Home health, rehabilitation, and long-term care
Learn how Medicare treats skilled care at home, short-term rehabilitation, personal care, assisted living, and long-term nursing-home care.
Start with the care—not the location
Medicare may cover skilled care in a home or facility, but it generally does not cover long-term personal care by itself. Choose the closest situation to see what to verify.
Medicare may cover qualifying home health
A provider must certify the need for qualifying skilled services and homebound status, and a Medicare-certified home health agency must provide the care.
Short-term skilled nursing facility care
Original Medicare generally requires a qualifying inpatient hospital stay and daily skilled care in a Medicare-certified facility. Medicare Advantage and approved waivers can follow different admission rules.
Usually not covered by Medicare alone
Help with bathing, dressing, eating, shopping, cleaning, or supervision is generally not covered when it is the only care needed.
Medicare is not long-term care insurance
Medicare can still cover qualifying hospital, physician, therapy, equipment, hospice, or prescription services while someone lives in a residential setting.
This selector is educational and does not determine coverage. Medicare, your health plan, and official agencies make coverage and eligibility decisions.
Medicare home health
You need qualifying skilled nursing, physical therapy, speech-language pathology, or continuing occupational therapy.
Leaving home is not recommended or requires help and considerable effort. Short, infrequent absences can still be allowed.
A qualified provider completes a face-to-face assessment, orders the care, and reviews the plan.
The services must come through a Medicare-certified home health agency.
Short-term skilled nursing
For Original Medicare, observation time generally does not count toward the qualifying three-day inpatient hospital stay. Ask the hospital to state your status clearly and in writing.
Review official skilled nursing coverageCommonly confused care settings
May be Medicare covered when homebound and skilled-care requirements are met.
May be Medicare covered when hospital, skilled-need, timing, and facility requirements are met.
Medicare generally does not pay room and board, but qualifying medical services may still be covered.
Medicare generally does not cover a long-term custodial stay. Medi-Cal may help eligible Californians.
California long-term services
Depending on eligibility and assessed care needs, Medi-Cal may cover nursing-facility services, personal care, or home- and community-based services. Some waiver programs have additional requirements or limited availability.
Before care starts
Keep notices, hospital-status records, orders, and plan decisions together. Written records are especially important if coverage is denied or ends sooner than expected.
Official help and sources
Skyline Benefit can help explain how a Medicare plan works. Medicare, your plan, providers, facilities, and official agencies make coverage and eligibility decisions.
Reviewing a Medicare plan?
We can help you understand the network, authorization, and cost-sharing questions to ask your Medicare plan.
Personal Medicare guidance
Share the basics and a licensed Skyline Benefit advisor will follow up within one business day.
No obligation. Please do not include Medicare, Social Security, or medical information.
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FAQ
Medicare may cover part-time or intermittent home health aide services only when you also qualify for skilled home health services. It generally does not pay for 24-hour care, homemaker services unrelated to a care plan, or personal care when that is the only care you need.
Being homebound generally means leaving home is not recommended or requires help because of illness or injury, you are normally unable to leave home, and leaving requires a considerable effort. Short or infrequent absences do not automatically disqualify you.
Original Medicare generally requires a medically necessary inpatient hospital stay of at least three consecutive days before covered skilled nursing facility care. Observation time does not count. Certain approved waivers and Medicare Advantage plan rules may differ, so confirm your status and plan requirements.
No. One hundred days is a coverage limit per benefit period, not a guaranteed stay. You must continue to need and receive qualifying skilled care, use a Medicare-certified facility, and meet the other coverage requirements.
Medicare generally does not cover room, board, or long-term custodial care when help with daily activities is the only care you need. Medicare may continue covering qualifying hospital, physician, prescription, therapy, or other medical services.
Full-scope Medi-Cal may cover qualifying nursing-facility services and certain home- and community-based long-term services. Eligibility and program requirements are determined by California and county agencies.
Skyline Benefit is an independent insurance agency and is not connected with or endorsed by the U.S. government or the federal Medicare program.
We do not offer every plan available in your area. Currently we represent 11 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
