Medicare vs. Medicaid: What Covers In-Home Care?
Quick Snapshot
“Confused about in-home care coverage? Read this straightforward guide to discover the differences between Medicare and Medicaid in home care to make better choices.”
How can you get help at home without leaving it? Support from in-home care providers is more popular than ever, as it means getting necessary care at home rather than in a medical facility. Knowing how to pay for in-home care is as important as picking the proper care options. For many, Medicare and Medicaid become key sources of financial assistance for in-home care. The government sponsors both, but their guidelines, coverage, and exclusions are different. This article compares the two programs so you can make the best home care decisions.
Understanding the Basics: What Are Medicare and Medicaid?
Medicare
Medicare provides national health coverage for seniors aged 65 and above and those younger than 65 with approved disabilities or dialysis-based kidney disease. As a federal effort, Medicare gives all states equal access to the same level of coverage. Mostly, it is meant to help with urgent medical conditions, hospital stays, and skilled home health care for limited periods following hospitalization. Eligibility is set by your age or qualifying medical condition, not based on income or assets.
Medicaid
Medicaid is a cooperative program between the federal and state governments to provide complete health coverage to those with moderate incomes and few possessions. It covers a broader group of people, such as children, pregnant women, and people with disabilities, and usually pays for personal and custodial care given at home. Since every state manages its Medicaid program, the policies, income standards, and benefits for in-home support differ significantly, so checking your state’s guidelines is essential.
Due to these basic differences, Medicare assists with short-term skilled needs, while Medicaid is set up to support long-term daily living care.
Key Difference Between Medicare and Medicaid in Covering In-Home Care
Medicare’s Scope for In-Home Care
In-home care through Medicare is only allowed for specific medical conditions. Part-time, medically required care is available to patients under Medicare if they have been through a major illness or accident. Only licensed professionals can give care when a doctor has ordered it. Because Medicare does not cover non-skilled or general supportive care, it signals that the program is for recovery and not continued care.
Medicare considers in-home care transitional help after discharge but does not cover continuous care demands.
Medicaid’s Approach to In-Home Support
Medicaid prioritizes people who need daily help for an extended period. State-run Medicaid programs pay for various non-medical and personal support services. Services such as meal preparation, getting around, bathing, and overseeing someone’s safety are covered, regardless of a medical skill requirement. Medicaid’s flexibility in providing services shows its priority is supporting community life.
Unlike Medicare, Medicaid recognizes long-term dependency needs and integrates personal care as a core coverage element.
What In-Home Care Services Are Typically Needed?
People receiving in-home care may benefit from skilled nursing services for complex tasks such as caring for wounds, administering IV treatments, or monitoring chronic diseases. Therapists who are licensed can help with physical therapy, progress in speech, and teach lost skills. These services make it possible for people to stay healthy and recover at home.
Many people who receive in-home care also need help with daily living tasks. Personal care aides take care of daily bathing, dressing, and toileting, while homemaker services provide meals, clean the house, and do errands. Home health aides assist with mobility and enhance safety. Medical equipment such as oxygen tanks, walkers, or hospital beds can help people stay home and avoid returning to the hospital. Getting familiar with these needs enables you to match up with the proper coverage.
Medicare Coverage for In-Home Care: Limited and Conditional
Medicare covers in-home care for a limited time to help with serious medical needs. Strict criteria determine who is covered and which services are paid for.
A physician has to confirm the patient’s homebound status.
Certification must confirm that the patient’s health conditions prevent them from leaving home safely unless assistive devices or medical care are available.
Care has to be necessary due to the patient’s illness or injury.
Coverage includes care designed to handle or improve a diagnosed illness or injury needing skilled nursing skills.
Care must be intermittent, not full-time.
Medicare will only pay for care given part-time or from time to time. If a patient gets daily or live-in care, Medicare will not pay for it.
A Medicare-certified home health agency must deliver the care
Only agencies approved and monitored by Medicare may deliver reimbursable care under an authorized treatment plan.
What Medicare Does Cover:
Medicare will pay for short-term skilled nursing, physical therapy, speech-language therapy, and medical social work when there is a prescription. In addition, it includes medical equipment that needs to be durable, like oxygen, walkers, or beds, when needed at home. Medicare pays for services meant to help you heal or keep your health from worsening after an illness or stay in the hospital.
What Medicare Does Not Cover:
Medicare does not pay for home care provided daily, or for someone to stay with them at home and assist with supervision. Medicare will not pay for help with bathing, dressing, or eating if it is not paired with skilled care. Getting help with household chores such as cooking, shopping, laundry, or cleaning isn’t part of Medicare’s home health benefits, even if daily help is needed.
Medicaid Coverage for In-Home Care: Broader and State-Driven
Medicaid offers many in-home care options for low-income people who require continuous help. It supports personal care in people’s homes by offering flexible benefits, but these benefits and eligibility standards change by state.
What Medicaid Typically Covers:
Long-term in-home care services
Provides continuous, non-institutional support to individuals needing assistance with chronic conditions or disabilities while remaining safely at home.
Personal care aides and homemakers
Covers assistance with daily living tasks such as bathing, dressing, meal preparation, light housekeeping, and maintaining personal hygiene.
Home health aid services
Funds part-time, medically directed care like monitoring vitals, managing medications, and supporting mobility under clinical supervision.
Case management
Offers coordination of care, service planning, and oversight to ensure timely access to essential medical and non-medical resources.
Medical equipment and supplies
Includes mobility aids, oxygen systems, wound care materials, and other physician-prescribed devices to support health and independence at home.
Transportation to medical appointments
Ensures access to non-emergency medical visits by covering transportation to doctors, therapy centers, pharmacies, and diagnostic services.
Medicaid’s home care model helps people remain at home and avoid nursing homes by making community-based care more accessible.
What Are HCBS Waivers and Why Do They Matter?
With an HCBS waiver, Medicaid pays for in-home and community-based support for individuals who would otherwise require institutional care. These waivers allow aging, disabled, or chronically ill people who would rather stay at home than enter a nursing facility to enjoy greater independence and dignity.
States have their standards for HCBS waiver eligibility, which involve financial needs, medical exams, and how people function. States also cap services, choose providers, and decide who gets access. Some HCBS programs have long wait times, so people who need ongoing care at home should apply and plan as soon as possible.
Under HCBS waivers, people receive personal care support, home health assistance, breaks for family caregivers, and adaptive living upgrades such as grab bars and wheelchair ramps. Some HCBS programs add meal delivery, adult day health services, and behavioral health care. Medicaid recipients benefit from more safety at home, as these supports are also more budget-friendly than long-term institutional stays.
State-by-State Variability in Medicaid Home Care Benefits
Medicaid home care coverage differs widely across states due to decentralized program administration. Eligibility, covered services, and delivery models vary by state, making access to in-home support different for each area.
California – In-Home Supportive Services (IHSS):
IHSS is a service that provides broad caregiving help to seniors with low incomes and people with disabilities so they can continue living at home safely.
The state of New York relies on Managed Long Term Care (MLTC):
With MLTC, seniors and people with chronic illness get medical, personal, and social services under a single plan, which helps them stay at home and independent.
Texas – STAR+PLUS Waiver Programs:
The STAR+PLUS program integrates healthcare and long-term support within Medicaid managed care, providing in-home support to adults with disabilities or serious health issues in different regions.
Applicants should check with their state Medicaid agency or Area Agency on Aging because benefits significantly change. This makes sure people know the eligibility rules, what waivers exist, and when to sign up for crucial home-based support.
Dual Eligibility: When You Qualify for Both Medicare and Medicaid
Dual eligibility is for people who do not exceed Medicaid’s income and resource limits and get Medicare due to aging or disabilities.
Medicare typically covers acute and short-term care
Hospital stays, doctor visits, short-term nursing needs, and home health care after surgery or sickness are all paid for by Medicare.
Medicaid takes on expenses not paid by Medicare.
As state programs vary, Medicaid might pay for things like long-term home care, home support services, prescriptions, and additional copayments not paid by Medicare.
Individuals eligible for both programs may benefit from Special Needs Plans (SNPs) or Programs of All-Inclusive Care for the Elderly (PACE), which combine Medicare and Medicaid services into one care plan. Having one plan makes coordinating home care easier and lowers the risk of missing important services.
Out-of-Pocket Costs and Financial Considerations
Most Medicare beneficiaries pay the remaining 20% of equipment costs for durable medical items after hitting their deductible. These individuals are responsible for expenses not paid by Medicare, such as long-term custodial care or full-time home aids. Supplemental insurance or Medigap plans may help reduce out-of-pocket expenses, but do not eliminate all gaps.
Most eligible people have little or no out-of-pocket costs with Medicaid. Full coverage for in-home services without any co-payments is available in most states. In some states, cost-sharing is needed by clients based on how much they earn or impose service caps. It is important for beneficiaries to check their state’s Medicaid rules to learn about their costs and benefits before starting long-term care.
How to Apply for Medicare or Medicaid In-Home Care Benefits
Medicare:
Obtain a physician’s referral.
Have your physician determine if home health care is needed and create a treatment plan for those services.
Use a home health provider that is certified by Medicare.
Work with a Medicare-approved company to make sure your services will be paid for and meet all care guidelines and paperwork requirements.
Make sure Medicare covers the services in your care plan.
Confirm that the services you get are needed, provided only when needed, and handled by licensed staff under certifying agency rules.
Medicaid:
Go through your state’s Medicaid office to begin the application.
Communicate with your state’s Medicaid agency by submitting proof of your finances and relevant medical records.
Complete a functional needs assessment.
Go through a personal assessment by a state worker to find out what support is needed for in-home care services.
After being approved, you can sign up for an HCBS waiver or a Medicaid-managed plan.
After approval, choose an at-home care program that corresponds with your state’s long-term care choices and service limits.
An eldercare professional assists with making applications faster, explaining eligibility, and organizing services for better care access.
Common Misconceptions About Medicare and Medicaid Home Care
Myth: Medicare pays for full-time home care.
Reality: Medicare covers only part-time skilled care after you have a medical event. This coverage is limited to professional services, not round-the-clock or long-term daily help.
Myth: Medicaid coverage is the same everywhere.
Reality: Each state manages Medicaid independently. What Medicaid covers, who is available to help, and who can apply changes vary according to where you live and your state’s rules.
Myth: You can’t qualify for Medicaid if you own a home.
Reality: Medicaid typically excludes your primary residence from financial evaluations, allowing many homeowners to qualify for long-term care benefits.
Understanding these misconceptions helps families avoid planning errors and financial setbacks. Always verify each program’s rules on official state or federal sites to make the best home care choices.
Choosing the Right Program Based on Individual Needs
When choosing between Medicare and Medicaid, you should consider your health, personal finances, how long you need care, and where you can find in-home services locally.
Your age and health condition
Medicare offers help with short-term skilled care to seniors and disabled adults who are confident in their abilities. Medicaid supports individuals of any age who have specific clinical or functional conditions.
Financial situation
Income does not determine if someone is eligible for Medicare. Medicaid has specific income and asset restrictions, and you must be financially eligible to get ongoing or custodial home care coverage.
Length and type of care needed
Medicare covers temporary skilled recovery care, while Medicaid supports long-term personal care, regular daily help, and non-medical care for chronic conditions.
Location and availability of services
Medicaid offerings vary by state. Program availability, waiver slots, and care coordination options depend heavily on your Medicaid agency’s structure in your area.
Evaluate each program carefully to match your needs with eligibility and coverage. Prioritizing personalized support ensures sustained independence and prevents care disruptions.
Final Thoughts: Empowering Decisions Through Knowledge
Proper knowledge empowers better care decisions. Don’t wait for a crisis—evaluate your options, explore eligibility, and consult experts today. Will you take control of your care journey now or leave it to chance? Plan proactively, choose wisely, and unlock the support you or your loved ones deserve to age confidently and comfortably at home.
Need Help Navigating Your Options?
“To receive personalized guidance, consult your local Medicaid office, Medicare counselor, or Area Agency on Aging. Additionally, websites like Medicare.gov and Medicaid.gov provide comprehensive resources tailored to your state and circumstances.
By gaining clarity on these programs, you’re not just planning for care—you’re planning for independence and dignity at home.”
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