What is skilled nursing care at home?
Skilled nursing care is medical care that can only be performed safely and effectively by a licensed nurse or a skilled professional under a doctor's supervision. This differs significantly from custodial care, which involves assistance with activities of daily living (ADLs) like bathing or dressing, and can be provided by non-licensed caregivers.
Examples of skilled nursing care often covered by Medicare as part of a home health care plan include:
- Wound care for pressure sores or surgical wounds
- Patient and caregiver education
- Intravenous (IV) or nutrition therapy
- Injections
- Monitoring of serious illness and unstable health status
- Catheter care
Eligibility requirements for Medicare home health care
To receive Medicare coverage for skilled nursing care at home, you must meet several conditions certified by a doctor:
- Doctor's Order: A physician or other healthcare provider must certify that you need skilled care and create a home health care plan for you.
- Homebound Status: You must be certified as homebound, meaning you have a condition that makes it a taxing effort to leave your home without assistance. Leaving home for medical appointments or brief, infrequent non-medical trips is generally allowed.
- Intermittent Care: Your need for skilled nursing must be on a part-time or intermittent basis. This generally means fewer than eight hours a day, fewer than seven days a week, and for a limited duration. Medicare does not cover 24-hour-a-day care.
- Medicare-Certified Agency: The care must be provided by a Medicare-certified home health agency. Your doctor can give you a list of agencies in your area.
- Face-to-Face Encounter: You must have a face-to-face meeting with a doctor or qualified medical professional within a specified timeframe relative to the start of home health services.
What does Medicare cover for home health services?
If you meet the eligibility requirements, Medicare covers a range of services as part of your home health care plan, typically with no out-of-pocket costs for the approved services.
- Skilled Nursing Care: As detailed above, this includes medically necessary, part-time or intermittent skilled nursing tasks.
- Therapies: Medicare covers medically necessary physical, speech-language, and occupational therapy services.
- Medical Social Services: Counseling for social and emotional concerns related to your illness or injury may be covered if you are also receiving skilled care.
- Home Health Aide Services: Help with activities of daily living (ADLs) like bathing and dressing is covered only if you are also receiving skilled nursing or therapy services.
- Medical Supplies: Certain medical supplies, such as wound dressings, are covered when provided by the home health agency.
- Durable Medical Equipment (DME): Medicare Part B covers 80% of the Medicare-approved amount for certain DME, like wheelchairs or walkers. You are responsible for the remaining 20% after meeting the Part B deductible.
What Medicare does not cover at home
It is equally important to understand what is not covered to avoid unexpected costs. Medicare does not pay for:
- 24-hour-a-day care at home.
- Long-term skilled care beyond the intermittent limits.
- Custodial care (help with ADLs) when it is the only care you need.
- Homemaker services like shopping, cleaning, and meal preparation that are unrelated to your care plan.
- Home meal delivery.
Understanding the difference: home health care vs. institutional skilled nursing
It is easy to confuse home health care with skilled nursing facility (SNF) care, which has different rules and costs. This table provides a quick comparison.
| Feature | Home Health Care | Institutional Skilled Nursing Facility (SNF) |
|---|---|---|
| Location | Patient's home | Medicare-certified facility |
| Duration | Short-term, intermittent (typically <8 hrs/day, limited weeks) | Short-term rehab after a qualifying hospital stay (up to 100 days per benefit period) |
| Prior Stay Required? | No, but doctor's certification is needed | Yes, typically a qualifying 3+ day inpatient hospital stay |
| Cost for Days 1-20 | $0 for approved services | $0 (in 2025) for covered services |
| Cost for Days 21-100 | $0 for approved services | Daily coinsurance ($209.50 in 2025) |
| Long-Term Coverage | Not covered | Not covered |
For additional resources, you can visit the official Medicare website to find certified agencies and learn more about coverage details.
Conclusion
While Medicare does cover skilled nursing care at home, it's not a blanket policy. The coverage is specifically for short-term, intermittent, medically necessary care for homebound individuals and is subject to strict eligibility requirements. This type of care is designed to help patients recover or manage a condition, not for indefinite, long-term support. Understanding these critical distinctions and working closely with your doctor and a Medicare-certified agency will ensure you receive the benefits you need and minimize unexpected costs.
