What is the Difference Between Medicare Nursing and Private Nursing Care?

Quality care is delivered in the home.  

When your loved one’s needs begin to change and evolve, they deserve extra love, care, and attention. Thanks to home health care, many services can now be delivered in the comfort of their own home rather than in a hospital or assisted living center. 

With home health care, you can help create a quality of life for your loved one, empowering the confidence, convenience, and comfort of their care today, tomorrow, and in the months to come.  

Choosing a Home Health Care Provider 

There are two main routes you can take in home health care: Medicare Nursing and Private Nursing Care. Let’s define each method to determine which is best for your loved one.  

What is Medicare Nursing? 

Medicare nursing is a type of limited care covered by Medicare. Medicare is a government-funded health insurance program serving qualifying seniors ages 65+ and other eligible individuals with disabilities. Medicare nursing typically supports short-term care over long-term care solutions.  

The type, length, and scope of care the patient qualifies for depends on their doctor’s approval and Medicare regulations. To receive Medicare nursing services, you must work with a Medicare-certified home health care agency.  

What is Private Nursing Care? 

Private nursing care is for seniors or individuals with disabilities who need specialized assistance in the home. Private nursing care is paid for privately instead of through Medicare. As a result, private duty nursing care is personalized and flexible to provide for the patient’s individual needs.  

Private duty home care patients can receive as much support as they need, whether short-term or long-term.  

Differences Between Medicare Nursing and Private Duty Nursing Care 

While both types of care can be beneficial, there are some key differences to be aware of, particularly regarding pricing, services, and the overall structure of care:  

Medicare Nursing in Home Health Care 

Payment Methods 

Does Medicare pay for home health nursing? Yes, to an extent. 

Medicare pays for the services your Medicare-certified home health agency provides during a 30-day period. Patients can qualify for more than one 30-day period, depending on their eligibility.  

Application Process 

To qualify for Medicare home health benefits, you must meet each of the following criteria

  • Primary care physician’s approval for at least one of the following services: 
  • Part-time or intermittent skilled nursing care 
  • Physical therapy 
  • Speech-language therapy 
  • Occupational therapy 
  • Patient must be homebound or unable to leave home without assistance. 
  • You must receive services from a Medicare-certified home health care agency. 

Types of Services 

Medicare only covers part-time or “intermittent” skilled nursing care. Intermittent care can only be less than 8 hours daily and fewer than 28 hours weekly.  

You can receive this care for as long as you remain eligible and your doctor verifies you need it.  

Overall, Medicare nursing services can include: 

  • Skilled nursing care 
  • i.e., wound dressing, certain injections, IVs, tube feedings, and teaching about medical care. 
  • Physical therapy 
  • Speech-language therapy 
  • Occupational therapy  
  • Medical social services, such as counseling. 

Medicare nursing does not cover the following services: 

  • 24-hour or full-time care. 
  • Long-term care. 
  • Medication management and administration.  
  • Homemaking or housekeeping. 

Private Nursing Care 

Payment Methods 

Private duty home care is private-pay, meaning you have control over the services, timeframes, and care methods. Private duty home care is typically covered by a combination of long-term care insurance, private medical insurance, the patient, or the patient’s family.  

One of the main differences between Medicare and private duty home care is that Medicare only pays for skills-based visits. This means a nurse will visit the patient’s home and check their vitals for a quick visit. Unlike private duty home care, Medicare is intended as a temporary service until nurses teach these same skills to the family or the patient gets better.  

Application Process 

With private duty home care, you will still need to be pre-approved by a doctor but you are not limited to the number of hours needed with a nurse for services. When you partner with a home health care agency, they will help match your loved one with the right services and plan based on their unique needs.  

Types of Services 

Private duty nursing care is indefinite and tailored to the patient’s medical and day-to-day needs. It can be offered either short-term or long-term and typically provides specialized nurses and professionals to deliver quality in-home care. 

Even if a nurse is scheduled with a patient for four hours, they will deliver comprehensive, customized services. During that time, they can provide expert wound care, medication management, or simple oversight, to mention a few.  

At Home Health Companions, our licensed nurses provide personalized one-on-one medical care for our patients, including general and specialized services such as: 

  • Medication and pain management 
  • Post-operative and wound care 
  • Diabetic care 
  • Heart disease and hypertension 
  • Respiratory therapy and care 
  • Foley/Colostomy care 
  • Personalized care plans, including light housekeeping and personal hygiene 
  • Parkinson’s care 
  • Alzheimer’s and dementia care 
  • Cancer care 
  • Hospice and palliative care 

Having flexible, diverse care options is essential, especially if your loved one needs specialized care and skills not paid for by a Medicare home health nurse.  

Key Differences Between Medicare Nursing and Private Duty Nursing Care 

In summary: 

  • Private duty home care offers a variety of specialized services, while Medicare only pays for limited care services
  • Private duty home care can be customized as a short-term or long-term solution, while Medicare is a temporary service. 
  • You do not have to qualify for private duty home care, while Medicare nursing requires ongoing doctor’s approval and the maintaining of other eligibility requirements. 

Find the Best Private Duty Nursing Home Health Care for Your Loved One in Dallas/Ft. Worth 

At Home Health Companions, we are on a mission to help you find the best care possible for your loved ones. With a team of exceptionally skilled nurses and caregivers, we are honored to create customized care options for your family members and their unique needs.  

Give us a call today at 214-295-8213 to learn more about our 24/7 private duty nursing care services. Together, we can provide the support and specialized care your loved one deserves in the comfort of their own home.