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Medicare considers home health care to be skilled, in-home nursing care or outpatient therapy services to treat an illness or injury. Nursing home care services are somewhat similar, but delivered in a skilled nursing facility (SNF). Whether Medicare covers these services will depend on the type of nursing care you need and how long you need it.
Intermittent or short-term home health services (for example, if you’re recovering after a recent hospitalization) are covered under Medicare Part A and Part B. These services must be provided by a Medicare-certified home health agency that works with your doctor to manage your care.
To be eligible for Medicare coverage:
Medicare covers your home health services over a 60-day period, after which the doctor must review your plan of care. However, there is no limit to the number of times your doctor can reorder this care for you, as long as it remains medically necessary to treat your condition.
Medicare-covered home health care may include:
Medicare coverage for in-home nursing care doesn’t usually include meals, homemaker services, or round-the-clock nursing. Custodial care isn’t covered if this is the only kind of care you need. Custodial care refers to personal assistance with daily living activities, such as bathing or getting dressed. These tasks are usually performed by home health aides and don’t require a medically trained nursing or rehabilitation team.
If you have Original Medicare, Part A and Part B, you pay nothing for the home health services and 20 percent of the Medicare-approved amount for any durable medical equipment (DME).
Medicare doesn’t generally pay for long-term nursing home care. Medicare Part A does cover medically necessary, short-term care in a skilled nursing facility under certain conditions. Part A covers a semi-private room, medical supplies used in the facility, meals, and other items; see What is Medicare Part A? for details.
To be eligible for nursing home coverage, Medicare requires you to meet criteria such as, but not limited to:
If you live in a nursing home, Medicare still covers hospital and medical services under Part A and Part B. If you take medications, pharmacies contract with Medicare Part D Prescription Drug plans to provide drug coverage for nursing home residents.
Although Original Medicare generally doesn’t cover long-term nursing home care, you may be able to get help with costs if you have limited income and qualify for Medicaid. Contact your state Medicaid office to find out if you’re eligible.
In addition, some Medicare Advantage plans (offered by private Medicare-approved insurance companies) may include coverage for nursing home services. In most cases, long-term nursing home care is only covered if you live in a nursing home that is contracted with your plan. However, some Medicare Advantage plans have Special Needs Plans (SNPs) that may help you if you live in a nursing home or have certain conditions, such as congestive heart failure.
If you need short-term, skilled nursing care to recover from an illness or injury, Medicare Part A’s home health benefit might cover you. If you’re recovering from a hospital stay, Part A’s skilled nursing facility coverage might cover your needs. Your Medicare-assigned doctor can recommend the kind of care you need and help place you in the appropriate situation.
However, if you need full-time or long-term care, Original Medicare coverage may not be sufficient. eHealth’s plan comparison tool can help you find Medicare plan options that may offer nursing home coverage. To see which Medicare plan options are available in your area, simply enter your zip code into the form on this page. You can also compare plans at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227) (TTY users 1-877-486-2048), 24 hours a day, seven days a week.
Many beneficiaries will need long-term care at some point in their lives, whether that takes place at home, in an assisted living facility, or in a nursing home. If you need such care, visit LongTermCare.gov for information on long-term care options.
eHealth's Medicare website is operated by eHealthInsurance Services, Inc., a licensed health insurance agency doing business as eHealth. The purpose of this site is the solicitation of insurance. Contact may be made by an insurance agent/producer or insurance company. eHealth and Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. We offer plans from a number of insurance companies.