Medicare covers qualifying home health care under Part A or Part B. Coverage depends on your need for skilled services, your ability to leave home and an authorized care plan. A diagnosis by itself does not establish coverage, and this benefit is different from ongoing help with everyday activities.
Who qualifies?
You must need part-time or intermittent skilled services and meet Medicare’s homebound requirements. Generally, illness or injury makes leaving home difficult without help, or leaving is medically inadvisable, and you normally cannot leave without considerable effort. Medical appointments and short, infrequent nonmedical outings do not automatically disqualify you.
A doctor or other authorized clinician must see you in person, confirm the need for home health and order the care. A Medicare-certified home health agency must provide the covered services. Occupational therapy must initially be ordered with qualifying nursing, physical therapy or speech-language pathology; it may continue alone afterward when appropriate.
Services and limits
| Service | Coverage distinction |
|---|---|
| Skilled nursing and therapy | Medically necessary services may help improve, maintain function or slow decline. |
| Home health aide | Part-time or intermittent help is covered only while also receiving qualifying skilled nursing or therapy services. |
| Personal care alone | Bathing, dressing or toileting assistance is not covered when that is the only care needed. |
| Continuous supervision | The home health benefit does not pay for 24-hour care at home. |
| Meals and housekeeping | Meal delivery and homemaker services unrelated to the care plan are excluded. |
For a person with dementia, Alzheimer’s disease or ALS, ask the care team which skilled needs qualify. Do not assume the diagnosis covers a full-time aide or supervision. If eligible, there is no fixed limit on covered home health visits, but each service must continue meeting coverage requirements.
What you pay
You pay nothing for covered home health services under Original Medicare. Covered medical equipment has separate rules: after the Part B deductible, you generally pay 20% of the Medicare-approved amount. The agency should explain uncovered services and their charges in advance, including the required notice when applicable.
Before care starts
- Confirm the agency’s Medicare certification and your written care plan.
- Ask exactly which visits, aide hours and equipment are included.
- Separate covered skilled care from privately paid daily support.
- Ask whom to contact when needs change or a visit is missed.
- If you have Medicare Advantage, confirm network and authorization rules with the plan.
Keep the plan and notices. If coverage ends or a service is denied, follow the review or appeal instructions and deadline on the notice rather than assuming every unpaid charge is automatically your responsibility.
Related coverage questions
- Nursing Home Care and Medicare: Understand the Difference
- Medicare Respite Care: The Hospice Benefit and Its Limits