Covered by Medicare (if eligibility is met):

• Skilled nursing care – administered by licensed professionals on a part-time or intermittent basis

• Physical therapy

• Occupational therapy

• Speech-language pathology

• Home health aide services – but only if tied to skilled care above

• Medical social services

• Durable medical equipment and some medical supplies

Medicare will foot the bill for these services only if they’re deemed medically necessary and provided by a Medicare-certified home health agency.

🔍 Real Example: A Jupiter resident recovering from a stroke receives physical therapy, wound care, and weekly nursing visits—all covered by Medicare. However, when she requested help with bathing and cooking, she was told: “That’s not covered.” Cue family panic.

❌ Not Covered:

• 24-hour home care

• Homemaker services (cleaning, laundry, errands)

• Meal delivery

• Custodial or personal care not directly related to a medical need (i.e., help with dressing, using the bathroom, etc.)

Let’s be blunt: Medicare is not long-term care insurance. If your loved one needs daily help, Florida Medicaid planning or private-pay strategies are your next stop—and we can help with both.

Who Qualifies for Medicare Home Health Benefits in Florida?

To qualify, your loved one must meet all of the following criteria. Miss just one, and the whole benefit is denied or revoked:

1. A Physician Must Certify the Need

They must be under the care of a doctor who creates and regularly reviews a care plan. No physician? No benefit.

2. A Skilled Service Must Be Required

This includes nursing, PT, OT, or speech therapy. Aides alone don’t qualify—there has to be a skilled medical need.

3. The Patient Must Be Homebound

Defined by Medicare as:

Leaving home requires considerable and taxing effort—such as a wheelchair, walker, or help from another person—and is medically contraindicated or infrequent.

⚠️ Hypothetical: A Palm Beach Gardens retiree who can go out for bridge club twice a week may not qualify as homebound, even if she needs help getting dressed.

4. The Care Must Be Delivered by a Medicare-Certified Home Health Agency

No certification, no check. Always verify the agency’s Medicare approval status before starting services.

The Timeline and Red Tape: What to Expect

🗓️ Face-to-Face Encounter with a Doctor

Must occur within 90 days before or 30 days after starting home health care. This isn’t a suggestion—it’s required. Medicare will deny claims if this box isn’t checked.

🗂️ 60-Day Certification Cycle

Care must be recertified every 60 days to remain eligible. A physician must continue to deem services medically necessary.

💡 Tip from Welch Law: Keep a shared calendar with your loved one’s care team. Missed recertifications = missed payments. And once those services are out of pocket, they’re often very out of budget.

Medicare-Certified Home Health Agencies in Palm Beach County

Here’s where most families slip up: they assume any home health agency is fine.

Not true.

Florida is home to hundreds of agencies—but only Medicare-certified ones qualify for reimbursement. Before you sign anything, confirm the agency’s certification status via Medicare’s Home Health Compare Tool.

✅ Look for agencies with a strong track record of compliance, responsive billing teams, and nurses who understand the 60-day recert cycle.

What to Do When Medicare Doesn’t Cover Enough

Even with Medicare paying its share, many families find themselves filling the gap—physically, financially, or both.

Here’s what that gap looks like:

• Your dad gets 2 PT visits a week… but still needs daily help dressing

• Your mom’s nurse comes Mondays and Thursdays… but she needs help eating every day

• Your aunt qualifies for a walker… but not someone to help her use it

That’s where legal and financial planning step in.

The Legal Side of At-Home Care in Florida

We’re not just talking about healthcare here—we’re talking about preserving dignity, protecting assets, and qualifying for every dollar of benefit legally available.

Consider These Strategies:

1. Florida Medicaid Planning

If your loved one’s care needs exceed what Medicare covers, Florida’s Medicaid program may help. But the asset and income limits are strict. That’s why proactive planning—trusts, transfers, and spend-down strategies—makes all the difference.

2. Caregiver Agreements

Florida law allows formal contracts between a parent and child for care services. Done right, this is a way to pay you legally and preserve Medicaid eligibility later. Done wrong, it’s a red flag to AHCA and a fast track to Medicaid denial.

3. Pooled Trusts or D(4)(C) Trusts

These are useful tools for preserving excess assets while still qualifying for needs-based benefits.

4. Living Trusts & Powers of Attorney

If your loved one becomes incapacitated and lacks proper legal documents, the whole family can be locked out of financial and healthcare decisions. Every Floridian over age 60 should have a current:

• Durable Power of Attorney

• Healthcare Surrogate Designation

• Living Will

• Revocable Trust (if appropriate)

Your Next Move

Caring for aging loved ones is a gift—but it shouldn’t break you emotionally or financially.

Here in Florida, you have options. Medicare is one. Medicaid is another. Estate planning gives you structure and peace of mind. Our team at Welch Law, PLLC is here to help you combine all three into a plan that works.

Book a free consultation and let us guide you through it—whether you’re just getting started or drowning in paperwork already.

Key Takeaways

• Medicare covers home health services only under strict conditions.

• Eligibility hinges on physician oversight, medical need, and certified agencies.

• Medicare does not cover 24/7 care, cooking, cleaning, or routine help.

• Families must plan for the gaps through Medicaid, caregiver contracts, or private-pay support.

• Legal planning—from powers of attorney to Medicaid eligibility—is crucial for long-term success.

📍Serving Jupiter, Palm Beach Gardens, and Beyond

Welch Law, PLLC is based in Jupiter, FL and proudly serves families across Palm Beach County. If your loved one needs care and you’re not sure what’s covered, what’s legal, or what’s next—call us.

By:  Edward J. Welch, Esq. ||| Estate Planning | Wills | Trusts | Asset Protection | Welch Crypto Trust™

If you would like to discuss your legacy options with an estate planning attorney in Jupiter or Palm Beach Gardens, Florida, schedule a complimentary call with Edward J. Welch at Welch Law, PLLC.  At Welch Law, WE WANT TO DRAFT YOUR LEGACY!

Reference: AARP (July 13, 2022) “Does Medicare Cover Caregiver Costs and Services?”