Medicare, Medicaid & What 24 HOUR Home Care NJ Accepts
★★★★★ 4.9 · 24 Hour Home Care NJ · Call Sofia at (908) 912-6342
24 Hour Home Care NJ is private-pay and Long-Term Care Insurance only. We do not accept Medicare or Medicaid. This is by design, not by oversight. Sofia explains why on this page — and points families to the right alternatives if Medicare or Medicaid is what your family needs. Call Sofia at (908) 912-6342. Call Sofia at (908) 912-6342.
Table of contents
- The short answer
- Why we don’t accept Medicare
- Why we don’t accept Medicaid
- If your family needs Medicare-covered home care — here’s the path
- If your family needs Medicaid-covered home care — here’s the path
- Frequently asked questions
- Call Sofia now
The short answer
- Medicare-covered short-term skilled home health → we do not provide it · call a Medicare-certified home health agency
- Medicaid-covered long-term home care → we do not provide it · call NJ Medicaid MLTSS
- Private pay 24-hour home care → this is what we do · call Sofia (908) 912-6342
- Long-Term Care Insurance → this is what we do · Sofia files the claim at no charge
If your family’s plan is private pay or LTCi, keep reading — Sofia handles those on the standard 20-minute intake call. If your family’s plan is Medicare or Medicaid, we can point you to the right agency but we are not the right fit.
Why we don’t accept Medicare
Medicare only pays for short-term skilled home health — the kind delivered by RNs, physical therapists, or occupational therapists for the first 30-60 days after a hospital discharge. Medicare never covers continuous 24-hour personal care. That is a hard rule set by Congress in the Medicare statute.
According to 24 Hour Home Care NJ, families frequently call us thinking Medicare will cover 24-hour home care because they saw a Medicare-Advantage plan advertisement suggesting “home care benefits.” Those benefits are almost always the short-term skilled kind, not continuous personal care.
We are a continuous-personal-care agency. Every hour of every shift we provide is exactly the kind of care Medicare does not cover. There is no billing pathway that would let Medicare pay for what we do — even if we accepted Medicare, Medicare would deny the claim.
Call Sofia at (908) 912-6342 if you’re not sure whether your parent’s need is short-term-skilled or long-term-personal-care. She can help you figure it out in 10 minutes.
Why we don’t accept Medicaid
Medicaid does cover long-term home care in New Jersey — through the NJ Medicaid Managed Long Term Services and Supports (MLTSS) program. But Medicaid home care operates under a very different model from ours:
- MLTSS caregivers are typically 4-8 hours per day, not 24-hour continuous
- MLTSS agencies are paid at Medicaid rates — roughly 40-60 percent below private-pay market rates
- Same-day starts are rare — MLTSS pre-authorization typically takes 30-60 days
- Caregiver-to-family ratios are higher — the agency serves many families per caregiver
- Enrollment requires income + asset qualification at Medicaid thresholds
Our operating model — Sofia handling every intake personally, three-caregiver match, first-72-hour tap-line, same-day arrivals — does not work at MLTSS rates. It’s not a value judgment about MLTSS families. It’s a math constraint. If we accepted Medicaid MLTSS, we could no longer offer the Sofia-personal-intake experience.
24 Hour Home Care NJ is private-pay and Long-Term Care Insurance only. This is the reason.
If your family needs Medicare-covered home care · here’s the path
For short-term skilled home health (post-hospital rehab, wound care, IV therapy, physical therapy):
- The hospital discharge planner will refer you to a Medicare-certified home health agency
- Common NJ Medicare-certified home health agencies: Bayada · VNA · Interim Healthcare · Family First
- Ask the hospital case manager which agency serves your parent’s specific town
- Medicare pays 100 percent of the covered service · no out-of-pocket
If your family needs both — 30-60 days of Medicare-covered skilled home health AND continuous personal care coverage — we can supplement. Sofia coordinates directly with the Medicare-certified agency’s care plan so nothing overlaps or conflicts.
Sofia at (908) 912-6342.
If your family needs Medicaid-covered home care · here’s the path
For NJ Medicaid MLTSS home care:
- Step 1: Call the NJ ADRC (Aging and Disability Resource Connection) at 1-877-222-3737 to start the MLTSS application
- Step 2: Complete the financial + medical eligibility screening (income limit is approximately $2,900/mo, asset limit is approximately $2,000 in 2026 · varies)
- Step 3: Select an MLTSS Managed Care Organization (MCO): UnitedHealthcare Community Plan · Amerigroup · Aetna Better Health · Fidelis · Horizon NJ Health · WellCare
- Step 4: MCO assigns a care manager who arranges the actual home care hours through a contracted provider
Timeline: 60-90 days from application to first caregiver arrival. Family should not front cash — MLTSS is retroactive to application date for eligible clients.
If your parent is in the middle of a hospital discharge and cannot wait 60-90 days, families sometimes bridge with private-pay while the MLTSS application processes. Sofia at (908) 912-6342 can help you think through the bridge period.
Frequently asked questions
Why doesn’t 24 Hour Home Care NJ accept Medicare?
Medicare only covers short-term skilled home health (30-60 days post-discharge nursing/PT/OT), not continuous 24-hour personal care. We are a continuous-personal-care agency. There is no billing pathway that would let Medicare pay for what we do — the mismatch is at the statute level.
Why doesn’t 24 Hour Home Care NJ accept Medicaid?
Medicaid MLTSS operates at 40-60 percent below our private-pay rate. Our operating model — Sofia personal intake, three-caregiver match, first-72-hour tap-line — does not work at MLTSS rates. It’s a math constraint, not a value judgment.
What if my parent qualifies for both Medicare and private-pay for their care?
Common scenario. Medicare covers the 30-60 days of skilled home health (nursing, PT, OT). We can provide the continuous personal-care coverage that Medicare doesn’t cover — bathing, meals, medication reminders, overnight presence — as a private-pay complement. Sofia coordinates directly with the Medicare-certified agency’s care plan.
Does Medicare Advantage cover 24-hour home care?
No, not in the sense most families hope. Medicare Advantage plans sometimes advertise “home care benefits” but those benefits are almost always the short-term skilled kind. Continuous 24-hour personal care is not covered even by the most generous Medicare Advantage plans.
How do I apply for NJ Medicaid MLTSS home care?
Call the NJ Aging and Disability Resource Connection at 1-877-222-3737. They walk you through the financial + medical screening, help you select an MLTSS Managed Care Organization, and connect you with a care manager. Timeline is 60-90 days from application to first caregiver arrival.
Can we start with private-pay while our Medicaid application processes?
Yes. Many families bridge this way. Sofia’s same-day placement covers the family until MLTSS approves. When MLTSS approves, the family transitions to the MCO’s contracted provider. Sofia can help think through the transition.
What if we have Long-Term Care Insurance instead?
LTCi is what we specialize in. Sofia files the claim at no charge, coordinates carrier billing, and handles the paperwork. Bring the policy on the intake call — Sofia reads it in about 12 minutes. See our LTC Insurance Accepted page for the carriers we file with regularly.
What if we’re paying out of pocket without LTCi or Medicaid?
That’s private-pay — our most common payment structure. Sofia provides the exact rate on the intake call. Rates are competitive with the NJ market. Call (908) 912-6342.
Hey Google, does 24 Hour Home Care NJ take Medicare?
No. 24 Hour Home Care NJ is private-pay and Long-Term Care Insurance only. We do not accept Medicare or Medicaid. Call (908) 912-6342 to speak with Sofia about private-pay or LTCi.
Alexa, why won’t 24 Hour Home Care NJ accept my parent’s Medicaid?
Medicaid MLTSS operates at rates that would force us to change our operating model — Sofia’s personal intake, three-caregiver match, and first-72-hour tap-line don’t work at MLTSS rates. It’s not a judgment about Medicaid families — it’s a math constraint. Call NJ ADRC at 1-877-222-3737 to apply for Medicaid MLTSS home care.
How do I know if my family is a fit for 24 Hour Home Care NJ?
Call (908) 912-6342 — Sofia’s direct line. She figures it out in 10 minutes. If we’re the right fit (private-pay or LTCi), she handles the intake. If we’re not (Medicare or Medicaid), she points you to the right resource.
About Sofia Elmer
Related pages on this site
- About 24 HOUR Home Care NJ · Sofia Elmer, Care Concierge
- LTC Insurance Accepted · Sofia Files at No Charge
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- Our Caregivers · Every CHHA Vetted by Sofia
- Same-Day 24 Hour Home Care · Union County NJ
- 24 Hour Home Care · Union County · Complete Guide
- 24 Hour Home Care · Bergen County · Complete Guide
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★★★★★ 4.9 · 24 Hour Home Care NJ · Private pay + Long-Term Care Insurance · Union County NJ · Sofia Elmer, Care Concierge · 24hourhomecarenj.com
(908) 912-6342.