Medicare vs. Medicaid: Who Pays For Home Health Services?

Deciding on a home health care agency can be scary. Figuring out how to pay for their services is even scarier, especially when that patient is on public insurance.

So, you begin asking a few questions: “What programs are they eligible for? How long can they receive them? What limitations are there?”

The good news is, home health care is eligible for both Medicare and Medicaid reimbursement. Both plans push for your loved one to stay at home longer because it’s much more affordable than an assisted living or skilled nursing home, and the advantages it offers helps reduce the risk of hospital readmissions and further injury.

However, knowing which plan your loved is eligible for can be tricky.

The Difference Between Medicare vs. Medicaid

The first thing to learn is the differences and similarities between the two plans.

What is Medicare Health Insurance?
Medicare is a federally funded program for seniors over age 65 and individuals who become disabled.

Throughout your work life, you contribute to Medicare just as you do to the Social Security pot. There are two parts to the insurance – Medicare Part A and B.

  • Part A covers hospital expenses as well as skilled nursing care and home health care services.
  • Part B covers services, like screenings and shots, and medical equipment, like wheelchairs and oxygen machines.

Finally, the plan includes Medicare Silver Sneakers™, which encourage seniors to participate in physical activities.

What is Medicaid Health Insurance?
Medicaid is a program run by both federal and state governments. Missouri Medicaid serves low-income residents of any age, including seniors, who are unable to pay for or receive private insurance. Some seniors are eligible for both programs, but Medicaid only helps cover those costs not paid by Medicare.

As with Medicare, home health care* falls under Medicaid’s coverage umbrella.

Need Help?
Our staff can help you determine the best plan for you and your loved one.

So, Who Pays For My Loved One’s Care?

What Does Medicare Cover?
Medicare Part A is your family member’s first line of payment for home health care if they’re over age 65. Seniors are eligible if they are under the care of a physician, require part-time care, and are unable to leave home for services.

Medicare covers six different home healthcare disciplines:

  1. Skilled Nursing
  2. Physical Therapy
  3. Occupational Therapy
  4. Speech-Language Pathology
  5. Home Health Aide
  6. Medical Social Services

In addition, there are no limitations on the length and amount of services they receive.

What Does Medicaid Cover?
According to the Missouri Department of Social Services, if your loved one is under age 65 and receiving Medicaid, they are eligible for home health care under the Missouri Independent Living Waiver (ILW). Through the ILW, they can receive nursing care and therapy as well as home aide care to assist with bathing, grooming, and eating.

For those over age 63 and eligible for skilled nursing care, the Aged and Disabled Waiver allows them to stay in their own homes. As with the ILW, they can receive elderly care and therapy services, but are also eligible for programs like adult day care, home-delivered meals, and assistance with daily chores. This waiver is a supplement to Medicare Part A.

Getting the Most Coverage For Your Loved One

Schedule a free home health assessment with us today.

As you and your family member begin looking into home health care, talk to the experts at Envision Health Partners. Through our free assessment, we can determine your loved one’s Medicare vs. Medicaid eligibility and maximize the level of service they receive to ensure their specific healthcare needs are met. Like you, we want to keep your family member out of the nursing home and at home as long as possible.


Need help talking with your parent or other family members?
Feel free to contact us today for a free in-home assessment as we can provide helpful suggestions that will make this difficult conversation a little easier.