Guide
Does Medicare cover home health care?
Short answer
Yes, if you qualify. Medicare Part A and Part B cover eligible home health services, and you pay nothing for covered home health services. You must be homebound, need part-time or intermittent skilled care, have a doctor or allowed practitioner order the care, and use a Medicare-certified agency (Medicare.gov).
Who qualifies
According to Medicare.gov and the Medicare Benefit Policy Manual, Chapter 7, §30, you must meet all of these:
- You are homebound (see our homebound guide).
- You need part-time or intermittent skilled nursing care (other than only drawing blood), physical therapy, speech-language pathology, or a continuing need for occupational therapy.
- You are under the care of a doctor or allowed practitioner (a nurse practitioner, clinical nurse specialist or physician assistant), and you get services under a plan of care they set up and review regularly.
- A doctor or allowed practitioner saw you in person (a face-to-face encounter) no more than 90 days before or within 30 days after care starts, for the main reason you need home health.
- A Medicare-certified home health agency provides the care.
What Medicare covers
Covered services listed on Medicare.gov include:
- Medically necessary part-time or intermittent skilled nursing care, such as wound care, patient and caregiver education, IV or nutrition therapy, injections, and monitoring serious illness.
- Physical therapy, occupational therapy and speech-language pathology services (if you meet certain conditions).
- Medical social services.
- Part-time or intermittent home health aide care, such as help with bathing, but only if you are also getting skilled nursing or therapy at the same time.
- Injectable osteoporosis drugs for women who meet certain criteria, durable medical equipment, and medical supplies for use at home.
In most cases, "part-time or intermittent" means skilled nursing and home health aide services combined of up to 8 hours a day and a maximum of 28 hours a week, or up to 35 hours a week for a short time if your provider decides it's necessary. If you qualify, there is no limit on the number of visits.
What Medicare does not cover
Per Medicare.gov, Medicare doesn't pay for:
- 24-hour-a-day care at home
- Home meal delivery
- Homemaker services (like shopping and cleaning) unrelated to your care plan
- Custodial or personal care (like bathing, dressing or using the bathroom) when that is the only care you need
That kind of non-medical help is usually called "home care." See home health vs. home care.
What it costs
- You pay nothing for covered home health services.
- After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for Medicare-covered medical equipment.
- Before care starts, the agency should tell you how much Medicare will pay, and tell you verbally and in writing if Medicare won't pay for something. It should give you an Advance Beneficiary Notice (ABN) before giving services Medicare doesn't cover.
- If you have a Medicare Advantage plan, check with your plan about its home health benefits.
Source: Medicare.gov, "Home health services".
How to get started
- Talk to your doctor or other provider. They must see you in person, confirm you need home health, and order the care.
- Your provider should give you a list of agencies that serve your area, and must tell you if their organization has a financial interest in any agency on the list (Medicare.gov).
- Compare agencies. You can use Medicare Care Compare or our city pages, which use the same CMS data. You choose the agency.
- The agency schedules a visit to talk about your needs and coordinates the care plan with your provider.
Frequently asked questions
Does Medicare pay for home health care?
Yes, if you qualify. Medicare Part A and Part B cover eligible home health services, and you pay nothing for covered home health services. You must be homebound, need part-time or intermittent skilled care, and get the care ordered by a doctor or allowed practitioner from a Medicare-certified agency. Source: Medicare.gov.
Does Medicare pay for a home health aide?
Only part-time or intermittent aide care, and only if you are also getting skilled nursing, physical therapy, speech-language pathology or occupational therapy at the same time. Source: Medicare.gov.
Does Medicare pay for 24-hour care at home?
No. Medicare doesn't pay for 24-hour-a-day care at home. Source: Medicare.gov.
How many home health visits does Medicare cover?
If you qualify, you can get unlimited home health visits, within the part-time or intermittent limits (in most cases up to 8 hours a day and 28 hours a week combined). Source: Medicare.gov.