Medicare does not generally cover custodial care services, including Visiting Angels. But, it may cover medically necessary skilled nursing care in the home under certain circumstances.
Original Medicare (parts A and B) does not usually cover custodial home care or long-term care. But it may cover short-term skilled nursing care that’s medically necessary, provided you meet certain criteria.
You may get additional coverage for home care services through a private insurance company.
This article will cover the difference between home care and skilled nursing care, the criteria for receiving coverage for care in the home, and where else to find financial help for these services.
Medicare covers skilled nursing care in a skilled nursing facility or at home if medically necessary. However, Medicare does not cover custodial care at home or in a nursing home.
Skilled nursing care and covered home health services
Skilled nursing care involves care provided by a skilled nurse rather than a nurse assistant. A nurse can come to your house to provide this care. It can include:
- providing wound care for pressure sores or after surgery
- providing patient and caregiver education, such as teaching wound care practices or how to use durable medical equipment at home
- administering intravenous (IV) or nutrition therapy
- administering injections, such as for osteoporosis
- monitoring serious illness and health status
- providing hospice care
Other covered home health services may include:
- physical or occupational therapy
- speech-language pathology
- medical social services
- part-time or intermittent home health aide care if you’re already receiving skilled nursing care or other approved home services
The nurse can also provide intermittent nurse aide care if you’re already receiving skilled nursing care or approved home health services. This can include help with:
- bathing or grooming
- using the bathroom
- walking
- feeding
- changing bed linens
Custodial care and home health aide care
Medicare does not cover custodial care, including at home, in nursing homes, or in assisted living facilities, if it’s the only care you need. This includes providing help with:
- bathing or grooming
- using the bathroom
- walking
- feeding
- changing bed linens
- ordering or delivering meals
- shopping or cleaning
Medicare covers part-time or intermittent skilled nursing care in the home for an illness or injury if it’s medically necessary. This includes situations where:
- your treating physician orders home care for you after a face-to-face appointment
- you cannot leave your home without help because of an illness or other health condition, leaving home requires a major effort, or a doctor recommends you do not leave your home
Medicare covers home health services for as long as you need them.
If you require home health services, Medicare usually covers the full cost of services you receive at home.
If you receive the covered home health services from a Medicare-approved home health provider, you typically won’t have any out-of-pocket costs.
If you require durable medical equipment at home, it is usually covered under Medicare. You’d pay 20% of the approved amount for Medicare-covered medical equipment.
For home health services and durable medical equipment, it’s best to ensure that the skilled nursing facility and medical equipment supplier are enrolled in Medicare and “accept assignment,” or the Medicare-approved cost for the service. Otherwise, you may have to pay additional costs out of pocket.
While Medicare does not cover custodial care services, it does cover skilled nursing care at home. This is care similar to that you’d receive in a hospital or skilled nursing facility but provided at home.
Medicare also covers durable medical equipment that you need at home.
Medicare does not cover home health services if you only require custodial care. This is similar to the care you’d receive in a nursing home or assisted living facility, which Medicare does not cover.
You may be able to get coverage for custodial care services through Medicaid or a separate private insurance plan.