Medicare home health coverage lets eligible people get skilled care at home instead of in a hospital or nursing facility. For many older adults, that difference matters a lot. Recovery often goes better in familiar surroundings. Families also get help managing wounds, medications, and therapy without daily trips to a clinic.
However, the benefit has strict rules. You must be homebound, you must need skilled care, and a doctor or allowed practitioner must certify your plan. Many beneficiaries don’t know that Medicare home health coverage has no time limit and no copay for covered visits. Knowing the rules helps you avoid denials and get every service you qualify for.
The Core Eligibility Rules for Medicare Home Health Coverage
Medicare.gov lists the conditions you must meet. All of them apply at the same time. If you miss one, the claim can be denied.
- You are under the care of a doctor or allowed practitioner. Your care must follow a plan of care that a doctor, nurse practitioner, clinical nurse specialist, or physician assistant sets up and reviews regularly.
- You need skilled services. This means intermittent skilled nursing, physical therapy, speech-language pathology, or continuing occupational therapy.
- You are homebound. A practitioner must certify that leaving home takes considerable and taxing effort.
- You use a Medicare-certified agency. Agencies that are not certified cannot bill Medicare.
- You had a face-to-face visit. The visit must happen within 90 days before or 30 days after care starts.
Medicare home health coverage also depends on a plan of care that is reviewed at least once every 60 days. CMS calls each 60-day stretch a “certification period.” Payments to agencies are made in 30-day periods. As long as you still qualify, your practitioner can recertify you again and again. There is no lifetime cap on the number of periods.
The face-to-face visit can be done by telehealth in many cases. It must relate to the main reason you need home care. For example, a patient recovering from hip surgery might see the surgeon or a primary care provider about mobility limits and wound healing.
What “Homebound” and “Skilled Care” Actually Mean
The homebound rule confuses many families. Being homebound does not mean you can never leave the house. CMS uses a two-part test. First, you need help to leave home. That help could be a cane, walker, wheelchair, special transportation, or another person. Alternatively, a doctor may advise you not to leave because of your condition. Second, leaving home must take a considerable and taxing effort. You typically cannot leave without that effort.
You can still leave home for medical care, such as dialysis or doctor visits. You can attend adult day care or religious services. Short, infrequent trips are also allowed, like a family event or a haircut. As a result, an occasional outing will not end your benefit.
The skilled care rule matters just as much. Skilled care needs a licensed nurse or therapist. Examples include wound care, injections, IV therapy, and catheter changes. Patient teaching and therapy after a stroke also count. “Intermittent” nursing generally means fewer than 7 days a week. It can also mean daily care for 21 days or less. In most cases, combined nursing and aide time must be under 8 hours a day and 28 hours a week. Some cases allow up to 35 hours a week.
Importantly, you don’t need to be improving. The 2013 Jimmo v. Sebelius settlement confirmed this. Medicare home health coverage can continue when skilled care maintains your condition or slows decline. Agencies sometimes misstate this rule, so ask questions if care is cut.
| Service | Covered? | What You Pay |
|---|---|---|
| Part-time skilled nursing | Yes | Nothing for covered visits |
| Physical, occupational, speech therapy | Yes | Nothing for covered visits |
| Home health aide (bathing, dressing) | Only with skilled care | Nothing for covered visits |
| Medical social services | Yes | Nothing for covered visits |
| Durable medical equipment | Yes, under Part B | 20% coinsurance after Part B deductible |
| 24-hour care at home | No | Full cost |
| Meal delivery | No | Full cost |
| Homemaker services only | No | Full cost |
| Custodial care only | No | Full cost |
Note the aide rule. A home health aide is covered only when you also get skilled nursing or therapy. If you need help with bathing alone, Medicare won’t pay. Long-term custodial care falls outside the benefit entirely.
Part A, Part B, and Medicare Advantage: Who Pays
Both Part A and Part B can pay for home health. Part A typically covers the first 100 visits after a qualifying stay. That means at least 3 inpatient days in a hospital or a stay in a skilled nursing facility. Home care must begin within 14 days of discharge. Part B covers home health visits that don’t follow a qualifying stay. It also covers visits beyond the first 100. Either way, you usually pay nothing for the visits themselves.
Medicare Advantage plans must cover home health too. Plans from UnitedHealthcare, Humana, Aetna, Cigna, and Blue Cross must meet Original Medicare’s standard. However, they can add rules. You may need to use an in-network agency. Prior authorization is common. Some plans also offer extra in-home support, such as meals after discharge or limited personal care. Check your plan’s Evidence of Coverage for the details.
Medigap does not change home health eligibility. Plans sold by companies like Mutual of Omaha and AARP/UnitedHealthcare can help with the 20% coinsurance on medical equipment. Because home health visits already cost nothing, Medigap’s main value here is equipment and related Part B costs.
How to Get Medicare Home Health Coverage Started
Start with your doctor. Ask whether you meet the homebound and skilled care rules. If so, the practitioner orders home health and certifies your eligibility. Hospital discharge planners can set this up before you go home.
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Next, choose an agency. Use the Care Compare tool on Medicare.gov. It shows star ratings, patient survey scores, and services each agency offers. You have the right to pick any certified agency that serves your area. A hospital may suggest agencies. Typically, they must give you a list and respect your choice.
Then review your plan of care carefully. It should list your diagnoses, services, visit frequency, and goals. Keep a copy. Track every visit on a calendar. If visits are missed, call the agency right away.
Finally, know your appeal rights. Before services end or are reduced, the agency must give written notice. Common forms include the Notice of Medicare Non-Coverage and the Home Health Change of Care Notice. You can request a fast appeal through your state’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). For example, you may ask for review when therapy stops because you “plateaued.” Remember, improvement is not required. Your local SHIP program offers free, unbiased counseling on appeals and coverage questions.
Some states face extra review. CMS runs a Review Choice Demonstration for home health in Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma. Agencies there go through added claim checks. This shouldn’t change your eligibility. Still, paperwork must be complete, so confirm your practitioner documented the face-to-face visit.
Frequently Asked Questions
How long does Medicare pay for home health care?
There is no fixed limit. Medicare home health coverage continues as long as you stay eligible. Your practitioner must recertify your plan every 60 days.
Can I get home health care if I live alone or in assisted living?
Yes. “Home” can be a house, apartment, relative’s home, or assisted living facility. However, a skilled nursing facility or hospital doesn’t count as home. Living alone does not affect eligibility.
Will Medicare pay for a caregiver to help with daily tasks?
Only in limited cases. Medicare home health coverage includes aide help with bathing or dressing only while you also receive skilled care. Ongoing custodial or 24-hour care is not covered. Medicaid or long-term care insurance may fill that gap.
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Official Sources & Resources
For verified information on Medicare regulations and consumer protection:
- Medicare.gov (Official Site): medicare.gov
- CMS (Centers for Medicare & Medicaid Services): cms.gov
- NAIC (National Association of Insurance Commissioners): naic.org
- KFF Medicare Research: kff.org/medicare
- Social Security Administration: ssa.gov
Content last reviewed October 2026. If you notice any outdated information, please contact us.