What Does Medicare Cover for Home Health Care?

Medicare covers home health care when a doctor certifies that you're homebound and need skilled nursing care or therapy on a part-time or intermittent basis. Covered services include skilled nursing, physical therapy, occupational therapy, speech-language pathology, home health aide services, and medical social services. Both Medicare Part A and Medicare Part B can pay for home health care, and in most cases you pay nothing for the services themselves if you meet Medicare's eligibility rules.

This guide explains exactly what's included, who qualifies, what it costs, and what home health care does not cover, so you know what to expect before care starts.

Who Qualifies for Medicare Home Health Coverage

To qualify for Medicare-covered home health care, according to Medicare.gov, you must meet all of the following conditions:

• A doctor or allowed practitioner must certify that you need intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy
• You must be under a care plan that a doctor reviews regularly
• The doctor must certify that you're homebound, meaning leaving home takes considerable effort and is generally not recommended
• The home health agency providing your care must be Medicare-certified

Being homebound doesn't mean you can never leave the house. You can still attend medical appointments, religious services, or occasional family events without losing eligibility, as long as leaving home requires substantial assistance or is medically inadvisable for routine activities.

Services Medicare Covers at Home

Once you qualify, Medicare covers a defined set of home health services. These typically come through Part A if you're recovering after a hospital stay, or through Part B if you haven't had a qualifying hospital stay but still meet the homebound and skilled-care requirements.

• Skilled nursing care on a part-time or intermittent basis, such as wound care, injections, or monitoring a serious health condition
• Physical therapy to help restore mobility or strength
• Occupational therapy to help you relearn daily living skills
• Speech-language pathology services for communication or swallowing difficulties
• Home health aide services, but only when you're also getting skilled care such as nursing or therapy
• Medical social services to help with the emotional and social concerns related to your illness
• Durable medical equipment such as wheelchairs or walkers, covered under Medicare Part B coverage rules
• Medical supplies used as part of your care, like wound dressings

Home health aide visits are only covered when they're tied to skilled care you're already receiving, Medicare won't pay for a home health aide as a standalone service.

What Home Health Care Costs You

If you have Original Medicare and meet the eligibility requirements, you pay:

• $0 for covered home health visits
• 20% coinsurance of the Medicare-approved amount for durable medical equipment

There's no deductible for home health services under Part A or Part B. If you have a Medicare and Medicaid dual eligible status, Medicaid may help cover remaining costs like equipment coinsurance. If you're enrolled in a Medicare Advantage plan instead of Original Medicare, your cost-sharing and network rules may differ, so check your plan's specific benefits.

How to Start Home Health Care

Home health care usually begins after a doctor identifies a need, often following a hospital stay, surgery, or a new diagnosis that limits your mobility. Your doctor or discharge planner will typically refer you to a Medicare-certified home health agency, which will then work with your doctor to build a care plan.

You can search for Medicare-certified agencies in your area using the Medicare Care Compare tool, which lists quality ratings and services offered by agencies near you.