Takeaways
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Original Medicare generally does not cover long-term care at home. Families often pay out of pocket or rely on unpaid caregivers for help. -
The proposed Medicare at Home Act would add a Medicare Part B benefit for up to 20 hours per week of home care.
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The act would not only alleviate familial caretaking burdens, but also incentivize home care workers.
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The bill has only just been introduced, so nothing will change for now. Families needing home care today can explore Medicaid, Area Agencies on Aging, or Medicare Advantage benefits.
Advances in health care technology and practices have made it possible for us to live longer lives. This means we get to have more experiences with those we love. It also means that more people will live long enough to one day need help with daily activities that were once second nature.
These activities of daily living, or ADLs, include everyday tasks, such as eating, bathing, using the toilet, and dressing. Staff members of institutional settings, such as assisted living facilities and nursing homes, help residents with these activities. Increasingly, however, many older adults prefer to age at home.
Assistance with ADLs at home requires a relative living in the home or nearby to provide (usually unpaid) help. Alternatively, family members will hire a professional from outside the home.
Despite so many across the United States requiring long-term care at home, paying for it is not simple.
What Many People Don’t Know
Many people assume Medicare will pay for long-term care at home when they can no longer manage daily activities on their own; however, it usually does not. Original Medicare covers doctor visits, hospital stays, and short-term skilled care after a qualifying illness or injury. It does not generally cover ongoing, day-to-day personal care.
Families often find this out only when the need arises. When that happens, they often pay out of pocket or turn to unpaid family caregivers. A new proposal in Congress aims to fix this discrepancy.
What Is the Medicare at Home Act?
The Medicare at Home Act was introduced in August 2026 by Rep. Debbie Dingell (D-MI) in the House and Sen. Andy Kim (D-NJ) in the Senate. The bill proposes a new home care benefit to Medicare Part B. Part B already covers outpatient and everyday medical services.
Features of the bill include:
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Help with daily activities. Home care workers would assist with tasks such as bathing, dressing, eating, using the toilet, and moving around within the home.
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Home care provided under the new benefit would be time-limited. The benefit would cover up to 20 hours per person per week. It would not provide around-the-clock care.
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Home health will remain separate. The new long-term home care benefit would function separately from Medicare's existing short-term home health benefit.
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A set minimum wage will apply. The bill calls for a payment system that includes a “reasonable wage floor” for home care workers. An exact dollar amount has not been set.
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Medicare Part B premiums. The Part B premium would be adjusted to cover the cost of the benefit.
How This Could Affect Older Adults
If the bill becomes law, it could make it easier for people to stay in their own homes as they age. Instead of paying privately for a few hours of help each week, many people could use their Medicare coverage to cover ongoing personal care, meaning activities of daily living like bathing, dressing, eating, toileting, transferring, meal preparation, medication reminders, light housekeeping, for up to 20 hours per week. This could ease financial strain and give people more choice about where they live.
However, there are trade-offs to consider. Firstly, Part B premiums would likely rise to fund the benefit. As of now, how much they would rise by is unknown.
Next, the 20-hour cap means people with heavy care needs would still need additional help. Lastly, people who already receive identical services through Medicaid would not be able to receive payments for those services from Medicare.
How This Could Affect Family Caregivers
Millions of families provide unpaid care to a parent, spouse, or other relative. Family caregivers spend an average of 27 hours a week on care, and nearly a quarter provide 40 hours or more. Caregivers of people with dementia face higher rates of depression, anxiety, and chronic conditions like heart disease.
Additionally, the time burden of caregiving often forces them to cut hours or leave work altogether. As a result, they give up wages, career advancement, retirement savings, and Social Security credits. They also spend an average of roughly $7,200 a year out of pocket on supplies, transportation, and home modifications.
A Medicare-covered home care benefit could give them some relief, such as several hours each week to work, rest, or handle appointments. It could also reduce the pressure to leave a job or spend savings to hire help.
Further details about out-of-pocket costs and who qualifies as a paid worker are especially important for families. Check the full bill text and follow-up on later changes as the bill progresses.
How This Could Affect Home Care Aides
The wage floor would make a difference to the paid home care workforce, which is often low-paid and hard to retain. In a 2025 report by PHI, a non-profit dedicated to creating direct care jobs, home care workers earned a median income of just over $22,000. Many work part-time and around 40 percent reside in low-income households.
Home care aides also perform demanding work, often with irregular schedules, few paid sick days, and limited benefits. Many leave for other occupations that pay as much with less strain. Meanwhile, demand is growing as the population ages.
This results in high turn-over and shortages in the workforce. Implementing a minimum base pay could attract more people to the field and encourage them to stay.
What Happens Next
The bill is still at the start of the process. The current version has been referred to the Energy and Commerce and Ways and Means Committees. Nothing has been voted on yet.
Most bills never become law — and those that do are often changed along the way. If this bill becomes law, it may look quite different from how it looks now. Advocacy groups including LeadingAge, Caring Across Generations, and Justice in Aging have voiced support.
For now, Medicare’s rules regarding coverage of long-term care at home remain unchanged. If you or a loved one needs home care today, you can look into:
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Medicaid Home and Community-Based Services. Medicaid's home and community-based services (HCBS) programs help pay for personal care aides, adult day programs, and home modifications. Eligibility, covered services, and waiting lists vary widely by state, and some programs cap the number of participants.
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Area Agencies on Aging. These local organizations connect older adults and caregivers with services. They can arrange meal deliveries, transportation, and respite care for family caregivers. Many services are free or based on a sliding fee scale.
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Medicare Advantage. Some Medicare Advantage plans offer extra benefits, such as limited in-home support, meal delivery, or rides to appointments. Available support depends on the plan, the county, and the year. Before enrolling, review plan documents for important information.
Ways to Stay Informed and Additional Reading
You can review the full bill and track its progress at congress.gov by searching “H.R. 10020.” Watch the websites of the House Energy and Commerce and Ways and Means Committees for posted hearing dates. Advocacy groups like LeadingAge, Caring Across Generations, and Justice in Aging often publish plain-language updates and action alerts.
Contact your U.S. representative and senators to share how home care affects your family.
For additional reading on issues related to long-term care and Medicare, check out the following articles:
