If you or a loved one needs medical care at home, you may be wondering, “does Medicare pay for home health care?” The good news is this: Medicare does provide coverage for home health care, but only under specific conditions and for certain types of services.
Understanding the things that Medicare covers under home health care can help you plan for care needs, help avoid unexpected costs, and make informed decisions about your healthcare options. This guide explains exactly what Medicare pays for, who qualifies, and how to access these important benefits.
What Is Medicare Home Health Care?
Home health care (without relation to Medicare) encompasses a range of medical services delivered in your home for an illness or injury. Under Medicare plans, these services are provided by Medicare-certified home health agencies and are designed to help you recover or manage a health condition without requiring hospitalization or facility-based care.
That being said, the definition of “home health care” under Medicare is not the same as non-medical home care or custodial care. The key difference is that Medicare only covers skilled services: those that require the expertise of licensed healthcare professionals like registered nurses, physical therapists, or speech-language pathologists.
The Difference Between Home Health Care & Home Care
Before diving into Medicare coverage, we’ll give a few specific examples to clarify further and help you understand the distinction:
Home Health Care (which Medicare may cover):
- Skilled nursing care for wound care, injections, or monitoring health conditions
- Physical therapy to improve mobility and strength
- Occupational therapy to help with daily activities
- Speech-language therapy for communication or swallowing disorders
- Medical social services
- Home health aide services (only when combined with skilled care)
Home Care or Custodial Care (which Medicare does not cover):
- Help with bathing, dressing, and grooming when this is the only care needed
- Meal preparation and cooking
- Light housekeeping and laundry
- Companionship and supervision
- Transportation to appointments
- 24-hour care
Does Medicare Pay for Home Health Care?
Yes; Medicare covers home health care services when you meet specific eligibility requirements.
Both Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) provide coverage for home health services, and in most cases, you'll pay nothing out of pocket for covered services. If you have Medicare Part C (Medicare Advantage) instead of Original Medicare, your plan must cover everything that Original Medicare covers, including home health care. Keep in mind that because Medicare Advantage is offered by private companies, plan specifics may vary, as well as network restrictions and potential additional benefits.
What Medicare Covers for Home Health Care
When you qualify for the Medicare home health benefit, coverage includes:
Skilled Nursing Care: Part-time or intermittent skilled nursing services provided (or supervised) by a registered nurse. This includes:
- Wound care and dressing changes
- IV therapy
- Administration of injections
- Catheter care and management
- The monitoring of unstable health conditions
- Patient and caregiver education
Physical Therapy: Services to improve strength, mobility, and physical function, including:
- Rehabilitation post-surgery or procedure
- Recovery from injury or illness
- Balance exercises and gait training
- Techniques for pain management
Occupational Therapy: Therapy focused on helping you perform activities necessary for daily living, such as:
- Adaptive techniques for necessary activities like dressing, bathing, and eating
- Home safety evaluations
- Recommendations for assistive devices
- Cognitive rehabilitation
Speech-Language Pathology Services: Treatment for communication or swallowing disorders, including:
- Speech therapy following a stroke
- Treatment for swallowing difficulties
- Cognitive-communication therapy
- Voice and language disorders
Medical Social Services: Counseling and assistance from a licensed social worker to help:
- Access community resources
- Navigate financial concerns related to an illness
- Cope with the social and emotional aspects of a condition
- Coordinate care with other services
Home Health Aide Services: Personal care assistance provided by a home health aide, but only when you're also receiving skilled nursing care, physical therapy, speech-language pathology, or occupational therapy. Services include:
- Assistance with bathing and dressing
- Help with walking and transferring
- Basic personal hygiene care
- Light meal preparation (only if related to dietary restrictions)
Medical Supplies & Equipment: Medicare helps covers durable medical equipment (DME) provided by your home health agency as part of your treatment plan, such as:
- Hospital beds
- Wheelchairs and walkers
- Wound care supplies
- IV equipment and supplies
- Oxygen equipment
If you or a loved one requires home health care coverage, but you aren’t sure where to start, try Healthpilot today; our tool lets you compare plans and specific benefit information, helping you make the best choice when it comes to Medicare coverage.
What Medicare Does Not Cover for Home Health
While knowing what is covered by Medicare when it comes to home health care, understanding Medicare's limitations can also help you plan appropriately, and avoid unexpected costs:
Services Medicare Does NOT Cover
- 24-hour care; Medicare covers only part-time or intermittent care.
- Meals delivered to your home (unless provided as an extra benefit through Medicare Advantage).
- Homemaker services such as cleaning, laundry, shopping, and similar tasks.
- Personal or custodial care, when it's the only care you need (not combined with skilled care).
- Prescription drugs delivered to your home; medications are covered under Part D, not the home health benefit.
- Long-term care, as Medicare is not a long-term care insurance program.
Alternative Coverage Options
If you’ve just read these lists and find yourself in need of services that Medicare doesn't cover, you still have options. Consider things like:
- Medicaid, which may cover custodial care for those who qualify based on income and assets.
- Long-term care insurance, which can help pay for extended custodial care.
- Veterans benefits; VA benefits may provide additional home care services.
- State programs, as some states offer assistance programs for home care.
- Private pay, such as hiring caregivers directly or through private agencies.
Who Qualifies for Medicare Home Health Care?
To receive Medicare-covered home health services, you must meet all four of the following criteria:
1. You Must Be Under a Doctor's Care
A doctor or other Medicare-approved healthcare provider must:
- Order home health care for you
- Set up a plan of care and review it regularly (typically every 60 days), AND
- Conduct a face-to-face evaluation related to your need for home health care
The face-to-face requirement means your doctor must see you in person (or via telehealth in some cases) to certify your need for home health services.
2. You Must Be Homebound
To qualify for Medicare home health care, Medicare requires that you be "homebound," meaning leaving your home requires considerable and taxing effort. To be considered homebound, you may be required to:
- Be in need of the help of another person or supportive devices (a cane, wheelchair, walker, or crutches) to leave home
- Be caused significant pain or fatigue by leaving home due to your medical condition, OR
- Have a condition that makes leaving home medically inadvisable
Important: You can still qualify as homebound even if you:
- Leave home for medical treatment or short, infrequent trips for non-medical reasons
- Attend religious services occasionally
- Participate in adult day care programs
- Take brief walks around your neighborhood
Simply not having transportation or a driver's license does not make you homebound under Medicare's definition.
3. You Must Need Intermittent Skilled Care
You must require at least one of the following skilled services on a part-time or intermittent basis:
- Skilled nursing care
- Physical therapy
- Speech-language pathology services
"Part-time or intermittent" typically means you can receive skilled nursing care and home health aide services combined for up to 8 hours per day, with a maximum of 28 hours per week. In some cases, more hours may be approved if medically necessary for a short period.
Note on Occupational Therapy: While occupational therapy alone cannot qualify you for Medicare home health coverage, it can continue your coverage once you've already qualified through skilled nursing, physical therapy, or speech-language pathology.
4. You Must Use a Medicare-Certified Home Health Agency
The home health agency providing your care must be certified by Medicare. Not all home care agencies meet Medicare's certification requirements, so it's important to verify that your chosen agency is Medicare-approved.
You can find Medicare-certified home health agencies in your area by visiting the Medicare Care Compare site or by calling 1-800-MEDICARE (1-800-633-4227).
How Much Does Original Medicare Pay Towards Home Health Care?
One of the most significant benefits of Medicare home health care is that in most cases, you will pay nothing for covered services.
Medicare Part A & Part B Coverage
- 100% coverage for skilled nursing care, physical therapy, speech-language pathology, occupational therapy, medical social services, and home health aide services (when provided as part of your plan of care)
- No Part A or Part B deductible applies to home health services
- No coinsurance or copayment for covered home health visits
What You May Pay For
Durable Medical Equipment (DME): If your home health agency provides DME, you'll pay:
- Your Part B deductible (if you haven't met it yet for the year)
- 20% of the Medicare-approved amount for the equipment
For 2026, the Part B deductible is $283.
Non-Covered Services: You'll pay the full cost for any services or supplies that Medicare doesn't cover, such as:
- 24-hour care
- Meals delivered to your home
- Homemaker services (cleaning, laundry, etc.)
- Personal care when it's the only care you need
Before your home health agency provides any services or equipment that Medicare won't cover, they should give you an Advance Beneficiary Notice (ABN) explaining what you'll need to pay.
How Much Does Medicare Advantage Pay Towards Home Health Care?
If you have a Medicare Advantage plan (Part C) instead of Original Medicare, your plan must cover everything that Original Medicare covers, including home health care. However, there are some differences to keep in mind:
Network Restrictions
Unlike Original Medicare, Medicare Advantage plans typically have network restrictions. You may need to:
- Use home health agencies in your plan's network
- Get prior authorization before services begin
- Follow specific referral procedures
Always check with your Medicare Advantage plan before starting home health services to understand your specific coverage, any costs you might have, and which home health agencies are in your network.
If you’re curious about whether the Medicare Advantage plans that you’re considering offer any of these potential additional benefits, using a plan comparison tool like Healthpilot may be the best option for you.
Does Medicare Pay for Home Health Care for Dementia Patients?
Yes, Medicare does cover home health care for people with dementia or Alzheimer's disease, but coverage follows the same eligibility rules as for any other condition. The person with dementia must:
- Be under a doctor's care who orders home health services
- Be homebound
- Need intermittent skilled nursing care, physical therapy, or speech-language therapy
- Use a Medicare-certified home health agency
What Medicare Covers for Dementia Home Health Care
Skilled Nursing Services:
- Monitoring of vital signs and symptoms
- Medication management and education
- Assessment of safety in the home environment
- Caregiver training on managing dementia behaviors
Therapy Services:
- Physical therapy for mobility issues
- Occupational therapy for safety and daily activities
- Speech therapy for communication or swallowing problems
Home Health Aide Services:
Medicare will cover home health aide care (assistance with bathing, dressing, and personal care) only if the person with dementia is also receiving skilled nursing or therapy services at the same time.
What Medicare Does NOT Cover for Dementia
Medicare does not cover:
- 24-hour custodial care or supervision
- Personal care services when these are the only services needed
- Memory care facility costs (room and board)
- Long-term care in nursing homes (beyond the first 100 days after a qualifying hospital stay)
Note: If you find that Medicare's home health benefit provides valuable short-term support but is not sufficient for the ongoing, around-the-clock care that people with advanced dementia often require, we recommend exploring Medicaid, long-term care insurance, or private pay options.
Additional Medicare Benefits for Dementia
Beyond qualifying home health care services for those with dementia or Alzheimer’s, Medicare also covers:
- Cognitive assessments during annual wellness visits
- Care planning services for newly diagnosed cognitive impairment
- Depression screenings (once per year)
- Prescription medications through Medicare Part D
- Behavioral health services through Medicare Part B
Does Medicare Pay for Home Health Care After Hospitalization?
Yes, Medicare commonly covers home health care following a hospital stay; this is actually one of the most frequent scenarios for qualifying for the home health benefit.
However, unlike skilled nursing facility coverage, Medicare does not require a hospital stay to qualify for home health care.
Post-Hospital Home Health Care
After getting discharged from the hospital, the doctor may order home health services as part of a recovery plan. This often happens when:
- You need continued skilled care but don't require facility-level care
- You're recovering from surgery and need physical therapy at home
- You require wound care or IV antibiotics
- You need help regaining strength and mobility
Your discharge planner at the hospital will work with you and your doctor to coordinate home health services if needed. They'll help you select a Medicare-certified home health agency and ensure your plan of care is in place before you leave the hospital.
How to Access Medicare Home Health Care
If you think you might benefit from home health services, follow these steps:
1. Talk to Your Doctor
Discuss your care needs with your physician or healthcare provider. They'll evaluate whether home health care is appropriate for your condition and whether you meet Medicare's eligibility criteria.
2. Get a Doctor's Order
Your doctor must order home health care and create a plan of care that outlines:
- The specific services you need
- How often you'll receive care
- The goals of your treatment
- How long you'll need services
3. Choose a Medicare-Certified Agency
Select a home health agency that:
- Is certified by Medicare
- Serves your geographic area
- Has good quality ratings and reviews
You have the right to choose any Medicare-certified agency you prefer. You can compare agencies at Medicare Care Compare to see quality ratings, services offered, and patient satisfaction scores.
4. Begin Services
Once your doctor's order is in place and you've selected an agency, the home health agency will:
- Contact you to schedule an initial assessment
- Assign a care team
- Begin providing services according to your plan of care
- Coordinate with your doctor for regular updates
Planning for Home Health Care Costs
While Medicare provides valuable coverage for home health care, it's important to plan for the full scope of your care needs:
Consider Supplemental Coverage:
- Medigap (Medicare Supplement Insurance): Can help cover the 20% coinsurance for durable medical equipment
- Medicare Advantage plans: May offer additional home care benefits
- Long-term care insurance: Important for custodial care needs that Medicare doesn't cover
Explore Additional Resources:
- State Health Insurance Assistance Programs (SHIP): Free local counseling about Medicare benefits
- Area Agencies on Aging: Can connect you with local home care resources
- Medicaid: For those with limited income and assets who need long-term care
- Veterans benefits: Additional home care services for eligible veterans
Getting Help with Medicare Home Health Care
Navigating Medicare's home health care benefit can feel overwhelming, but you don't have to figure it out alone. Resources are available to help you understand your coverage and access the care you need.
If you’re feeling overwhelmed with choosing the best Medicare plan for your needs, try Healthpilot today; our tool provides you with a Summary of Benefits for each plan you compare, so you know exactly what is and isn’t covered when it comes to home health care.