Does Medicare cover home health care? Eligibility, costs and limits
Who qualifies for Medicare home health, what it pays for, what it never covers, and how Medicare Advantage differs.
Medicare pays for part-time skilled care at home — nursing, physical therapy, speech therapy and related services — when a doctor orders it and you meet a short list of conditions. For people who qualify, the home health services themselves cost nothing. This guide covers who qualifies, what's included, and the gaps families most often run into.
Who qualifies
According to Medicare.gov: Home health services, Original Medicare (Part A and/or Part B) covers home health care if all of these are true:
- You're under the care of a doctor (or an allowed practitioner such as a nurse practitioner), and your care follows a plan of care they set up and review regularly.
- A doctor certifies you need skilled care — intermittent skilled nursing, physical therapy, speech-language pathology, or continued occupational therapy.
- You're homebound. Leaving home takes considerable and taxing effort, or needs help from another person, a device such as a wheelchair or walker, or special transportation. You can still attend medical appointments, adult day care, religious services and occasional short outings like a haircut.
- A face-to-face visit happened with a doctor or allowed practitioner, related to the reason you need home health care, within the 90 days before or 30 days after care starts.
- The agency is Medicare-certified. Every agency on Home Health Stars is — that's the data we list.
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 (personal care such as bathing), but only while you're also getting skilled care
- Durable medical equipment and some medical supplies used at home
What it costs
If you qualify, you pay $0 for the home health services. For durable medical equipment such as a walker or hospital bed, you generally pay 20% of the Medicare-approved amount after the Part B deductible. Before care starts, the agency must tell you if any service won't be covered and how much you'd owe.
What Medicare doesn't cover
- 24-hour care at home
- Meal delivery
- Homemaker services such as shopping, cleaning and laundry, when that's the only care you need
- Custodial or personal care (bathing, dressing, using the bathroom) when that's the only care you need
Families often discover this gap after a hospital stay: Medicare will send a nurse and a therapist a few times a week, but not someone to stay overnight. That help is non-medical home care, usually paid privately or through long-term care insurance or Medicaid programs.
Medicare Advantage plans
Medicare Advantage (Part C) plans must cover home health care too, but they can require prior authorization and usually limit you to agencies in their network. Call the plan before choosing an agency and ask which agencies in your ZIP code are in network. Then compare those agencies' scores here.
How to start
- Ask the doctor or hospital discharge planner to order home health care.
- Compare certified agencies that serve your ZIP code — search by city.
- Tell the discharge planner which agency you want. You have the right to choose.
Official sources: Medicare.gov: Home health services; Medicare & Home Health Care (CMS publication 10969).