Medicare covers home health care for people who are homebound and need skilled nursing or therapy, but only when a doctor certifies the need and the care comes from a Medicare-certified agency. If you’re trying to figure out whether a parent or loved one qualifies, here’s what Medicare actually requires, what’s covered, and what isn’t.
What Counts as Home Health Care?
Home health care covers skilled medical services delivered in a patient’s home. This is different from home care or personal care, which covers non-medical help like bathing, dressing, and light housekeeping. Medicare-covered home health typically includes:
- Skilled nursing care, wound care, injections, monitoring a health condition
- Physical therapy, occupational therapy, and speech-language pathology
- Medical social services
- Part-time home health aide services, when skilled care is also needed
The 4 Medicare Requirements for Home Health Eligibility
Medicare has specific rules. A patient must meet all four of these to qualify:
- A doctor must certify the need for care. A physician (or an allowed non-physician practitioner) has to document that home health services are medically necessary and sign a plan of care.
- The patient must be homebound. Medicare’s definition of homebound doesn’t mean never leaving the house. It means leaving home takes considerable effort, usually requires help from another person or a device like a walker or wheelchair, and absences are infrequent, short, and typically for medical appointments or short, infrequent non-medical outings.
- The patient must need skilled care. This means skilled nursing on an intermittent basis, or physical, speech, or continued occupational therapy. Needing only non-medical help with daily activities doesn’t qualify for Medicare-covered home health.
- Care must come from a Medicare-certified home health agency. Not every home health provider is Medicare-certified. Confirming certification before starting care avoids a coverage surprise later.
What Medicare Pays For
When a patient meets all four requirements, Medicare Part A and/or Part B typically covers:
- 100% of the cost of covered home health services, no copay for the services themselves
- 80% of the cost of durable medical equipment, like a wheelchair or walker, needed as part of the care plan (patient pays the remaining 20%)
There’s no separate deductible for home health services under Medicare.
What Medicare Does NOT Cover
Medicare home health benefits have real limits. It does not cover:
- 24-hour-a-day care at home
- Meal delivery
- Homemaker services unrelated to the care plan, like cleaning or laundry
- Personal care, such as bathing or dressing, when that’s the only care needed (no skilled care involved)
If a loved one needs full-time supervision or purely non-medical help, home health under Medicare isn’t the right fit, and it’s worth asking about other options like personal care aides or, if the situation is end-of-life, hospice care, which covers a broader range of support.
How to Get Started
Getting home health care usually starts with a conversation with the patient’s doctor. If the doctor agrees home health is appropriate, they’ll create a plan of care and refer the patient to a Medicare-certified home health agency. Many people are also connected to home health during a hospital discharge, when a discharge planner helps coordinate the referral.
Home Health vs. Hospice: Not the Same Thing
Home health and hospice both bring care into the home, but they serve different needs. Home health is for people recovering from an illness, injury, or surgery, or managing a chronic condition, with the goal of improving or maintaining their condition. Hospice is for people with a terminal diagnosis and a prognosis of six months or less who have chosen to stop curative treatment, with the goal of comfort rather than recovery. If you’re not sure which one fits your situation, our guide to hospice vs. home health care breaks down the difference in more detail.
Frequently Asked Questions
Does Medicare cover home health care?
Yes, when a doctor certifies the need, the patient is homebound, skilled care is required, and the agency is Medicare-certified.
What does homebound mean for Medicare home health?
It means leaving home takes considerable effort and usually requires help from another person or a device, with absences that are infrequent and short.
Does Medicare pay for 24-hour home care?
No. Medicare home health benefits do not cover round-the-clock care at home.
Is home health care the same as hospice care?
No. Home health is for recovery or managing a chronic condition. Hospice is for a terminal diagnosis with a prognosis of six months or less.
How much does Medicare-covered home health cost?
Covered home health services are generally provided at no cost. Durable medical equipment ordered as part of the plan of care is covered at 80%, with the patient responsible for the remaining 20%.
Figuring out what kind of care fits your family’s situation can be confusing, especially when a loved one’s needs are changing. If you’re weighing home health, palliative care, or hospice, the team at Suncrest can help you understand your options. Contact us today with any questions.
