Medicare vs. Medicaid — What Caregivers Need to Know

Medicare and Medicaid sound similar, but they work very differently.

What Medicare Covers

Medicare covers anyone 65 or older, or people under 65 with certain disabilities or end-stage kidney disease.

Medicare pays for medical care — doctor visits, hospital stays, prescriptions, and short-term rehabilitation.

Medicare will pay for a licensed nurse or therapist to visit someone at home after a hospitalization or qualifying medical event, but this is only a temporary arrangement.

Medicare does not cover ongoing help with bathing, dressing, meals, or mobility. It does not pay a family member or friend to provide care at home.

What Medicaid Covers

Unlike Medicare, Medicaid has different rules in each state, and eligibility is based on income, assets, and medical need — not age.

In Virginia, the CCC Plus Waiver is the Medicaid program that funds in-home care for people who would otherwise need to live in a nursing facility. Inside that program, the Consumer-Directed care model allows the person receiving care or a designated representative to hire their own caregiver, including a family member or friend.

For a full explanation of how Consumer-Directed care works, see: What Is Consumer-Directed Care?

Can Someone Have Both Medicare and Medicaid?

Yes. This is called being dual-eligible.

When someone has both Medicare and Medicaid, Medicare pays first for covered medical services. Medicaid covers costs Medicare does not pay, and it funds in-home care through the CCC Plus Waiver regardless of Medicare enrollment.

What About Home Care Agencies?

Some families choose to work with a home care agency rather than managing the Consumer-Directed process independently. An agency can help coordinate caregivers and handle much of the administrative setup.

For more on how these two paths compare, see: Agency Care vs. Consumer-Directed Care — Which Is Right for You?