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Medicare & Medicaid: What is the difference between Private Duty Home

Updated: Jan 10, 2021

Private duty home care is a service that provides elderly or frail seniors who require assistance with their day to day activities (ADL's - activities of daily living) i.e. - bathing, assistance getting dressed, personal hygiene, errands, transportation, medication management, homemaker services, companionship, chronic disease management, personal care, etc. The goal of private duty care is to help seniors remain independent and safe comfortably in their own home and offer respite care to family caregivers. Private duty home care is reimbursed by private pay, LTC (long term care insurance) or a veteran's benefit called Aid & Attendance. Private duty home care agencies are able to offer a broad range of non-medical services. Medicare or private health insurance does not pay for non-medical private duty care.

Medicare and Medicaid government funded home care services are usually structured to be a short term measure. Medicare will not reimburse for non-medical care such as meal deliveries, or in home meal preparation, 24 hour care, or personal care such as help with bathing, toileting, dressing. Medicare may pay for short term caregivers if there is a need to recover from surgery, illness or injury. Medicare will pay for short term home health services like skilled nursing care, physical therapy or occupational therapy if you are home bound and your doctor orders it. In Florida, Medicaid Waiver programs offer private duty home care and will cover the cost with capped hours of service. There are strict eligibility requirements to qualify and a there is a long wait list for these services.

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