows you to search for home health care providers near you and review their services, quality, and patient ratings.

The Programs of All-Inclusive Care for the Elderly are run by Medicare and Medicaid to help people meet their health care needs in the community rather than in a nursing home or other care facility.5 Find a qualifying program in your area by visiting the PACE website.

USAging (formerly the National Association of Area Agencies on Aging) supports family caregivers, as well as people with chronic illnesses and dementia and those who want to age well at home.6 For an in-depth look at all the program offers, visit our Area Agency on Aging report.

The U.S. Administration on Aging’s Eldercare Locator can also help to connect older adults and their caregivers with trustworthy local support resources nationwide, such as meals, transportation, and home care.7

Expert Insights

From Jason Milz, Medicare and Social Security Expert

In addition to Medicaid, I have encountered several home health care plans entering the market over the last few years that offer companion care coverage. This level of care can be more affordable than traditional long-term care insurance. It’s important to remember premiums are based on age at time of purchase and the coverage must be in place prior to encountering a health situation that requires this level of care.

Curious about adult day care companion care? Today, more than 34,000 adult day care centers are functioning in the United States, which is a significant increase of 7.3 percent compared to active facilities in 2022.8 Over a quarter million Americans enjoy a wide range of social and recreational activities at adult day care centers. In the video below, Jeff Hoyt, editor-in-chief of SeniorLiving.org, talks about the types, costs, and benefits of adult day care.

How Much Does Companion Care Cost?

We’ve talked about Medicare and Medicaid’s companion care benefits and what is (and isn’t) covered. However, the elephant in the room is the potentially high cost. According to a study at the Center for Retirement Research at Boston College, over one-third of retirees won’t have the resources to pay for even the minimal level of long-term services and support as they age.8 Let’s take a look at the financial impact of companion care.

Genworth’s most recent Cost of Care Survey reports the estimated monthly median cost for homemaker services is $5,892 in 2024.10 Employing a home health aide comes at an estimated $6,481 per month. Assisted living facilities have an estimated median cost of $5,511 per month, lining up with in-home care costs. Nursing home facilities have a much higher estimate of $10,025 monthly for a private room and $8,929 for a semiprivate room. Remember that these figures are based on a projection of the national monthly median from 2023, so costs will vary based on your location and needs.

How Else Can I Pay for Companion Care Without Medicare or Medicaid?

There are many different ways to pay for companion care, but finding the best option for your needs requires a hard look at your finances — especially if you’re on a fixed income and living solely on your monthly Social Security payments.

After you’ve reviewed your savings and assets, consider which of these five popular options fit into your budget:

1. Out of pocket
2. Long-term-care insurance
3. Home equity line of credit
4. Reverse mortgage
5. Veterans benefits