Medicare vs. Medicaid: who pays for home care?
Why Medicare stops paying after a few weeks, and why Medicaid is the program that pays for a long-term aide at home.
Many families learn this the hard way after a hospital stay: Medicare doesn't pay for a long-term home health aide. Here's the difference.
What Medicare pays for at home
- Short-term, skilled care: a nurse, physical therapy or speech therapy after an illness or hospital stay.
- The person must be homebound and under a doctor's plan of care.
- Aide help is covered only part-time and only alongside skilled care.
When the skilled care ends, so does the Medicare aide.
What Medicaid pays for at home
- Long-term personal care: help with bathing, dressing, eating, toileting and getting around, for as long as it's needed.
- Hours can range from a few a week to, in some cases, 24-hour care.
- CDPAP, which lets a family member be the paid aide.
Side by side
| Medicare | Medicaid | |
|---|---|---|
| Long-term daily aide | No | Yes |
| Short-term skilled nursing/therapy | Yes | Yes |
| Family member can be paid | No | Yes (CDPAP) |
| Income/asset limits | None | Yes, but planning can help |
Have both? That's common
Many older Caribbean New Yorkers have both Medicare and Medicaid (they're "dual eligible"). Medicare stays your main health coverage, and Medicaid adds the home care, usually through an MLTC plan.
Paying privately?
A full-time private aide in New York can cost thousands of dollars a month. Before spending savings, find out whether Medicaid planning could get the same care covered.
General information, not legal advice.