Some people who require daily medical assistance are homebound. And in order to receive help or treatment for their condition without ever going out, they may need the help of a caregiver.
So a common question many people have is, “does Medicare cover skilled nursing at home?” In this article, we answer that question in clear, plain English. You will also find the average costs of home health care and other helpful info.
Does Medicare Cover Skilled Nursing At Home?
The short answer is yes; Medicare will cover the cost of skilled nursing at home. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your home health care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for skilled nursing at home.
However, Medicare does not provide coverage for all types of home health care. Coverage for home health care is provided by both Medicare Part A and Part B. Medicare Part A and Part B provide coverage for your skilled nursing care at home if you have an illness or injury that requires in-home caregiver care.
You must meet at least one of the following conditions for Medicare Part A and Part B to provide coverage for your home health care:
- Due to your illness or injury, you cannot leave your home unless the reason for leaving is for a short outing such as visiting the doctor. Medicare still provides coverage for home health care if you visit adult daycare
- Your healthcare provider finds it necessary and prescribes home health care and writes an outline of the kind of care you need
- You require skilled nursing care. However, your skilled nursing care is only limited to 8 hours per day and 28 hours per week for up to three weeks
- Your healthcare provider finds it likely that your condition will improve in a reasonable amount of time
- You need assistance from a skilled physical, occupational, or speech therapist to design a program that can help you improve or maintain your current state, or prevent it from getting worse
- Your home-health agency is Medicare-approved
Some of the services that you may receive in home-based skilled nursing care include:
- Physical therapy
- Occupational therapy
- Speech therapy
- Nursing care
- Home-health aides
Though Medicare Part A and Part B provide coverage for skilled nursing care at home, they do not provide coverage for custodial care.
Part C Coverage for Skilled Nursing At Home
Medicare Advantage plans (Medicare Part C) also provide coverage for skilled nursing at home. They cover everything Original Medicare covers, as well as offer some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
Medicare Part D covers prescription drugs that you may need during your home healthcare period.
How Much Does Home-Based Skilled Nursing Care Cost?
Skilled nursing care at your home can cost you $20 per hour. In-home care usually costs around $4,000 per month. The cost will vary from state to state.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover ophthalmologists?