Does Medicare Cover Home Health Care?

Medicare covers home health care services that are considered both reasonable and necessary for the treatment of an illness or injury. Home health care is covered by Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance).^[01] Under Part B, Medicare recipients are eligible for home health care with no prior hospitalization requirement. The services must be provided by a Medicare-certified home health agency, not a family member.

Medicare benefits for home health care coverage include the following:^[01]

• Skilled nursing care. Under Medicare, in-home skilled nursing services are covered if they’re part-time or intermittent. This is classified as fewer than eight hours per day and fewer than 28 hours per week for up to 21 days. (The hours and days may be extended in certain situations.) Services include certain types of injections, tube feeding, wound care, and IV drugs.
• Occupational therapy, physical therapy, and speech pathology. Therapy services performed as a part of Medicare-covered home health care must be necessary to restore or improve functions affected by an injury or illness. The amount of therapy and how long the senior receives these services must be considered reasonable.
• Home health aide services. Medicare will cover part-time or intermittent home health aide services only if they’re performed in conjunction with skilled care, physical therapy, speech-language pathology, or occupational therapy. Home health aides provide assistance with activities of daily living (ADLs), such as walking, bathing, and feeding. These services may also be referred to as personal care or custodial care.
• Medical social services. If emotional or social concerns may delay a person’s recovery or interfere with treatment, Medicare may cover medical social services such as counseling. These services must be ordered by a doctor, and they’re only covered if the person is also receiving skilled care.
• Medical supplies and equipment. Medicare will cover wound dressings and other medical supplies if they’re ordered by a doctor as part of home health care. Additionally, Medicare will typically pay 80% for durable medical equipment, such as walkers, wheelchairs, oxygen equipment, or hospital beds.

Medicare does not cover:

• Skilled nursing care that’s provided for more than eight hours per day or more than 28 hours per week for more than 21 days
• Home meal delivery
• Homemaker services that are unrelated to medical care, such as cleaning or shopping
• Help with ADLs when this is the only care needed

Home health care agencies are required to provide an Advance Beneficiary Notice of Non-coverage (ABN) before providing services or supplies that Medicare likely won’t cover.

Does Medicare cover nonmedical home care?

No, Medicare won’t pay for nonmedical home care if this is the only type of service that a person needs. However, Medicare home care benefits may cover personal care that’s provided in conjunction alongside eligible home health services, such as transitional home care. To qualify, your loved one must first meet the eligibility criteria for Medicare-covered home health care. Then, nonmedical home care services, such as help with ADLs, might be covered as a part of the overall care plan.

Read more:How Much Does In-Home Care Cost in 2024? A State-by-State Guide

The initial coverage period is 60 days, after which the beneficiary’s doctor must review the need for home health care.^[01] After this initial 60-day period, Medicare may continue to provide coverage in 30-day increments as long as the skilled care is still needed and all other criteria are met. Unlike other programs such as veterans benefits and Medicaid, Medicare does not cover any type of long-term care in any setting. Home health care services are meant to be short-term to assist in a person’s recovery or help maintain their condition.

Let our care assessment guide you

How many hours of home health care does Medicare cover?

Medicare will only pay for home health care if a person requires skilled care for:

• Fewer than 8 hours a day
• Fewer than 7 days a week
• Fewer than 28 hours a week
• No more than 21 days

The coverage may be extended for more than 3 weeks if a doctor can foresee when the person’s need for skilled nursing will end.^[01]

To qualify for home health care, Medicare beneficiaries must meet the following requirements:^[01]

• They must be enrolled in Medicare. To receive home health benefits, they must be enrolled in Medicare Part A and/or Part B.
• They’re getting care from a doctor. The services they’re receiving must be part of a care plan that’s reviewed regularly by a physician. Their doctor (or a medical professional working with their doctor) must document that they’ve had face-to-face appointments within certain time frames, and those appointments must be related to the need for home health care.
• They require certain health-related services. Medicare home health care services include part-time or intermittent skilled nursing, physical therapy, speech-language pathology services, or occupational therapy.
• They’re certified by a doctor as homebound. This means that leaving their house without help is difficult, requires a major effort, or isn’t recommended. However, if someone is considered homebound, they may still leave home for medical treatment or brief and infrequent trips for nonmedical purposes like haircuts, birthday parties, or religious services.
• They must get care from a Medicare-certified agency. These agencies not only meet strict federal standards but also qualify for Medicare reimbursement.

Talk with a Senior Living Advisor

If a family member needs help finding home care, A Place for Mom’s Senior Living Advisors will go over options in your loved one’s area that best fit their needs. They can also provide information about other senior living options, such as independent living, assisted living, and memory care — all at no cost to seniors and their families.

For additional resources, seniors and their families can talk to a doctor, hospital discharge planner, or a representative at their local Area Agency on Aging. To compare home health care options, visit the Medicare website.