Medicare Home Health Care: What's Covered and How to Qualify

# Medicare Home Health Care: What's Covered and How to Qualify

Medicare home health benefits let you get skilled care at home. You do not need to stay in a facility. Are you healing from an illness, injury, or surgery? Home health gives you key care in a place you know. It often costs you nothing.

!A home health visit, representing Medicare home health care coverage

> Quick reference: For a 2026 breakdown of what Original Medicare and Medicare Advantage cover — by Part A, B, and D — see our guide: Medicare Coverage for Home Health Care.

What Medicare Home Health Covers

> About 54% of Medicare beneficiaries are in Medicare Advantage, where this care runs through the plan's network; the rest use Original Medicare, accepted by any participating provider nationwide. (Source: CMS / KFF, 2024.)

Skilled Nursing Care

• Wound care and dressing changes
• IV therapy and shots
• Help managing your drugs
• Checks of your vital signs
• Teaching you to manage your illness

Physical Therapy

• Exercises to build strength and movement
• Balance training
• Ways to ease your pain
• Help to move and walk
• Home safety checks

Occupational Therapy

• Training for daily tasks
• How to use special equipment
• Tips to make your home safer
• Ways to save your energy

Speech-Language Pathology

• Swallowing therapy
• Help to speak again
• Therapy for thinking and language
• Ways to talk and be understood

Medical Social Services

• Counseling to help you cope with illness
• Links to local resources
• Help to plan your care
• Support for your family

Home Health Aide Services

• Help with bathing and grooming
• Help getting dressed
• Reminders to take your drugs
• Light cleaning tied to your care

Important: Medicare covers aide services only when you also get skilled nursing or therapy.

Eligibility Requirements

To qualify for Medicare home health, you must meet ALL of these rules:

1. Homebound Status

You are "homebound" if leaving home:

• Takes a lot of effort
• Needs another person or medical equipment to help
• Is bad for your health

You can still leave home for:

• Doctor visits
• Religious services
• Adult day programs
• A short trip now and then, like a haircut or family event

2. Skilled Care Need

You must need at least one of these:

• Skilled nursing care
• Physical therapy
• Speech-language pathology

Occupational therapy alone does not qualify you at the start. But it can go on once your care has begun.

3. Doctor's Orders

A doctor must:

• Confirm you need home health services
• Set up a plan of care
• Review and renew it from time to time

4. Medicare-Certified Agency

Your care must come from a Medicare-certified home health agency.

Cost to You

Original Medicare:

• $0 for home health services
• 20% coinsurance for durable medical equipment

Medicare Advantage:

• Check what your plan asks you to pay
• Many plans cover home health at $0
• Some plans charge a copay for certain services

How to Access Home Health Services

Step 1: Get a Referral

Ask your doctor if home health is right for you. Your doctor can send you to a Medicare-certified agency.

Step 2: Initial Assessment

A home health nurse or therapist visits you. They check your needs and build a care plan.

Step 3: Care Begins

Your care starts based on the plan your doctor approved.

Step 4: Ongoing Review

Your doctor reviews your need and renews it every 60 days.

What Home Health Doesn't Cover

• Round-the-clock care
• Homemaker help alone, like cooking and cleaning
• Personal care alone, like bathing and dressing, when you have no skilled need
• Meal delivery
• Custodial care

For these, you may need other ways to pay. You could use private pay, Medicaid, or long-term care insurance.

Home Health vs. Other Care Options

Skilled Nursing Facility (SNF):

• Short-term rehab after a hospital stay
• Round-the-clock skilled care
• Medicare covers up to 100 days after a qualifying hospital stay

Home Health:

• Skilled care at home now and then
• You keep your independence
• No hospital stay needed first

Long-Term Care:

• Ongoing custodial care
• Medicare does not cover it
• You pay with private pay, Medicaid, or long-term care insurance

Tips for Getting the Most from Home Health

1. Be honest about your limits - A true homebound check helps you keep coverage 2. Take part - Do your therapy exercises between visits 3. Talk to your team - Tell them when your health changes 4. Ask questions - Be sure you know your care plan and goals 5. Know your rights - You get to choose your home health agency

Medicare Advantage Home Health Benefits

Some MA plans give you more home health benefits:

• Looser homebound rules
• More aide hours
• Telehealth check-ins
• Help with rides
• Meal delivery programs

Check your MA plan to see if it adds home health coverage.

Need Help Understanding Your Options?

Our Medicare advisors help you understand your home health benefits. We help you find coverage that fits your needs. Do you have Original Medicare or Medicare Advantage? Either way, we will explain your options.

Get Your Free Medicare Review

Next steps: Take our 2-minute Medicare plan quiz, book a free Medicare review, or see our Medicare Advantage vs. Supplement comparison.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.