Every fall between October 15 and December 7, people with Medicare can review and change their coverage for the year ahead. And every fall, families across Metro Atlanta sit down with a stack of plan documents and ask the same question: will any of this pay for someone to help Mom at home?
The answer is usually not the one they were hoping for. But understanding why is one of the most useful things a family can do this time of year, especially before a hospital discharge forces the question on a Friday afternoon.
This year’s Open Enrollment period runs October 15 through December 7, 2026, and any changes take effect January 1, 2027.
Two different things with one confusing name
Most of the confusion here comes down to two terms that sound nearly identical and mean very different things.
Home health care is short-term, medically necessary, skilled care ordered by a physician after an illness, injury, surgery, or hospital stay. Think of a nurse changing a wound dressing or a physical therapist rebuilding strength after a hip replacement. It has a defined clinical goal and an end date.
Home care is also called personal care, private duty, or non-medical care. It is ongoing help with daily life. Bathing, dressing, meals, light housekeeping, transportation to appointments, medication reminders, companionship, and simply having a trained person present so an older adult can stay safely at home.
Medicare was built to pay for the first one. It was not built to pay for the second.
What Medicare does cover
Under the home health benefit, Original Medicare (Part A and Part B) can cover:
- Part-time or intermittent skilled nursing care
- Physical therapy, occupational therapy, and speech-language pathology services
- Medical social services related to the treatment plan
- Part-time home health aide help — but only when skilled nursing or therapy is also being provided
- Certain medical supplies, and durable medical equipment such as a walker or wheelchair (equipment is generally subject to coinsurance)
Four things must all be true
A person has to meet every one of these conditions, not just some of them:
- They are homebound. Leaving home takes considerable effort, requires help or special transportation, or is medically inadvisable. Trips to medical appointments, religious services, and occasional outings are still allowed.
- They need skilled care. A need for aide help alone does not qualify. There has to be a nursing or therapy need behind it.
- A physician orders it and establishes and reviews the plan of care.
- The care comes from a Medicare-certified home health agency.
Coverage is also limited in scope. Home health is intermittent by design — generally fewer than eight hours a day and up to 28 hours a week of combined skilled nursing and aide services, with more available for short periods when a clinician documents the need. The plan of care is certified in 60-day episodes and can be renewed if the skilled need continues.
What Medicare does not cover
This is the part that surprises families. Medicare’s home health benefit does not pay for:
- 24-hour care at home — in any form
- Homemaker services such as cooking, cleaning, laundry, and errands, when they are not part of a skilled plan of care
- Home-delivered meals
- Personal or custodial care — help with bathing, dressing, toileting, and transfers — when that is the only care needed
- Companion care and supervision
The help most families are actually looking for is a trained person in the home several hours a day, several days a week, so a parent can stay safe and independent. This is precisely what the Medicare home health benefit is not designed to pay for.
Where families usually discover this
It is rarely during Open Enrollment. It is usually about six weeks after a hospitalization.
A discharge planner arranges home health. A nurse visits twice a week, a physical therapist three times. Everyone is relieved. Then the episode ends, because it is supposed to — the wound has healed, the gait is steadier, the skilled need has resolved.
What has not resolved is the daily one. Someone still needs to be there in the morning to help with a shower. Someone still needs to notice that the same three pills are sitting in the organizer at 8 p.m. The family looks at each other and realizes the coverage that was carrying them has just stopped, and nothing is scheduled to replace it.
Knowing this in October rather than in the moment changes what a family can plan for.
One thing worth checking in your plan documents
Medicare Advantage plans have to cover everything Original Medicare covers. Some also offer supplemental benefits that Original Medicare does not, and a growing number include a limited in-home support or personal care benefit.
These vary enormously between plans. They are typically capped at a modest number of hours per year or a fixed dollar allowance, and many carry eligibility criteria tied to specific chronic conditions rather than being available to every member. If your plan offers something like this, it will be described in the Annual Notice of Change your plan mailed by September 30 and in the Evidence of Coverage.
It is worth reading. It is not worth choosing a plan over on its own. A small in-home benefit rarely offsets a worse provider network or a formulary that drops a medication your parent depends on.
What actually pays for ongoing in-home care
There are several ways that families cover the cost of home care, but not all companies accept each form of payment:
Private pay
The most common route. Families often fund it from retirement income, savings, home equity, or a combination, and many use care part-time rather than daily — a few mornings a week is a legitimate and much more affordable starting point than most people assume.
Long-term care insurance
If a policy exists, read three things: the elimination period (the waiting days before benefits begin), the daily or monthly benefit amount, and whether the policy requires care to be delivered by a licensed agency rather than an individual. That last clause disqualifies a lot of informal arrangements.
VA Aid and Attendance
Wartime veterans and surviving spouses who meet service, income, asset, and care-need requirements may be eligible for a monthly benefit above the standard VA pension that can be applied toward in-home care. The application takes time; starting early matters.
Georgia Medicaid waiver programs
For older adults who meet both a nursing-facility level of care and Georgia Medicaid’s financial criteria, the Community Care Services Program (CCSP) and SOURCE can cover personal support services at home. Both are administered through Georgia’s Area Agencies on Aging. Both have a limited number of participant slots, which means eligible applicants can still wait — another reason this is a planning conversation, not a crisis conversation.
What to actually do during Open Enrollment
- Read the Annual Notice of Change your plan mailed by September 30. Premiums, copays, networks, and drug formularies all change year to year.
- Confirm your parent’s physicians and preferred hospitals are still in network for 2027.
- Check the drug formulary against their current medication list, not last year’s.
- Look for any supplemental in-home support or caregiver benefit, and note the eligibility conditions attached to it.
- Get free, unbiased help. GeorgiaCares, Georgia’s State Health Insurance Assistance Program, provides one-on-one Medicare counseling at no cost through the Division of Aging Services. Counselors do not sell insurance. Call 1-866-552-4464 and select option 4.
- Separately from the plan itself, get honest about what daily help is actually needed — and price it before you need it.
Where CaraVita fits
CaraVita Home Care provides the kind of care Medicare’s home health benefit is not built for: ongoing, in-home personal care and companionship for older adults across Roswell, Alpharetta, Sandy Springs, Milton, Johns Creek, and North Fulton.
CaraVita accepts both private pay and provides the documentation needed for reimbursement through long-term care insurance.
What makes that care different is what sits behind the caregiver. Our caregivers are W-2 employees who receive ongoing training and supervision, with a clinical team behind them who build the care plan, keep staff trained as needs change, and coordinate with families when a caregiver notices something new. Founded in 1998, our team brings over 175 years of combined clinical experience to that oversight.
Open Enrollment is a good annual prompt to look honestly at how a parent is really doing at home, not just at what a plan costs. If you are trying to work out what level of help makes sense — and what it would actually cost — we are glad to talk it through with no obligation.
Call CaraVita Home Care at 770-643-1712 or visit caravitahomecare.com to schedule a free consultation.
This article is general information about Medicare coverage and is not insurance, legal, or medical advice.
If you or an aging loved one is considering home care in Roswell, GA, please contact the caring staff at CaraVita Home Care today. (770) 643-1712
