Yes. Medicare covers home health care for eligible beneficiaries, and for most people the covered skilled services come at no out-of-pocket cost. The key is meeting Medicare’s eligibility rules and receiving care from a Medicare-certified home health agency. Below is exactly what’s covered, who qualifies, what it costs, and how to get started.
Does Medicare cover home health care?
Yes. Both Medicare Part A (hospital insurance) and Part B (medical insurance) can cover home health services when you meet the eligibility criteria. There is no deductible or copay for the covered home health visits themselves. You may pay 20% of the Medicare-approved amount for certain durable medical equipment, such as a walker or wheelchair.
If you have a Medicare Advantage (Part C) plan, it must cover at least the same home health benefits as Original Medicare, though provider networks and prior-authorization rules can differ, so it’s worth confirming with your plan.
What home health services does Medicare cover?
Medicare’s home health benefit covers medically necessary care delivered on a part-time or intermittent basis, including:
- Skilled nursing care, wound care, injections and IV therapy, medication management, monitoring of a serious illness, and patient or caregiver education.
- Physical therapy, to rebuild strength, balance, and mobility after surgery, illness, or a fall.
- Occupational therapy, to safely relearn daily activities like dressing, bathing, and cooking.
- Speech-language pathology, for speech, communication, and swallowing difficulties.
- Medical social services, counseling and help connecting to community resources.
- Home health aide services, part-time help with personal care when you are also receiving skilled nursing or therapy.
You can see how each of these works on our home health services page.
Who qualifies for Medicare home health coverage?
To be covered, you generally must meet all of the following:
- A doctor (or an allowed provider) certifies that you need skilled nursing care or therapy, and sets up and regularly reviews a plan of care.
- You need care on a part-time or intermittent basis, not full-time, around-the-clock care.
- You are homebound, leaving home takes a considerable and taxing effort, and you generally need help or a device to do so. Short trips for medical care, religious services, or family events are still allowed.
- Your care comes from a Medicare-certified home health agency.
A face-to-face visit with your provider (in person or by telehealth) is required around the time care begins.
How much does home health care cost with Medicare?
For patients who qualify, Medicare pays 100% of the cost of covered home health services, $0 for the visits themselves. Your only potential out-of-pocket cost is 20% of the Medicare-approved amount for durable medical equipment. Before care begins, your agency must give you written notice (an “Advance Beneficiary Notice”) if any service won’t be covered, so there are never surprise charges.
| Medicare home health covers | Medicare does not cover |
|---|---|
| Part-time / intermittent skilled nursing | 24-hour-a-day care at home |
| Physical, occupational & speech therapy | Meal delivery |
| Home health aide (with skilled care) | Homemaker services, if that’s all you need |
| Medical social services | Personal care alone (custodial care) |
| Medical supplies used in your treatment | Full-time or live-in caregiving |
How do you start Medicare home health care?
- Talk with your doctor. A physician’s order (referral) starts the process.
- Choose a Medicare-certified agency. You have the right to pick any certified agency, you do not have to use the one a hospital suggests.
- Complete the initial visit. A nurse or therapist comes to your home to build your personalized plan of care.
Care can often begin within a few days of the order and coverage confirmation. Not sure whether you’re in our area? Check your city or ZIP or give us a call.