Introduction
One of the most common questions families ask when seeking home healthcare services is, “Will Medicare or Medicaid cover home care?” Understanding how these programs work can help you or your loved one receive quality home care without unnecessary financial stress.
This guide will break down the differences between Medicare and Medicaid, what services they cover, and how you can apply for coverage.
1. What’s the Difference Between Medicare & Medicaid?
Although both programs help cover healthcare costs, they have different eligibility requirements and coverage benefits:
✅ Medicare – A federal health insurance program primarily for people aged 65 and older or individuals with certain disabilities.
✅ Medicaid – A state and federal program that provides free or low-cost healthcare to eligible individuals, including seniors, low-income families, and people with disabilities.
✔️ If you or your loved one qualifies for either program, you may be able to receive home healthcare services at little or no cost.
2. Does Medicare Cover Home Healthcare?
Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) cover certain home healthcare services if you meet the following conditions:
✅ A doctor certifies that you need home healthcare
✅ You are homebound (unable to leave home without assistance)
✅ The care is provided by a Medicare-certified home health agency
Medicare Covers:
✔️ Skilled Nursing Care – Wound care, injections, and medical monitoring
✔️ Physical Therapy – Rehabilitation after injury or surgery
✔️ Occupational Therapy – Assistance with regaining daily life skills
✔️ Speech-Language Therapy – Help with swallowing, speech, and communication issues
✔️ Medical Social Services – Counseling and support for patients and families
Medicare Does NOT Cover:
❌ 24/7 in-home care (only part-time, intermittent care is covered)
❌ Personal care services (like bathing, dressing, and housekeeping) unless tied to skilled nursing
❌ Long-term care
✔️ If you need non-medical care, you may need to explore Medicaid, Private Pay, or Community-Based Alternatives (CBA).
3. Does Medicaid Cover Home Healthcare?
Medicaid provides more extensive home care benefits than Medicare and is a great option for individuals needing long-term care. Eligibility varies by state, but most Medicaid programs cover:
✅ Personal Care Services (PCS) – Help with bathing, grooming, dressing, and mobility
✅ Community-Based Alternatives (CBA) – In-home, foster home, or assisted living support
✅ Primary Home Care (PHC) – Non-medical, daily living assistance
✅ Family Care (FC) – Non-skilled in-home caregiving
✔️ Medicaid often covers long-term personal care services, making it a better option for those needing ongoing home healthcare support.
4. Who Qualifies for Medicaid Home Healthcare?
Medicaid eligibility is based on income level, disability status, and medical needs. If you:
✔️ Are a low-income senior or person with a disability
✔️ Need assistance with daily activities
✔️ Meet state-specific income requirements
💡 You may qualify for full or partial home healthcare coverage under Medicaid.