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Medicare

Does Medicare Cover Home Health Care?

Medicare covers part-time skilled care at home if you are homebound and your doctor certifies you need it. Here is who qualifies, what is covered and what is not.

By the Bonivitas editorial team

Updated

2-minute read

Health worker checking an older woman's blood pressure while they sit on a sofa
Medicare home health care focuses on skilled nursing and therapy, not round-the-clock help. Photo: Pexels

Key takeaways

  • Medicare covers part-time skilled nursing and therapy at home if you are homebound and a doctor certifies your need.
  • You pay $0 for covered home health services, though a 20% share applies to medical equipment.
  • Medicare does not cover 24-hour care, meal delivery or help with daily activities when that is the only care you need.
  • The agency must be Medicare-certified.

After a hospital stay or during an illness, many people prefer to recover at home. Medicare can help pay for certain care in your home, but the rules are specific. Knowing them can help you get the services you are entitled to and plan for those Medicare does not cover.

Who qualifies

Original Medicare covers home health care if all of these apply:

  • You are homebound. Leaving home takes considerable effort, for example because you need a walker, a wheelchair or another person's help, or because leaving is not advised by your doctor. You can still leave home for medical care, religious services, adult day care and short, infrequent outings such as a trip to the barber.
  • You need skilled care on a part-time or intermittent basis, such as skilled nursing or physical, occupational or speech therapy.
  • A doctor or certain other providers have seen you in person or by telehealth and certify that you need home health care, and they set up and review a plan of care.
  • The home health agency is Medicare-certified.

You do not need a prior hospital stay to qualify.

What Medicare covers

  • Part-time or intermittent skilled nursing care.
  • Physical therapy, occupational therapy and speech-language pathology.
  • Medical social services.
  • Part-time home health aide services, such as help with bathing, but only when you are also receiving skilled care.
  • Medical supplies for use at home.
  • Durable medical equipment, such as a walker or hospital bed.

What you pay

You pay $0 for covered home health services. For durable medical equipment, you usually pay 20% of the Medicare-approved amount after your Part B deductible.

Before your care begins, the agency should explain what Medicare will and will not pay for, and give you written notice if it believes Medicare will stop paying for a service.

What Medicare does not cover

  • 24-hour care at home.
  • Meals delivered to your home.
  • Homemaker services, such as shopping, cleaning and laundry, when that is the only care you need.
  • Personal care, such as bathing or dressing, when that is the only care you need.

For help with these needs, look into Medicaid home and community-based services, local programs through your Area Agency on Aging and private home care. Read choosing a home care agency and Area Agencies on Aging.

Choosing an agency

You have the right to choose any Medicare-certified agency that serves your area. Use Care Compare on Medicare.gov to compare agencies' quality ratings and patient survey results. Ask:

  • How quickly can you start care?
  • Who will I call with questions, including at night and on weekends?
  • How do you coordinate with my doctor?

If you have Medicare Advantage

Medicare Advantage plans must cover home health care, but they may require you to use agencies in their network and get prior approval. Check with your plan before services start.

Sources

We checked this guide against these sources. Figures change, so confirm current amounts with the source before you act.

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