When a Pennsylvania family starts looking into home care, the first question is almost always: “Is this covered?” The honest answer is it depends on which program. Medicare and Medicaid are different programs with different rules, different funding, and very different coverage for in-home services.
This guide explains plainly what each program pays for in Pennsylvania, who qualifies, and which one fits your situation.
The short version
| Medicare | PA Medicaid (CHC) | |
|---|---|---|
| Covers skilled nursing at home | Yes (after physician order) | Yes |
| Covers personal care (bathing, dressing, ADLs) | No (unless attached to skilled care) | Yes |
| Covers companion care | No | Yes |
| 24-hour live-in care | No | Some plans |
| Time-limited | Yes — episodes of care | Ongoing as long as eligible |
| Income/asset test | No | Yes |
Medicare home health: skilled, short-term, physician-ordered
Medicare Part A and Part B cover skilled home health services when:
- A physician has signed a plan of care
- You’re “homebound” (leaving home is a considerable, taxing effort)
- You need skilled services — meaning nursing, physical therapy, occupational therapy, or speech therapy
- The agency providing care is Medicare-certified
Medicare home health is provided in time-limited episodes (typically 60 days, renewable while skilled need remains). It pays for:
- Part-time skilled nursing visits (wound care, IV management, medication administration, etc.)
- Physical, occupational, speech therapy
- Home health aide services only when attached to a skilled visit
- Medical social services
- Durable medical equipment
Medicare does not pay for:
- Personal care alone (bathing, dressing) without skilled services
- 24-hour care
- Meal delivery
- Homemaker services
- Companion care
Source: Medicare.gov — Home Health Services Coverage. A-Team Home Care provides skilled home health when ordered.
Pennsylvania Medicaid Community HealthChoices: ongoing personal care
For Pennsylvania residents who need ongoing personal care — daily help with bathing, dressing, toileting, mobility, meal prep — the program is Community HealthChoices (CHC). CHC is administered by three managed care organizations:
- Keystone First CHC
- UPMC Community HealthChoices
- PA Health & Wellness CHC
CHC covers:
- Personal care services (ADLs)
- Companion care during approved hours
- Adult day services
- Home modifications (some)
- Skilled nursing (under separate authorization)
- Some 24-hour live-in care
To qualify for CHC long-term services and supports:
- Pennsylvania resident, age 21+ (or aged 18-20 with disability)
- Income within Medicaid limits (PA’s limits are higher for LTSS than for regular Medicaid; verify with PA DHS or your CHC plan)
- Clinical assessment showing nursing-facility level of need (typically 2-3 ADL deficits)
- Enrolled with one of the three CHC plans
Source: PA Department of Human Services — Community HealthChoices.
Which program fits your situation? A decision tree
Choose Medicare home health if:
- Your loved one is recovering from surgery, hospital stay, or acute illness
- A physician has ordered skilled services
- The need is short-term (weeks, not years)
Choose PA Medicaid CHC if:
- Your loved one needs ongoing daily personal care
- The condition is chronic (dementia, Parkinson’s, mobility loss, post-stroke)
- Care is needed for months or years, not weeks
- Your loved one’s income/assets are within Medicaid limits
Both can be used together. Many Pennsylvania families use Medicare during a recovery period (skilled nursing + therapy) and then transition to CHC for ongoing personal care once Medicare’s skilled need ends.
Other Pennsylvania programs to know
- OPTIONS Program (Philadelphia Corporation for Aging) — non-Medicaid program for Philadelphia residents 60+ with financial need who don’t qualify for CHC
- VetAssist (VA Aid & Attendance pension) — for wartime veterans and surviving spouses
- PACE (Pennsylvania Pharmaceutical Assistance Contract for the Elderly) — for prescription costs
A-Team Home Care accepts Medicare, all three Community HealthChoices plans, OPTIONS, VetAssist, and private pay across personal care, companion care, 24-hour home care, Alzheimer’s and dementia care, skilled nursing, and our Family Caregiver Program.
How to find out what’s covered for your family
The fastest path is a free 15-minute call with A-Team’s intake team. We can:
- Verify which program your loved one is currently enrolled in (Medicare, Medicaid, or both)
- Identify which services are likely to be approved
- Walk through the enrollment or authorization process for whichever program applies
Call (215) 490-9994 for a free assessment.
Frequently Asked Questions
Does Medicare cover home care for my mom in Pennsylvania?
Medicare covers skilled home health — nursing visits, physical therapy, occupational therapy, speech therapy — when a physician orders it and your mom is homebound. It does not cover personal care alone (bathing, dressing, ADL help) or 24-hour care. For ongoing personal care, the right program in Pennsylvania is Community HealthChoices (Medicaid). (Source: Medicare.gov — Home Health Services)
What’s the difference between Medicare and Medicaid for home care?
Medicare is federal health insurance for adults 65+ (and certain disabled adults), with no income test. It pays for short-term skilled care episodes. Pennsylvania Medicaid — Community HealthChoices — has both income and asset limits, but covers ongoing daily personal care for as long as the participant remains eligible. Many families use both: Medicare for a post-hospital recovery, then CHC for ongoing daily help.
Can someone have both Medicare and Medicaid in PA at the same time?
Yes. People who qualify for both are called “dual-eligibles.” In Pennsylvania, dual-eligible adults are automatically enrolled in Community HealthChoices for their Medicaid long-term services and supports while keeping their Medicare for hospital, doctor visits, and skilled home health. The two programs coordinate but do not overlap.
What income do I need to qualify for PA Medicaid home care?
Pennsylvania Medicaid LTSS income limits are higher than regular Medicaid limits and are updated annually. As of 2025, an individual applicant generally must have income at or below approximately 300% of the federal SSI rate. Asset limits are roughly $2,000 for an individual (with home and one vehicle excluded). Medical-expense deductions can adjust qualifying income. Verify exact current limits with PA DHS or your CHC plan. (Source: PA DHS — Community HealthChoices)
How long does Medicare pay for home health?
Medicare home health is paid in 60-day episodes, renewable as long as the patient still meets the homebound and skilled-need requirements. There is no fixed lifetime cap, but each renewal requires recertification by the ordering physician. Most patients receive home health for several weeks during recovery; some chronic patients receive it longer when the skilled need persists.
Will Medicare pay for a home health aide to bathe my dad?
Only if your dad is also receiving skilled care (nursing or therapy) at the same time. Medicare home health aide visits are an add-on to skilled care, not a stand-alone benefit. Once skilled care ends, Medicare-covered aide visits end too. For ongoing bathing and personal care, the right program in PA is Community HealthChoices (Medicaid).
How do I apply for PA Community HealthChoices?
Apply through the COMPASS portal at compass.state.pa.us or call 1-800-510-3848. After income/asset eligibility is confirmed, a clinical assessor visits the home to determine if the applicant meets nursing-facility level of need. Once approved, the participant chooses one of three CHC managed care plans (Keystone First CHC, UPMC CHC, or PA Health & Wellness CHC) and a Service Plan is created.
Sources and further reading
- CMS Medicare home health benefit — https://www.medicare.gov/coverage/home-health-services
- PA Community HealthChoices — https://www.dhs.pa.gov/Services/Assistance/Pages/Community-HealthChoices.aspx
- Medicare home health certification regulations — 42 CFR §§ 484.10 et seq.
This article provides general guidance on home care coverage in Pennsylvania. It is not personalized advice on enrollment, eligibility, or benefits. Coverage rules and income/asset thresholds change. Verify current rules with CMS, PA DHS, or your CHC plan. A-Team Home Care can confirm coverage for free.
Reviewed by the A-Team Home Care care-coordination team.
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