Medicare, Medicaid, and Home Care: What's Covered in 2026?
One of the most common questions families ask when exploring home care is:
"Will Medicare pay for this?"
Unfortunately, the answer is often more complicated than people expect.
Many older adults assume Medicare will cover ongoing help at home with bathing, dressing, meal preparation, housekeeping, or companionship. In reality, Medicare and Medicaid have very different rules regarding home care coverage.
Understanding the difference can help families avoid unexpected expenses and find the resources available to help their loved ones remain safely at home.
Understanding the Difference Between Medicare and Medicaid
Although the names sound similar, Medicare and Medicaid are very different programs.
Medicare
Medicare is a federal health insurance program primarily available to:
Adults age 65 and older
Certain individuals with disabilities
Individuals with specific medical conditions
Medicare is designed to cover medical care such as:
Hospital stays
Physician visits
Skilled nursing care
Home health services
Durable medical equipment
Prescription medications (depending on coverage)
Medicaid
Medicaid is a joint federal and state program designed to help individuals with limited income and assets pay for healthcare and long-term care services.
Unlike Medicare, Medicaid may cover long-term support services that help individuals remain safely in their homes.
This distinction is extremely important when planning for aging in place.
Does Medicare Cover Home Care?
The answer is: sometimes, but only under specific circumstances.
Medicare may cover home health services when:
A physician orders the care.
The services are medically necessary.
The individual meets Medicare eligibility requirements.
Skilled services are needed.
Examples of services Medicare may cover include:
Skilled nursing visits
Physical therapy
Occupational therapy
Speech therapy
Medical social services
These services are generally short-term and focused on a specific medical condition, injury, surgery recovery, or rehabilitation need.
What Medicare Usually Does NOT Cover
Many families are surprised to learn that Medicare generally does not pay for ongoing non-medical assistance such as:
Bathing
Dressing
Toileting assistance
Meal preparation
Housekeeping
Laundry
Transportation
Companionship
Medication reminders
Long-term personal care assistance
Long-term nursing services
These are often the services seniors need most to remain independent at home.
Does Medicaid Cover Home Care?
In many cases, yes.
South Dakota Medicaid offers several programs designed to help eligible individuals receive services at home rather than moving into a nursing facility.
These programs are often referred to as Home and Community-Based Services (HCBS).
Depending on eligibility, Medicaid may help cover services such as:
Personal care assistance
Bathing and grooming
Dressing assistance
Meal preparation
Housekeeping
Laundry
Transportation
Respite care
Nursing services
Other supports that help individuals remain safely at home
The goal is to provide the support needed for individuals to maintain their independence and quality of life while avoiding unnecessary institutional placement.
What Is Dakota at Home?
Many South Dakotans are unaware that a valuable resource already exists to help families understand their options.
Dakota at Home serves as South Dakota's Aging and Disability Resource Center.
Dakota at Home can help individuals:
Learn about available services
Determine eligibility for programs
Connect with local resources
Explore Medicaid-funded services
Navigate long-term care options
If you are unsure where to begin, Dakota at Home is often an excellent first call.
Dakota at Home can be reached at:
833-663-9673
What If I Don't Qualify for Medicaid?
Many older adults fall into what is sometimes called the "middle ground."
They may not qualify for Medicaid but still need assistance at home.
Fortunately, several other payment options may be available.
Family Caregiver Support and Respite Programs
Even if you do not qualify for Medicaid, you may still be eligible for support through South Dakota's Family Caregiver Support Program.
This program helps family members who are caring for an older adult or individual with a disability by providing respite services.
Respite care allows caregivers to take a temporary break while ensuring their loved one continues to receive safe, quality care. This can be especially valuable for family caregivers who are balancing work, children, and other responsibilities while providing ongoing care.
To learn more about caregiver support and respite programs available in South Dakota, visit the South Dakota Department of Human Services Caregiver Services page:
https://dhs.sd.gov/en/ltss/respite-and-caregiver-services
Private Pay
Many families choose to pay directly for home care services.
Often, a few hours of support each week can make a significant difference in helping someone remain independent.
Long-Term Care Insurance
If your loved one purchased long-term care insurance, some or all home care expenses may be covered depending on the policy.
Because every policy is different, it is important to review coverage details carefully.
Veterans Benefits
Eligible veterans and surviving spouses may qualify for programs that help cover home care services.
The Department of Veterans Affairs offers several programs designed to support veterans who wish to remain in their homes as they age.
Why Understanding Coverage Matters
One of the biggest mistakes families make is waiting until a crisis occurs before exploring payment options.
A fall, hospitalization, or sudden health decline can leave families scrambling to understand available resources while making important decisions under pressure.
Planning ahead allows families to:
Understand available benefits
Explore eligibility requirements
Create a long-term care plan
Avoid unnecessary stress during emergencies
The earlier these conversations happen, the more options families typically have.
Home Care Is About More Than Healthcare
When most people think about home care, they focus on medical needs.
However, many seniors remain independent because they receive assistance with everyday tasks that are easy to overlook:
Preparing nutritious meals
Managing household chores
Getting to appointments safely
Maintaining personal hygiene
Staying socially connected
These services can play a critical role in preventing falls, reducing hospitalizations, supporting caregivers, and helping older adults continue living where they are most comfortable—at home.
The Bottom Line
Medicare and Medicaid both play important roles in helping older adults access care, but they cover very different services.
Medicare generally covers short-term skilled medical services, while Medicaid may help pay for long-term home and community-based services that support independence.
If you are unsure what programs may be available for yourself or a loved one, don't wait until a crisis occurs. Understanding your options today can make future decisions much easier.
At Kore Cares, we help families navigate home care options every day. Whether you are exploring Medicaid services, private pay care, long-term care insurance, veterans benefits, or simply trying to understand where to start, our team is here to help.
Contact Kore Cares for a free consultation and learn how we can help you or your loved one remain safe, independent, and comfortable at home.
To find a location near you visit https://www.korecares.com/contact or if you would like us to contact you will out our referral form https://korecaresllc.clearcareonline.com/referrals/.