Paying for Care · A Pillar Guide from Preferred Care at Home
Your mother qualified for Medicare home health after hip surgery, a nurse came twice a week, then the visits stopped, and nobody explained that the daytime hours she actually needed were never covered in the first place. This guide breaks down what the federal Medicare program pays for at home, what it does not, and how Lexington families across Fayette County cover the difference.
You searched this because someone told you Medicare would handle it, and the bill said otherwise. Here are the four answers families need before anything else makes sense.
Because two different things share one word. Medicare covers medical care at home. Companion care is non medical support, and the federal Medicare program has never paid for it.
Ask what the caregiver is there to do. If the task requires a license, it is skilled care. If it makes an ordinary day possible, it is personal care or companion care.
The moment the need is ongoing rather than recovering. Medicare home health is built around improvement or maintenance under a skilled care plan, not around the years that follow.
Companion care cost is billed hourly, so the number depends entirely on schedule rather than diagnosis. Most families start small, then add hours as the situation asks for them.
01
The nurse comes Tuesday and Friday, checks the surgical site, does the wound care, adjusts the walker, and leaves a note on the counter about the next physical therapy session in Georgetown. That is skilled home health care, and it is real, valuable, and finite by design.
02
Getting into the shower without a rail, managing buttons with arthritic hands, standing long enough to make lunch, remembering the 4 p.m. pills. These are activities of daily living, and support here means the difference between staying home and touring assisted living facilities.
03
The quiet stretch between the 10 a.m. nurse visit and the evening phone call from a daughter in Ohio, when the television runs all afternoon and lunch gets skipped again. Companion care fills those hours with conversation, a grocery run, and someone who notices.
Most families discover the gap at discharge, when the hospital hands over a folder and the calendar stays empty between visits. Watch for these signals: mail piling unopened on the table, weight loss over two months, missed medications twice a week, bruises with no clear story, and the same anxious phone call every evening. That is when covered services and needed services separate.
One person leaves the skilled nursing facility walking and needs six weeks of help. Another leaves with congestive heart failure, mild dementia, and no spouse, and needs help for six years. Same discharge paperwork, same Medicare benefits, completely different reality afterward, which is why advice from a neighbor rarely transfers.
Stop tracking what the plan covers and start tracking unsupervised hours. The CDC reports that one in four adults 65 and older falls each year, and most falls happen during ordinary moments nobody was scheduled to be present for. Count those hours honestly, then build around them.
A local team steps in where the medical benefit stops, handling the ordinary hours that keep everything else working.
Call (859) 800-6237 and describe what is happening. No diagnosis required, no commitment, no minimum. We will tell you plainly whether your situation is likely covered elsewhere first.
We map hours to the actual need, not the maximum. A personalized care plan might start at three mornings a week and grow, or start with live-in coverage and taper.
We match on personality and life experience before availability. A retired farmer and a former schoolteacher want different company, and consistency matters more than speed.
Your Care Coordinator reviews the schedule as things change, so you adjust rather than restart. Recovery weeks look different from winter weeks, and the plan should follow.
Your Client Services Manager keeps notes flowing between family members, physicians, and discharge planners at hospitals like UK Chandler or Baptist Health, alongside any Medicare certified agency still involved.
Ethan Guerrieri founded Preferred Care at Home of Lexington after growing up in a family where caring for others was simply how the household ran. He spent a decade as a Director of Long Term Care before opening the doors here, and he means it when he says by your side, every step of the way.
Your Care Coordinator owns the schedule and catches the gaps nobody flagged at discharge. Your Client Services Manager tracks paperwork, authorizations, and communication across agencies, so nothing waits on a voicemail somebody forgot to return.
We hold Kentucky license PSA500533, and every caregiver clears our 7-step screening before entering a home. We match by personality rather than availability. We will also tell you when someone else covers what you need.
Medicare Part A and Part B pay a certified home health agency for eligible home health services and intermittent skilled care when a physician certifies you are homebound. Medicare pays nothing when custodial care is the only care you need, which is where our companion care in Lexington fits.
Some Medicare Advantage plans add supplemental in home care services beyond what original Medicare offers, including limited homemaker services or respite hours. Coverage varies by plan and year, so read the current benefits summary rather than last year's.
Kentucky Medicaid benefits include home and community based services waivers that can fund personal care and attendant support for people who meet income and level-of-care rules. Waiting lists are common, so apply early rather than at the crisis point.
Most companion care is private pay, often alongside long-term care insurance or veterans benefits. The VA Aid and Attendance pension can reimburse in home care for wartime veterans and surviving spouses who meet service, income, and asset thresholds.
Medicare home health genuinely works for what it was built to do, and after surgery or a new diagnosis it is often exactly right. But the question underneath most calls is not what happens this month. It is what happens in month four, when the skilled visits close out and the need has not.
Companion care is non medical help at home: conversation, shared meals, errands, light housekeeping, transportation, and a reliable presence during the day. Medicare and Medicaid Services classifies this category as custodial care because no license is required to perform it.
The practical implication is simple. If it does not require clinical training, it will not appear on any list of covered home health services.
Medicare defines skilled care as services delivered by licensed professionals: intermittent skilled nursing, physical therapy, occupational therapy, speech language pathology services, and medical social services. It also covers medical supplies and 80 percent of the Medicare approved amount for durable medical equipment.
That Medicare covered medical equipment includes walkers and hospital beds. Once the skilled need closes, home health aide services close with it, even when daily needs continue.
No. Medicare covers the therapy and any medically necessary services attached to it. It does not extend to companion hours simply because a therapist visits twice weekly, and the two are billed and authorized separately.
Families often assume one unlocks the other. Medicare covered services and privately arranged health care services run on separate tracks, so budget the companion hours separately from day one.
Kentucky Medicaid services can cover attendant and personal care through home and community based waiver programs, subject to financial eligibility and an assessed level of need. This is separate from Medicare and administered through the state.
Apply before you need it. Waiver capacity is limited, and approval timelines run months rather than weeks.
Sometimes, partially. Since 2019, plans have been allowed to offer supplemental benefits that original Medicare cannot, and a minority now include limited homemaker or personal care hours.
Call the number on the card and ask specifically about in-home supportive benefits. Do not rely on the marketing brochure.
Genworth's cost of care survey puts in home care in the Lexington area near $7,150 monthly at roughly 44 hours per week. Fewer hours cost proportionally less, and most families begin well below full-time coverage. Start with the hours that remove the most risk, usually mornings and evenings, then adjust as the picture becomes clearer.
The medical benefit closes and the household need does not. This is the single most common reason families call us, usually within two weeks of the final nurse visit.
You are not doing something wrong. You are hitting the designed edge of a medical program that was never built to cover daily life.
The tasks overlap, but companion care and home health serve different purposes. A home health aide works under a physician-directed plan through a Medicare certified agency for a limited period. A companion caregiver works for your family, on your schedule, indefinitely.
If you need someone three afternoons a week for the next two years, you are describing companion care, not home health.
No paperwork, no pressure, no diagnosis needed. Call the local team, describe a normal Tuesday at your parent’s house, and we will tell you honestly what peace of mind would cost.
