Does Medicaid or Medicare Pay for In Home Care Services?

August 25, 2015

medicare medicaidWhen helping a senior or loved one recovering from an injury or decline in condition, or those suffering from dementia, adult children often need to call on outside help from qualified caregivers. While family caregivers can reap tremendous reward from providing care to a loved one themselves, burnout should be avoided at all costs. (Read our post: “3 Dangerous Consequences of Home Care Provider Burn Out“.

Thankfully there’s a safety net, for those that qualify, for certain types of assistance with care from both state and federal sources.  Understanding the difference between Medicare and Medicaid and how they might help just takes a little research.  Before you tackle their in-depth websites, however, this overview will can help you get to the heart of these matters fast.

Who and What Medicare Covers

All Americans qualify for Medicare if they are over 65 or have certain disabilities such as mental illness, renal failure and other issues. Those without a Medicare card who might qualify should call their state Medicare office to apply. Even seniors with significant assets can qualify for assistance with their health care costs through Medicare.

Further, Medicare can help pay for in home medical services like intermittent skilled nursing care or physical, speech, or occupational therapy, but all of these must result from an illness or injury. Further, to qualify for Medicare payment, the family must show:

  • A prescription from a doctor.
  • Medicare-approval for any in home care services agency.
  • The senior is confined to their home by the injury, illness, or other medical condition. (Trips to the barber, church and other necessary trips excused.)
  • A healthcare plan set up by the doctor and in home medical services company.
  • The need for injections (or guiding the client to self-inject), catheter changes, wound care, observation and assessment of a patient’s condition, management and evaluation of a patient’s care plan.

Common senior care issues Medicare DOES NOT cover include:

  • Personal care services like help with bathing, toileting and dressing.
  • Occupational or physical therapy that is NOT due to a serious illness.
  • Meal delivery to the home.
  • Shopping, cleaning, laundry.
  • Assisted living facilities.
  • Transportation to and from medical appointments
  • Routine eye, dental and hearing exams

Arranging In Home Medical Services through Medicare 

Typically, the hospital social worker, doctor or other healthcare organization where the senior gets treatment helps to organize the in home medical care services that will support the nurse, other healthcare provider and/or the senior. While these entities will recommend specific agencies, the senior has flexibility about which to choose. Of course the service must be Medicare accredited. Family members can also call an in-home health care agency or caregiver to ask how they bill through Medicare.

Who and What Medicaid Covers

A limited subset of Americans receives both Medicare benefits AND Medicaid benefits. Medicaid is a state managed safety net that helps seniors and people with disabilities pay for various forms of long term care, such as in-home care, assisted living or memory care.  ONLY Medicaid pays for NON-medical in home care, or personal care, and ONLY for low-income seniors with limited resources. Seniors with assets and income above the maximum allowed amounts must pay for these services from their own funds.

Medicaid can help pay for some or all of the expenses for daily care from in home caregivers or assisted living facilities. Because Medicaid eligibility varies greatly from state to state, contacting your State Medicaid office to visit with a case manager is your first step.

Get the In Home Care Services You Need Today!

At you can find care agencies who accept Medicare ,Medicaid, private pay or insurance. When you complete your profile with, you can specify that you’re looking for Medicare- or Medicaid-approved services.  Click the links above to get started or contact us with any questions you may have. We look forward to assisting you with finding the best in home care services for yourself or your senior loved one!

About the Author

Doug Breuer is co-founder of and has worked in senior care for the last 9 years for the State of Oregon. From investigating cases of elder abuse to managing the delivery of long term care to residents of Central Oregon, Doug has been involved in all aspects of senior care.

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