When a senior loved one requires home assistance-either recovering from a hospital stay, managing a chronic condition, or simply needing more safety and support-one of the very first questions families ask is: “Will Medicare cover care at home?”
The short answer: “It depends.”
And for families in Arkansas, getting a clear sense of what Medicare covers, what it does not cover, and how it interfaces with other supports-like state programs or private pay-can make a meaningful difference in planning, peace of mind, and budgeting.
At A Place at Home – Little Rock, we have guided many Arkansas families through this process: helping them to navigate the rules of Medicare, avoid surprises, and actually create a care plan that works at home.
What is Medicare Coverage?
Medicare is a federal health insurance program that covers people 65 years of age and older as well as certain younger people with disabilities. It covers both hospital care (Part A), medical services (Part B), and prescription drugs (Part D). Some seniors opt for Medicare Advantage plans, often called Part C, which packages these benefits but may have different rules for home health services.
1. What Medicare does cover when it comes to home-care services
Medicare’s “home-care” benefit is most often called home health care. According to the official Medicare.gov site:
Eligible home health services can be covered under Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance), provided that certain conditions are satisfied.
Key eligibility criteria include:
- There must be a doctor’s certification that the beneficiary requires part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or occupational therapy.
- The person must be homebound, which means that leaving the house takes a considerable amount of effort or requires assistance, or is medically advised against.
- The care must be provided under a physician-ordered plan of care by a Medicare-certified home health agency.
When those criteria are satisfied, Medicare will cover:
- Skilled nursing visits in the home (wound care, injections, monitoring unstable health).
- Physical therapy, occupational therapy, speech therapy (when ordered and medically necessary).
- Home health aide services, but only if the patient is also receiving skilled nursing or therapy services.
- Durable medical equipment and supplies related to the home health services.
- Good news: Under Original Medicare, for all covered home health services you generally pay nothing (Part A) or nothing for the service itself (Part B), though standard rules apply for equipment.
What does this means for you as a family or senior:
If your loved one qualifies under these conditions, you may be able to receive skilled home-health services with no out-of-pocket cost via Medicare, which can be a huge relief.
2. What Medicare does not cover — and where the gap lies
Understanding the limitations is just as important, as many families assume “home care” means full-time in-home support, but it is not Medicare’s role. Some things Medicare does not cover include:
- Full-time, 24-hour home care is not covered by Medicare. If the only care you need is help with daily living-bathing, dressing, meals, cleaning-and no skilled nursing/therapy is being provided, Medicare generally won’t pay.
- Homemaker services (shopping, cleaning) are not covered when these are the only services required.
- If the patient is not homebound-that is, she or he can leave the home to go for medical treatments, pick up groceries, or perform other errands without great hardship-Medicare home health does not apply.
- If you are getting only custodial care–that is, help with daily living tasks–and no skilled care through a home health plan, Medicare will generally not pay for it.
Why this gap matters:
Many seniors require both types of care: skilled health services and ongoing personal care (assistance with meals, hygiene, mobility). Medicare will often cover the skilled component, but the personal care component may need to be covered another way, such as state waivers, private pay, or family/caregiver support. At A Place at Home – Little Rock, we support families in mapping both pieces-bringing together the divide between what Medicare covers and what other needs must be met.
3. Medicare Home Health Trends (2025 Update)
- Fewer visits for Medicare Advantage members: Seniors on Medicare Advantage often receive fewer home health visits than traditional Medicare enrollees, making it important to work with a provider who can navigate coverage.
- Rising Medicare Advantage enrollment: Over 55% of Medicare beneficiaries are now in Advantage plans, which can impact access to in-home care — especially in rural Arkansas.
- Hospital-to-home gaps: Many seniors who should get home health after hospitalization are still missing services, increasing the need for proactive care coordination.
- Growing demand for home care: The U.S. home health market continues to grow, highlighting the importance of skilled, local providers for families across Arkansas.
Medicare Advantage in 2025: Enrollment Update and Key Trends
4. What Arkansas families should ask when considering in-home care
Here are specific questions you should ask your agency or your loved one’s care team — and you should understand the answers.
| Question | Why it matters |
|---|---|
| Are you a Medicare-certified home health agency (or do you work with one)? | Only agencies certified by Medicare can provide the services that Medicare will cover. |
| Which of your services are covered under Medicare, and which will require private pay or other funding sources? | Helps you plan finances and avoid surprises. |
| Will my loved one’s doctor write a plan of care and certify homebound status if needed? | That’s a requirement for Medicare home health eligibility. |
| If the skilled home health portion ends, can you continue providing personal care/companion services (and how are those paid)? | Many families transition from Medicare-covered skilled care to private pay personal care — knowing how you’ll bridge that helps continuity. |
| How do you coordinate with other programs (Medicaid waivers, veteran’s benefits, etc.) in Arkansas? | Because Medicare may not cover everything, double-checking support options ensures better care. |
5. Building a care plan that covers all the bases
Because Medicare on its own may not be able to cover all that your loved one needs, here is a step-by-step roadmap for integrating Medicare with other supports and selecting the right in-home care.
Determine Medicare Eligibility
- Verify that the senior is covered by Medicare Part A and/or Part B.
- Meet with physicians for evaluation of need for skilled nursing and/or therapy in the home, and discussion of whether patient is considered homebound.
- Call a Medicare-certified home health agency and inquire about initiating the plan of care.
Understand the “End Game” of Medicare Home Health
- Recognize that Medicare home health is typically intermittent and part-time, not full-time care.
- Decide what happens at the close of a home health agency’s plan of care, for example, when the skilled services such as PT stop — this is when personal care support becomes more crucial.
Identify Additional Funding or Private Pay Options
- In Arkansas: explore state programs available to seniors through Medicaid, including but not limited to ARChoices in Homecare waiver and other Home & Community-Based Services (HCBS) under Medicaid for seniors.
- If private pay is required: ask your agency for a “personal care/companion services” rate sheet and how they handle transitions.
- Consider veteran’s benefits, long-term care insurance, or family budget options if the gap is substantial.
Choose an Agency with Dual Expertise
Choose an in-home care agency that:
- Is familiar with Medicare home health certification and paperwork.
- Also offers or partners with personal care/companion services, so you don’t need to make a big switch when Medicare ends.
- Understands local Arkansas geography (rural vs urban) and can coach you on logistics, especially if you live outside major metro areas.
Maintain Oversight and Communication
- Keep a copy of the plan of care, service visits summary, and any discharge or transition documents from the Medicare home health agency.
- Ask your provider for regular updates and verify that they coordinate with the physician and any other service providers.
- If your loved one’s condition changes, notify the provider/doctor promptly – new skilled services may restart the Medicare home health eligibility.
6. A real-life story that illustrates why these matters
Meet Mrs. Wilson (her name has been changed to protect her identity), an 82-year-old retired school teacher who lives just outside Conway, Ark. She fell and broke her hip, then was sent home after a short stay in the hospital. Her doctor expected that she could recover mobility with therapy and skilled nursing and avoid a prolonged stay in a nursing home.
In stepped the local Medicare-certified home health agency: physical therapy three times a week at home, a home health aide twice a week while she regained strength, and nursing oversight for her wound care. Because she met the “homebound” criteria and needed skilled therapy, Medicare covered it fully.
As the skilled part tapered off, Mrs. Wilson’s family employed A Place at Home to provide companion and personal care services: meal preparation, light housekeeping, and transportation to church-all private pay. Because everything transitioned well, she was able to avoid going into a facility and get back to being independent again.
That is a “Medicare + personal care” model that works in Arkansas; not a one-size-fits-all. It is all about knowing the rules, planning ahead, and partnering with the right provider.
7. Why choosing the right in-home care in Arkansas provider matters
At A Place at Home, our mission is to give Arkansas seniors and their families confidence and clarity about in-home care. Here’s how we deliver that:
- We take you through the eligibility and documentation process so that you understand what Medicare pays for, and what you may need to pay.
- We provide a ‘seamless’ transition from Skilled Care (when Medicare covers it) to personal/companion care (when Medicare coverage ends) so you don’t face a “service gap.”
- We know Arkansas — from Little Rock to the rural counties — and tailor care to your location, needs, and goals.
- We keep families informed: Medicare rules change, and having a provider who is there to update you adds security.
Frequently Asked Questions (FAQ)
Q: My loved one is ambulatory (can walk a little) — can they qualify for Medicare home health?
A: Possibly — “homebound” doesn’t always mean bed-bound. It means that leaving home requires considerable effort, assistance, or is medically discouraged. Ask the doctor whether homebound status applies in your case.
Q: If Medicare pays for home health, will it pay forever?
A: No. Medicare pays for as long as the skilled services are medically necessary and the conditions are met. When the skilled portion ends (therapy, nursing), you may transition to personal care services, which Medicare generally does not cover.
Q: What if my relative has a Medicare Advantage (MA) plan?
A: Home health rules apply, but real-world data shows MA beneficiaries receive fewer home health visits compared to traditional Medicare. Ask your MA plan directly about home health coverage and visit limitations.
Q: How much will out-of-pocket cost be?
A: For the covered Medicare home health services, out-of-pocket cost is typically zero under Original Medicare. But personal care services (not covered by Medicare) will have a cost — ask your provider for full transparency.
