If you need in-home personal care or skilled nursing services due to a recent hospitalization, chronic illness or other condition that has rendered you homebound, you may qualify for home health care through Medicare.
We examined eligibility requirements, costs and other details to provide you with an in-depth guide to Medicare home health benefits. Read on to find out more about the program.
Table of contents
- What is home health care?
- Does Medicare cover home health care?
- How to qualify for home health care under Medicare
- Does Medicare Cover Home Care? FAQs
- Summary of Money’s Does Medicare Cover Home Health Care?
What is home health care?
Home health care involves part-time or intermittent clinical care provided in your own home by health care professionals. It’s intended to help people who are homebound due to illness or injury regain as much independence as possible.
People sometimes confuse home health care, which is provided by skilled professionals, with home care, which is non-skilled or non-clinical care focused on support with activities of daily living (ADLs). Medicare does not typically cover home care.
If you're looking for a plan that covers home care, long-term care insurance could be an option. These plans cover extended care in a variety of settings and can be relatively affordable if you apply in your early 50s or while in good health. Medicaid can also cover these services, provided you meet the program's income requirements for your state.
Who qualifies for home health care services?
You may qualify for home health care services if you are homebound and need skilled care in your home on a part-time or intermittent basis as a result of a medical condition, illness, accident or surgery.
Medicare defines homebound as having difficulty leaving home without assistance from another person, special transportation or a mobility aid. In addition, a doctor, physician, nurse practitioner or other health care professional must certify that you are homebound and require home health care services.
People who receive home health care services may be living with a chronic condition like diabetes or Alzheimer’s Disease. Others may be experiencing a temporary situation, such as a recent hospitalization for surgery or due to a medical emergency.
Note that you can still qualify for home health care even if you attend adult day care. Additionally, while receiving home health care, you are permitted to leave your home for occasional medical treatments or religious services.
Does Medicare cover home health care?
Medicare covers home health care under Original Medicare, which includes Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). You can receive home health care up to seven days a week but for no more than eight hours per day or 28 total hours per week. (In some special cases, you may be approved for up to 35 hours per week.)
To receive home health care through Medicare, a doctor, nurse practitioner or other health care professional must certify that you need the service. Additionally, home health care services must be provided by a Medicare-approved home health agency.
If you are enrolled in a Medicare Advantage Plan (Part C), you can access the home health care benefit. However, eligibility requirements and restrictions may be different than those stipulated by Medicare for Part A and Part B. Speak with your health insurance company to find out how to qualify and if you’ll incur any out-of-pocket costs. The company can also provide you with a list of approved home health agencies.
What home health services are covered by Medicare?
Home health services covered by Medicare range from post-surgery care to assistance in relearning skills lost due to a medical condition or accident. Examples of covered services are listed below.
Skilled nursing services
- Administering injections and providing instruction on self-injection techniques
- Nutritional guidance
- Tube feedings
- Monitoring of blood pressure, temperature, breathing and heart rate
- IV therapy
- Continued observation and assessment of condition
- Catheter changes
- Patient and caregiver education
- Wound care
- Pressure sore care
- Medication management
Skilled therapy services
Home health aide services
Medical social services
Durable Medical Equipment (DME)* and medical supplies
- Physical therapy
- Speech-language pathology services
- Occupational therapy (focuses on regaining the ability to do daily activities, like eating and getting dressed)
- Going to the bathroom
- Counseling for emotional concerns
- Help finding local resources
- Wound dressings
- Hospital bed
*Medicare covers 80% of the Medicare-approved amount for certain pieces of durable medical equipment (DME) prescribed by your doctor or health care provider. This means that you will pay 20% coinsurance to rent or buy DME after you meet the Part B deductible.
What home health services are not covered by Medicare?
Some home health services are not covered by Medicare. These include:
- 24-hour care in your home
- Meal delivery
- Homemaker services, including cleaning and shopping, unless related to your care plan
- Custodial or parental care (if it’s the only care you need)
Not that if you only need occupational therapy, you may not be eligible for home health care. You must receive home health care in order to be provided occupational therapy. Additionally, if your doctor believes you require a higher level of care, such as inpatient treatment at a skilled nursing facility, you might be ineligible for home health care.
You should verify costs with the home health care agency before each period begins. If the home health care agency doesn’t cover certain costs, they should provide you with this information in writing through an Advance Beneficiary Notice (ABN). You should receive this notice before the agency provides any services or supplies that Medicare will not pay for.
Additionally, if you live in Florida, Illinois, Massachusetts, Michigan or Texas, you may be able to submit a request for pre-claim review of coverage through the Medicare demonstration program.
How long will Medicare pay for home health care?
Medicare will pay for home health care for three weeks at a time for as long as you qualify. Your home health agency should provide notice in writing via a Notice of Medicare Non-Coverage (NOMNC) a minimum of two days before your home health benefit ends.
To continue care, a doctor or health care professional must again submit certification of your need for home health care. Your doctor may adjust your plan of care during renewal.
How to qualify for home health care under Medicare
To qualify for home health care, a doctor, nurse practitioner or other health care professional must certify that you need part-time or intermittent skilled nursing care and other health care services in your home. This could be due to a chronic condition, temporary illness, recent surgery or other medical issue.
This certification is also called an order of care, which your healthcare professional will send to Medicare and a Medicare-certified home health agency. The order of care must be completed either three months before using your home health care benefit or within one month of when it begins.
You must meet the following criteria in order to obtain certification from a healthcare professional.
1. You are homebound, meaning that:
- It’s difficult for you to leave home and you require assistance from another person, special transportation, or the use of mobility aids like a cane, wheelchair, walker, crutches or other supportive devices.
- You frequently cannot leave your home because it requires too much effort.
- Your doctor has recommended you don’t leave your home due to your condition.
2. You need care for a health condition in order to prevent or slow its progression or maintain your current condition.
You can discuss with your healthcare provider which agency you want to use. Medicare provides a directory of home health care agencies on its website (medicare.gov), or you can call 1-800-MEDICARE for guidance.
Does Medicare Cover Home Health Care FAQs
What home health care is covered by Medicare?
Who qualifies for home health care?
What is the cost of home health care?
Does Medicaid cover home health care?
Summary of Money’s Does Medicare Cover Home Health Care?
Medicare covers home health care through Original Medicare Part A and Part B. To qualify, a doctor or other health care professional must certify that you need the home health benefit. You may qualify if you are homebound due to a recent hospitalization, sudden illness, chronic condition or other health issue.
Medicare coverage for home health care includes wound care, physical therapy, speech therapy, occupational therapy, injections, IV therapy, medication management, nutritional guidance, counseling and patient and caregiver education.
You can receive medical services and other home health care up to seven days a week. However, you cannot exceed eight hours per day or 28 hours weekly, except in special circumstances determined by your health care professional.