Home Health Care and Nursing Home Care: What’s the difference and how does Medicare cover them?

Home health care and nursing home care are quite similar when it comes to comparing services, but the main differences are where the services take place and how Medicare covers each service. 

Home health care is considered to be skilled, in-home nursing care, or outpatient therapy services. Nursing home care offers somewhat of the same services, but the services are offered in a skilled nursing facility. 

Depending on what services you need and how long you will need them, your Medicare coverage could vary.

Medicare coverage for home health care

To receive home health care, you need to be considered homebound and have a doctor certify your status and what care you need. You will only receive home health care if you are treated for an illness or injury, and do not need 24/7 care. Home health care is meant to help you heal while allowing you to be more self-sufficient and gain independence.

Medicare Part A and Part B can provide coverage for services such as:

• Part-time, intermittent care or intermittent home health aide
• Physical or occupational therapy
• Speech-language services
• Medical social services
• Osteoporosis drugs for women

While you will receive coverage for these services, there are specific services that Medicare will not cover. These services include:

• Meals
• Homemaker services, such as shopping or cleaning
• Round-the-clock nursing
• Custodial care, such as assistance with bathing or getting dressed

Medicare coverage for nursing home care

If you need long-term nursing care, it’s important to note that Medicare generally will not pay for long-term services, but Medicare Part A will cover any necessary short-term care required by a skilled nursing facility. Part A will provide coverage for specific items such as:

• Semi-private rooms
• Medical supplies
• Meals
• Skilled nursing care
• Certain prescription drugs (you can also enroll in a Medicare prescription drug plan to receive more drug coverage)
• Nutrition therapy
• Ambulance services if needed
• Physical, speech, or occupational therapy

Original Medicare will not cover:

• Private rooms
• Custodial care
• Services received at a facility that isn’t approved by Medicare

To receive coverage for nursing home care, you will also need to meet specific criteria, such as:

• Your doctor has ordered and confirmed the type of care you need
• The skilled nursing facility must be Medicare-certified
• You stayed in the hospital for at least three days before moving into a skilled nursing facility

If you’re unsure how much coverage is offered by a specific Medicare plan, reach out to a licensed insurance broker like the ones at Bobby Brock Insurance to learn more information.

Need help finding coverage?

At Bobby Brock Insurance, our well-trained and experienced agents are here to give you the answers you need. We can help you compare the costs of plans, estimate your savings, and help you with the enrollment process, so give us a call at 662-844-3300.