When you hear the term skilled care, you might think it’s just another type of long-term senior care, like a nursing home or assisted living. That’s a common misconception — skilled care is different.
This blog explains what skilled care is, who might need it and when, and how it differs from long-term senior care.
Skilled care exists to help you safely recover after a serious health event and regain independence. After surgery or an accident, like a stroke, fall, head injury, or heart attack, you might need skilled care before transitioning home.
It provides short-term medical support ordered by a health care provider and delivered by licensed professionals, such as nurses, physical therapists, occupational therapists, or speech therapists. Services often include:
Skilled care can be provided at home through home health services, in a skilled nursing facility (SNF), or at outpatient rehab centers. Your healthcare provider can refer you if it’s needed.
Skilled care is often confused with other types of support services, so it helps to understand the differences. Some common care options that are sometimes mistaken for skilled care are:
While skilled care can be provided in some of these settings — especially nursing homes — it differs because skilled care is medically necessary and usually short-term.
Skilled care is generally not for:
These needs are typically met by custodial care, assisted living, or nursing homes. And unlike skilled care, they are not usually covered by health insurance.
Skilled care is often mistaken for nursing home care, but they serve different purposes. Nursing homes provide long-term residential support, helping residents with daily activities like bathing, dressing, and eating. Some have medical staff on-site, but the focus is on maintaining quality of life rather than short-term recovery.
Skilled care, on the other hand, is medically necessary and ordered by a doctor. It’s short-term, focused on recovery after surgery, illness, or injury, and delivered by licensed professionals. You would not stay in skilled care permanently.
Another key difference is coverage. Skilled care is often covered by Medicare or private insurance, like the Compass Rose Health Plan, because it is doctor-referred and medically necessary. Nursing homes are typically not covered by health insurance.
Most health plans cover skilled care, but it’s important to understand the details, including how long coverage lasts and what costs you may owe. Skilled care is covered by Medicare as well as the Compass Rose Health Plan.
Original Medicare does cover skilled care under specific conditions. In general, Medicare covers up to 100 days of skilled care in a facility after a qualifying hospital stay, but coverage depends on meeting certain requirements. For example, you must need daily skilled services, and a doctor must certify that skilled care is necessary for your recovery.
It’s important to understand all the details listed on Medicare.gov, including any out-of-pocket costs, co-pays, or limits on services.
Coverage for skilled care may vary based on your plan. Check your plan materials for the current plan year for details on your benefits:
As an added bonus, Compass Rose Medicare Advantage offers benefits that can help during recovery after an inpatient hospital stay or skilled nursing facility, including six free rides back and forth to your doctor and up to six hours of custodial care, if needed.
If you have questions about your benefits and coverage, please contact us.
Understanding skilled care can make a big difference when recovering from surgery, illness, or injury. And it’s important to know how it differs from long-term senior care.
Our Compass Rose Aging Well team is here to help you navigate skilled care, understand your benefits and coverage, and get the support you need throughout your recovery.
Compass Rose Medicare Advantage Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. Benefits, features and/or devices vary by plan/area. Limitations and exclusions apply.