Medicare: Home Care Vs. Nursing Home Options

Medicare and Long-Term Care: Home Health Care, Skilled Nursing, and Assisted Living Explained
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When health needs change, one of the biggest questions Medicare beneficiaries and their families face is: “What kind of care will Medicare cover, and what will I have to pay for myself?”
It’s a complicated question—especially when trying to understand the differences between home health care, skilled nursing facilities, and assisted living. These three types of care are often grouped together, but Medicare treats them very differently.
Understanding what is and isn’t covered can help you prepare, avoid surprises, and make the best choices for your health and finances.

Medicare and Home Health Care
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​Many people hope to stay in their own homes as long as possible, and home health care can be an important part of that. Medicare does provide coverage for home health care—but only under certain conditions.

What Medicare Covers for Home Health Care

• Skilled Services Only – Medicare covers skilled care such as nursing visits, physical therapy, occupational therapy, and speech therapy.
• Must Be Medically Necessary – A doctor has to certify that you need these skilled services and that you are homebound.
• Homebound Requirement – This doesn’t mean you can never leave your home, but leaving must require considerable effort or assistance.
• Certified Agencies Only – Care must be provided by a Medicare-approved home health agency.

What Medicare Doesn’t Cover

This is where many people get surprised. Medicare does not cover long-term custodial care in the home. That includes things like:

• Help with bathing, dressing, or eating
• Housekeeping, laundry, or cooking
• Companion care or transportation

If those are the only services you need, Medicare will not pay for them.

Medicare and Skilled Nursing Facilities

Sometimes recovery after a surgery, stroke, or illness requires more than what can be provided at home. Skilled nursing facilities (SNFs) provide short-term, intensive rehabilitation and nursing care.

Coverage Rules for Skilled Nursing

• 3-Day Hospital Stay – You must have been admitted as an inpatient for at least three days before entering a SNF.
• Full Coverage for 20 Days – Medicare Part A covers 100% of the cost for the first 20 days.
• Copay After Day 20 – From days 21–100, you’ll pay a daily copay (over $200 per day in 2025) unless you have supplemental insurance.
• No Coverage After 100 Days – Medicare stops paying after 100 days in a benefit period.

What’s Included in Skilled Nursing

• Rehabilitation services (physical, speech, occupational therapy)
• Skilled nursing care
• Medications, medical supplies, and equipment used during the stay

It’s important to note that SNFs are designed for short-term rehabilitation, not for permanent residence.

Assisted Living and Medicare

Here’s where the confusion really begins. Many people assume that Medicare will help cover the cost of moving into an assisted living facility—but unfortunately, it does not.

What Assisted Living Provides

Assisted living is designed for individuals who need help with daily activities but do not require round-the-clock skilled nursing. Services typically include:

• Meals and housekeeping
• Help with bathing, dressing, or managing medications
• Social activities and community living

What Medicare Covers in Assisted Living

• Medical Care Only – Medicare will still cover doctor visits, hospital stays, lab tests, or preventive care for residents of an assisted living facility.
• Short-Term Skilled Care – If you temporarily need skilled nursing or home health care while living in assisted living, Medicare may cover those services separately.

What Medicare Does Not Cover

• Room and board in assisted living
• Custodial or personal care costs
• Non-medical support services

​Because assisted living is considered long-term custodial care, it falls outside Medicare’s coverage rules. Most people pay for assisted living through private funds, long-term care insurance, or Medicaid (if eligible)

The Role of Medicare Supplements and Advantage Plans

If you’re on Original Medicare, you may want to consider a Medigap (Medicare Supplement) plan. These plans can pay for the coinsurance in skilled nursing facilities (days 21–100) and reduce your out-of-pocket costs.
If you’re enrolled in a Medicare Advantage plan, your benefits may look different. Advantage plans may have their own rules for skilled nursing care and networks of approved facilities or agencies. Some plans offer limited extra benefits for in-home support, but they are not a replacement for full custodial care.

Why Long-Term Care Planning Matters

Medicare alone will not pay for long-term assisted living or nursing home care. That means planning ahead is crucial. Some options people consider include:

• Long-Term Care Insurance – Helps cover the cost of custodial care in nursing homes or assisted living.
• Medicaid – For individuals who meet strict income and asset requirements, Medicaid can cover long-term care.
• Personal Savings – Many families rely on retirement savings or home equity to pay for assisted living.

A Word of Caution: Protect Yourself from Scams

Unfortunately, seniors are often targeted with misleading phone calls about home health or assisted living. Remember:

• Medicare will never call to sell you services or ask for your Medicare number.
• Only work with licensed, Medicare-approved agencies or facilities.
• If something feels suspicious, check with a trusted family member—or call our office for guidance.

Final Thoughts

Medicare provides excellent coverage for short-term skilled care—whether that’s in your home or in a facility. But it does not pay for long-term assisted living or custodial care. Knowing these rules helps you plan wisely and avoid costly surprises.

At Prairie Grove Insurance, our goal is to make Medicare simple. We’ve helped thousands of Wisconsin residents understand their benefits and explore supplemental options to protect their health and finances.

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💡 Quick Tips: Medicare and Long-Term Care

• Medicare ≠ Long-Term Care – Medicare pays for short-term skilled care, not ongoing custodial or assisted living.
• Know the 100-Day Limit – Skilled nursing is covered up to 100 days per benefit period (with copays after day 20).
• Review Annually – Part D and Medicare Advantage plans change each year; Supplements do not. Always review your coverage.

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To Get Help Now, Call Our Office!

​Rob and Carrie Davies
Prairie Grove Insurance
800-254-5200
​608-839-0275