July 5th 2024
By Ari Parker
Medicare covers home health care under certain conditions. Learn what qualifies you for home health care, what's covered, and more in this post.
By Ari Parker
We receive many questions about what’s covered by Medicare. One common question is whether or not Medicare pays for in-home healthcare services.
The short answer is yes—Medicare does cover some home health care. However, you must meet eligibility requirements. When covered, Medicare only provides part-time care, and there are limits on the days and hours you can get coverage for.
In this guide, we’ll discuss Medicare’s coverage for home health care in detail, so you’re not surprised by limitations or out-of-pocket costs.
Medicare covers home health care, but only for short-term periods.
Medicare coverage for home health services includes physical therapy, skilled nursing care, speech-language pathology, occupational therapy, and part-time home health aide services.
You’ll pay $0 for covered home health care services, but you’ll pay 20% of the costs of medical equipment you need for home health care.
Home health care services, also called in-home health care, refers to medical care or assisted care for anyone who needs additional support to live safely in their homes. Home health care services are generally for people recovering from surgery or injury.
Common home health care services include:
Skilled nursing care like medication administration and monitoring vital signs
Speech therapy
Light housekeeping
Many people prefer home health care over temporarily moving to a nursing home, as it's often more cost-effective and allows them to receive care in familiar surroundings.
It's important to note that Medicare distinguishes between two types of care: home health care, which includes skilled nursing services, and home care, which covers non-medical services like companionship, bathing, and meal preparation.
Medicare covers home health care services under both Part A and Part B, with different rules for each.
Medicare Part A covers home health care for up to 100 days if you:
Had a qualifying hospital or skilled nursing facility (SNF) stay of at least 3 days
Need skilled nursing care
Are homebound and can't easily leave to get services
Start services within 14 days of leaving the facility
Medicare Part B covers home health care without requiring a hospital stay. Under Part B, you can receive:
Skilled nursing care
Physical, speech, and occupational therapy
Help from a home health aide for personal care and activities of daily living (ADL) like walking, bathing, and feeding
Services like changing bed linens, bathing, and grooming
If you start with Part A coverage after a hospital stay, your coverage can transition to Part B after 100 days. There's no Part B deductible for home health care services.
Medicare covers a variety of services for home health care if they are medically necessary.
Covered services include:
Part-time skilled nursing care
Part-time home health aides if you’re also getting skilled nursing care
Physical therapy and occupational therapy
Speech-language pathology services
Medical social services (like counseling and help with community resources)
Injectable osteoporosis drugs for women
Medical supplies like bandages, wound dressings, and catheters, when provided by a Medicare-certified home health agency (HHA).
Durable medical equipment (DME)*
*Medicare pays 80% of approved costs for durable medical equipment (DME), like wheelchairs and walkers. You pay the remaining 20%. If your home health agency doesn't accept Medicare assignment, you may pay up to 15% more. Your home health agency should tell you if any services or equipment won’t be covered by Medicare.
Medicare's home health care coverage is designed for part-time, skilled nursing care. Here's what you should know.
Your skilled nursing care and home health aide services are limited to:
No more than 8 hours per day
Maximum of 28 hours per week
Up to 21 days of care
Medicare will cover home therapy as long as it is medically necessary. Initially, your health care provider will create a plan of care that covers up to 60 days of home care services. While there's no limit to how long you can receive home health care services, your provider must recertify your need for care every 60 days to continue coverage.
To receive home health care services from Medicare, you must meet three requirements:
Your doctor must certify you as ‘homebound,’ meaning your illness, injury, or disabilities make leaving home difficult. Being homebound doesn't mean you're confined to your house. You can still leave for medical treatments, religious services, adult day care center visits, important events like funerals, graduations, or family reunions, and basic needs like haircuts.
You must have a face-to-face visit with a healthcare provider (like your doctor or nurse practitioner) who confirms you need home health services.
You must use a Medicare-certified home health agency to provide your care. Medicare won't cover services from loved ones or agencies without certification.
When you qualify for home health care services and don't need long-term care, Medicare covers 100% of home health care service costs. If you need medical equipment, you’ll pay 20% of the costs of the equipment once you’ve met your Part B deductible. A Medicare Supplement plan can help reduce these equipment costs.
Medicare Advantage plans must cover home health care at the same level as Original Medicare. These plans may also cover additional services not covered by Original Medicare, but additional benefits will vary between plans. Out-of-pocket costs for covered services will also vary between Medicare Advantage plans. Medicare Advantage plans each have their own copays, coinsurance, and deductibles, so you may pay more for home health service with these plans than with Original Medicare.
Medicare Advantage plans may also require prior authorization for you to receive coverage. To understand your specific costs and requirements, check your plan details or contact your insurance provider.
If you have Medicaid, it may cover home health care benefits. The eligibility, rules and specific benefits vary by state. In some locations, Medicaid beneficiaries can direct their own care and family caregivers may be paid for providing some services.
Some states have waiver programs in place to handle in-home services. These can also help with adult day care, companionship care, assistance with daily living activities, personal emergency response systems, durable medical equipment, and more. There may be waiting lists for some programs.
For more information about how Medicare and Medicaid work together, see our guide to Medicare vs. Medicaid.
Medicare covers skilled nursing care and therapy services under its home health care benefit. However, some services are limited or not covered.
Medicare does not cover:
Occupational therapy (when it’s not part of a broader care plan)
Meal delivery services
Shopping, cleaning, or household chores
Homemaker services like laundry and meal preparation
Personal care or custodial care (like grooming or bathing) when it's the only care you need
Prescription drugs (these are covered under Medicare Part D)
Note that home health aides may perform some light housekeeping while providing other health-related services, but cannot visit solely for housekeeping tasks.
Your home health care agency will work with you to create a plan of care and will:
Explain what services Medicare doesn't cover
Provide an advance beneficiary notice (ABN) showing potential out-of-pocket costs
Give you a Notice of Medicare Noncoverage (NOMNC) when you reach your coverage limit
Explain how to appeal if your physician confirms you need continued care
Medicare health insurance only covers "intermittent skilled nursing care" for a limited number of hours per day over a set time period. Medicare does not cover long-term care—24-hour care that many people need for long-term conditions.
If you have a chronic condition, Medicare may extend your coverage beyond typical limits. You don't need to show improvement to keep receiving care. Medicare should continue coverage if you need services to maintain your condition or prevent it from getting worse. Keep in mind that not all home health agencies (HHA) provide services for chronic conditions.
Unfortunately, Medicare doesn’t cover home health care for a long period of time. If a doctor recommends home health care services for a person with dementia, they’ll only receive short-term care. However, Medicare does cover treatment, occupational therapy, doctor visits, and other services to manage dementia and slow its progress.
→ Learn more about dementia and Medicare
Medicare will only cover home health care for cancer patients for a short period of time. That said, Medicare provides comprehensive coverage for cancer treatment and management.
→ Learn more about Medicare cancer coverage
While there is a limit to how many hours of home health care Medicare will cover, Medicare can provide other important benefits for people who need extra assistance.
Below are a few examples:
Some Medicare Advantage plans provide transportation services to the doctor or the grocery store.
Some Medicare Advantage plans provide caregiving services (e.g., Papa Pal).
Medicare provides home dialysis training for caregivers.
Get in touch with a Chapter Medicare Advisor to understand all of your Medicare benefits. Get in touch with an agent at 855-900-2427 or schedule a time to chat.
