Does Medicare cover home health care?
Yes. If you qualify, Original Medicare pays for covered home health care, and you pay $0 for the visits. You qualify if you are homebound, need skilled care part of the time, and your doctor orders it.
Updated
Who qualifies
All of these must be true:
- You are homebound. Leaving home takes a lot of effort, and you need help to do it. You can still go to the doctor, to church, and on short trips. See what “homebound” means.
- You need skilled care part of the time. This means visits from a nurse, a physical therapist, or a speech therapist. Occupational therapy can go on by itself after the other care ends.
- A doctor orders it. A doctor or another provider, like a nurse practitioner, must see you in person. The visit must be within 90 days before care starts or 30 days after. Then they order your care.
- A Medicare-certified agency gives the care.
Sources: Medicare.gov: Home health services and the Medicare Benefit Policy Manual, chapter 7, sections 30.1.1 and 30.5.1.1 (CMS).
What Medicare covers
- Part-time skilled nursing, like wound care, IV therapy, shots, and teaching you and your family
- Physical, occupational, and speech therapy
- Medical social services, to help with problems that affect your recovery
- Part-time help from a home health aide with bathing and dressing, if you also get skilled care
- Medical supplies for use at home, like wound dressings
- Medical equipment, like a walker or a hospital bed
You do not have to be getting better to qualify. Medicare also covers skilled care that keeps your health from getting worse.
Sources: Medicare.gov, Benefit Policy Manual chapter 7 section 20.1.2, and the Jimmo settlement (CMS).
What you pay with Original Medicare
| What you pay | |
|---|---|
| Home health visits | $0 |
| Supplies the agency uses, like dressings | $0 |
| Medical equipment, like a walker | 20% of the Medicare-approved amount, after your Part B deductible |
| Care Medicare does not cover | You may have to pay. The agency must tell you in writing before it gives that care. |
If you have a Medigap policy or other insurance, tell your doctor and the agency. This helps your bills get paid the right way.
Source: Medicare.gov: Home health services (Costs) and Durable medical equipment.
What Medicare does not cover
- Care at home 24 hours a day
- Meals delivered to your home
- Help with shopping and cleaning that is not part of your care plan
- Help with bathing, dressing, or using the bathroom when that is the only help you need
This kind of help is called home care, or personal care. Most people pay for it themselves. Learn more in home health vs. home care.
If you have a Medicare Advantage plan
Medicare Advantage plans cover home health too. But the rules can be different from Original Medicare.
- Approval first. Your plan may need to approve care before it starts. This is called prior authorization.
- Networks. Your plan may ask you to use an agency in its network.
- Costs. Your plan may charge a copay.
Call the number on your plan card to ask. Or call us at 214-440-1394 (Texas), 303-597-0505 (Colorado), 248-607-6698 (Michigan), or 702-450-1855 (Nevada), and we will check your coverage. Source: Medicare.gov: Compare Original Medicare and Medicare Advantage.
How to start
- Ask your doctor if home health is right for you. If you are in the hospital, ask the discharge planner.
- Pick an agency that serves your home. The choice is yours.
- Your doctor sends an order to the agency.
- The agency checks your coverage and calls you to set up the first visit.
- A nurse or therapist comes to your home. They make a care plan with you and your doctor.
Have questions first? Call us at 214-440-1394 (Texas), 303-597-0505 (Colorado), 248-607-6698 (Michigan), or 702-450-1855 (Nevada).
Related pages
Questions? Call us.
We can answer questions about home health, Medicare, and your insurance, before or during care.
General information, not medical advice. Follow your care team’s instructions. How we write and review.