After you’re hospitalized for an injury, heart attack, or other health emergency, you may need extra support when you return home. Medicare provides coverage for home health care services to help you during your recovery.

Find out what types of services home health care includes, what Medicare pays for, and how long this coverage lasts.

Does Medicare cover home health care?

The answer is yes—it’s covered under both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Under Medicare Part B, you qualify for home health care if you’re homebound and require skilled care—even if you haven’t been previously hospitalized. In certain cases, such as after a hospital stay or time spent in a skilled nursing facility, you can receive home health care coverage under Medicare Part A.

What defines home health care?

Home health care is meant to provide health services and equipment to people while they are recovering at home. It includes a wide range of health and social services delivered in the home to treat illness or injury, including skilled nursing care and home health aide care. 

What are Medicare's criteria for providing in-home nursing care?

1. To qualify for home health care, you must meet the following criteria:

• Be considered homebound based on the Centers for Medicare & Medicaid (CMS) criteria
• Require skilled care on a part-time or intermittent basis to improve, maintain, prevent, or further slow your health condition
• Be under the care of a nurse practitioner, clinical nurse specialist, physician’s assistant, or doctor, who completes and documents an in-person visit with you either:
  • Three months before the start of home health care, or
  • Within one month after the home health care benefit has begun
• Receive home health care from a Medicare-approved home health agency.

But what exactly does that mean? 

Here’s an example: Let’s say you end up in the hospital after a fall and get surgery on your knee. After spending at least three days in the hospital, it’s time to get discharged, but you have not completely healed. The discharge documents from your physician will include information about you being homebound and needing short-term skilled care. The documents will also include a plan of care that notifies Medicare and health care agencies of the services and equipment you will need while being cared for. 

Once this happens, you are now eligible to receive home health care from a Medicare-approved agency. Using a home health agency that’s certified by Medicare can help you reduce your out-of-pocket costs.

How long will Medicare pay for home health care? 

Under Medicare’s rules, you qualify for home health services if you need intermittent skilled nursing care. Medicare will continue to cover these services as long as they are deemed medically necessary and you meet the criteria for being homebound. 

"Being homebound doesn't mean you can never leave your house," explained Ryan Ramsey, NCOA Associate Director of Health Coverage and Benefits. “It means leaving home is difficult and requires a significant effort, often because you need assistance from another person or use mobility devices like a wheelchair or crutches.”

You aren’t typically eligible for Medicare home health benefits if you need full-time skilled nursing care for an extended time period.

2. Medicare only covers care for specific services.

Services covered by Medicare’s home health benefit include: 

• Skilled nursing care (medically necessary)
• Therapy (physical, speech, occupational)
• Personal care provided by a home health aide 
  • Walking
  • Bathing and grooming
  • Feeding
  • Changing bed linens
• Medical social services
• Injectable osteoporosis drugs (for eligible women)
• Durable medical equipment 
• Medical supplies for use at home

While you’re recovering at home, you may require certain assistive equipment such as a wheelchair or walker. Medicare also covers durable medical equipment—typically 80% of the Medicare-approved amount—as long as it meets certain criteria. You can often get the equipment you need through your home health agency and get it delivered directly to your door.

Note: Through December 31, 2027, Medicare covers many telehealth services you can receive from anywhere in the U.S., including your home. Covered services include cardiac rehabilitation, medical nutrition therapy, and many other types of care.

Medicare does not cover:

• 24-hour care at home
• Delivered meals
• Help with shopping, cleaning, or other household tasks that are not part of your care plan
• Help with daily activities, such as bathing, dressing, or using the bathroom, if that’s the only care you need

If there are any home-based services Medicare will not cover, your home health agency must advise you in writing through something called an Advance Beneficiary Notice of Noncoverage (ABN). If you disagree with Medicare’s decision to not provide coverage, you may be able to file an appeal.

3. If you are enrolled in original Medicare or Medicare Advantage, you pay nothing for home health care services.

But you may be responsible for 20% of the Medicare-approved amount for durable medical equipment and the standard Part B deductible applies. 

“It’s a good idea to ask your home health agency which services Medicare covers and which you'll have to pay for. Some agencies may recommend services that aren't covered by Medicare,” Ramsey suggested. “Before your care begins, the home health agency must give you a written notice that clearly explains what services may cost and what Medicare will cover.”

4. Medicare may cover custodial care (long-term care), or non-skilled personal care, in some cases.

Non-skilled personal care includes help with activities of daily living (ADLs) like bathing, dressing, toileting, and other tasks that don't require the skills of a registered nurse (RN). Agencies that offer these services are referred to as home care agencies, not to be confused with home health care agencies that offer home health care services. The professionals providing direct care on behalf of these agencies are called home health aides. 

Are home care (vs. home health care) services covered by Medicare? If you meet the conditions for home health care and you're also receiving skilled nursing care or other types of therapy, Medicare will cover home health aide services on a part-time or intermittent basis as part of your overall home care.

5. Medicare does not cover long-term nursing home care.

Medicare’s home health care benefit is not a long-term services and supports (LTSS) program, and it does not provide unlimited coverage. 

Medicaid sometimes pays for services to keep seniors in their homes. The services covered and requirements for enrollment vary by each state’s Home and Community Based Services program (HCBS).

6. Some states offer custodial care programs for older adults.

Programs like adult day health care, chore assistance, and homemaker services are offered by some state Medicaid programs. Vouchers may also be available for low-income households who qualify.

If you need help locating these programs, try BenefitsCheckUp®, a free, online tool from NCOA. This tool connects you with programs that can help you age well and stay healthy, including local respite care, adult day health care, and state Medicaid programs. We also recommend contacting your local State Health Insurance Assistance Program (SHIP) for free, confidential, and unbiased Medicare counseling.

7. It’s important to know the difference between home health care and home care.

Even with all this information, differentiating between home care and home health care can be confusing. Below is a chart to help highlight some of the major differences and similarities in services covered, enrollment requirements, and payment options.

 

 

 

 

Questions about home health coverage through Medicare?

If you have original Medicare and have questions about your home health care benefits, visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). If you receive your Medicare coverage through a Medicare Advantage (Part C) plan, call your insurance carrier directly.

We also recommend contacting your local State Health Insurance Assistance Program (SHIP) to talk to a trained Medicare expert for free.