Most people would rather recover at home than in a facility, and Medicare can help make that possible. Medicare home health care covers part-time skilled nursing, therapy and related services in your home when you are homebound and a doctor orders the care. For people who qualify, covered home health services cost $0, with no limit on the number of visits as long as you continue to qualify.
This guide explains who qualifies for Medicare home health care, what the homebound and face-to-face rules mean, which services are covered and which are not, what you pay for medical equipment, how to choose a certified agency, and how Medicare Advantage plans handle home health benefits.
Quick answer: Medicare Part A and Part B cover home health care if you are homebound, need part-time or intermittent skilled nursing or therapy, have a face-to-face visit with a doctor or other provider, and get care from a Medicare-certified home health agency under a plan of care. You pay $0 for covered home health services and usually 20% of the Medicare-approved amount for durable medical equipment. Medicare does not cover 24-hour care or custodial care on its own. (Medicare.gov)
What Is Medicare Home Health Care?
Medicare home health care is medical care you receive at home to treat an illness or injury. It is usually short-term and aimed at helping you recover, regain independence or manage a condition safely at home.
Home health care is different from “home care” in the everyday sense. Many families picture a caregiver who helps with bathing, meals and housework every day. That kind of help is called custodial or personal care, and Medicare does not pay for it when it is the only care you need.
Medicare home health care focuses on skilled services that require a nurse or therapist, such as wound care, injections, physical therapy after surgery, or teaching you and your family how to manage a new condition.
Who Qualifies for Medicare Home Health Care
To get Medicare home health care under Original Medicare, you must meet all of these conditions:
- You are homebound. Leaving home is difficult for you and takes a major effort.
- You need skilled care. You need part-time or intermittent skilled nursing, or physical therapy, speech-language therapy or continued occupational therapy.
- You are under the care of a doctor or other allowed provider, and you get services under a plan of care that the provider reviews regularly.
- You had a face-to-face visit with a doctor or other allowed provider related to the reason you need home health care.
- A Medicare-certified home health agency provides your care.
You do not need a hospital stay first. Many people start Medicare home health care after a hospital or skilled nursing stay, but your doctor can also order it if your health declines at home.
Who can order and certify your care
For many years, only a physician could certify that a patient needed Medicare home health care. Today, nurse practitioners, clinical nurse specialists and physician assistants can also order and certify home health services, as allowed by their state. This can make it easier to get care started, especially if your regular provider is a nurse practitioner.
Whoever certifies your care must also sign your plan of care. The plan lists the services you need, how often you will get them, which professionals will provide them and the goals you are working toward.
The Homebound Rule for Medicare Home Health Care
“Homebound” does not mean you can never leave the house. Medicare considers you homebound if both of these are true:
- You need help to leave home, such as a cane, walker, wheelchair, special transportation or another person, or your doctor advises against leaving because of your condition.
- You normally are unable to leave home, and leaving takes a considerable and taxing effort.
Trips that don’t break the homebound rule
You can still be homebound and leave home for:
- Medical appointments and treatment
- Adult day care
- Religious services
- Short, infrequent trips, such as a family event or a visit to the barber
If you drive yourself to the store several times a week or go out for long periods without help, you probably won’t meet the homebound rule.
The Face-to-Face Requirement for Medicare Home Health Care
Before Medicare home health care begins, a doctor or another allowed provider, such as a nurse practitioner or physician assistant, must see you, usually in person, and confirm that you need it. The visit must be related to the main reason you need home health services.
The face-to-face visit generally must happen within the 90 days before you start home health care or within the 30 days after. A visit during a hospital stay can count, and in some cases a telehealth visit can count too. Your doctor then certifies that you are homebound and need skilled care.
What Medicare Home Health Care Covers
When you qualify, Medicare covers these services in your home:
- Part-time or intermittent skilled nursing, such as wound care, injections, IV therapy, monitoring a serious illness, and teaching you or a caregiver how to manage your care
- Physical therapy to rebuild strength, balance and walking
- Occupational therapy to help you do daily activities safely
- Speech-language therapy after a stroke or for swallowing problems
- Medical social services to help with social and emotional concerns related to your illness
- Part-time home health aide services, such as help with bathing or dressing, but only while you are also getting skilled nursing or therapy
- Injectable osteoporosis drugs for certain women who meet specific conditions
- Medical supplies and durable medical equipment for use at home
What “part-time or intermittent” means
Skilled nursing and home health aide services combined are usually limited to fewer than 8 hours a day and 28 or fewer hours a week. Your provider can approve more care for a short time, up to 35 hours a week. If you qualify, there is no limit on the number of visits, as long as your provider recertifies your plan of care.
What Medicare Home Health Care Does Not Cover
Medicare does not pay for:
- 24-hour care at home
- Meals delivered to your home
- Homemaker services, such as shopping, cleaning and laundry, when they aren’t related to your care plan
- Custodial or personal care, such as bathing, dressing or using the bathroom, when this is the only care you need
This is the biggest surprise for many families. If a parent needs daily supervision because of dementia but has no skilled medical needs, Medicare will not pay for an aide. For that kind of help, families usually turn to Medicaid, long-term care insurance or private pay.
What You Pay for Medicare Home Health Care in 2026
| Service | What you pay with Original Medicare |
|---|---|
| Skilled nursing visits | $0 |
| Physical, occupational and speech therapy | $0 |
| Home health aide (with skilled care) | $0 |
| Medical social services | $0 |
| Durable medical equipment | 20% of the Medicare-approved amount after the $283 Part B deductible |
| Care Medicare doesn’t cover | 100%, after the agency gives you written notice |
There is no deductible or coinsurance for Medicare home health care services themselves. The 20% for equipment such as a walker, wheelchair or hospital bed is where most people see a bill. Many Medigap plans pay some or all of that 20%.
If you have Medicaid as well as Medicare, Medicaid may pay the 20% for equipment. If you have a Medicare Advantage plan, your equipment costs count toward the plan’s yearly out-of-pocket limit, which can be up to $9,250 in network in 2026.
The agency must tell you, both verbally and in writing, about any items or services Medicare won’t pay for before you receive them. If it believes Medicare won’t cover a service, it should give you an Advance Beneficiary Notice so you can decide whether to go ahead.
Durable Medical Equipment at Home
Medicare home health care often comes with equipment needs. Part B covers durable medical equipment your doctor orders for use in your home, such as:
- Walkers, canes and crutches
- Wheelchairs and scooters
- Hospital beds
- Oxygen equipment
- Commode chairs
Medical supplies during home health care
Supplies your home health agency uses as part of your care, such as wound dressings and catheter supplies, are generally included at no cost to you while you get covered home health services. Equipment you keep using over time, like a walker or hospital bed, is billed separately under Part B.
Ask the agency nurse which supplies they will bring and which items you need to order through a medical equipment supplier. Getting this clear at the first visit avoids delays and surprise bills.
To keep costs down, use a supplier that is enrolled in Medicare and accepts assignment. Learn more in our guide to Medicare durable medical equipment.
Part A or Part B: Who Pays for Medicare Home Health Care?
Home health care can be paid by either Part A or Part B, and you don’t usually need to worry about which one. In general, Part A pays for home health care that follows a qualifying inpatient hospital or skilled nursing facility stay, for a limited number of visits. Part B pays for home health care that doesn’t follow such a stay, or after the Part A visits are used.
Either way, you pay $0 for covered home health services. If you only have Part A or only have Part B, you can still get home health care through the part you have, subject to its rules. See our guides to Medicare Part A and Medicare Part B.
Choosing a Medicare-Certified Home Health Agency
Only a Medicare-certified home health agency can provide Medicare home health care. If you have a choice, compare agencies before you start. You can look up agencies near you, including quality ratings and patient survey results, with Medicare’s Care Compare tool.
Questions to ask an agency
- Are you certified by Medicare, and do you serve my neighborhood?
- Can you start care right away?
- Do you have nurses and therapists available for the services in my plan of care?
- Who do I call after hours or on weekends?
- Are you in my Medicare Advantage plan’s network?
In New York City, including Staten Island, demand for home health staff can be high, so it can help to have more than one agency in mind when a hospital discharge is approaching.
Medicare Home Health Care in Medicare Advantage Plans
Medicare Advantage plans must cover the same home health services as Original Medicare. However, the rules for getting care can be different:
- Network agencies: You usually must use a home health agency in the plan’s network.
- Prior authorization: Many plans require approval before Medicare home health care starts or continues.
- Costs: Most plans charge $0 for covered home health visits, but check your plan’s Evidence of Coverage. Equipment copays vary.
- Extra benefits: Some plans offer supplemental in-home support services, meal delivery after a hospital stay, or help with daily tasks that Original Medicare doesn’t cover.
Questions to ask your plan
- Which home health agencies near me are in your network?
- Do I need prior authorization, and how long does approval usually take?
- What do I pay for walkers, wheelchairs or a hospital bed?
- Do you offer any in-home support or meal benefits after a hospital stay?
If a plan denies or cuts back your home health care, you have the right to appeal. Learn more in What Is Medicare Advantage?
How to Start Medicare Home Health Care
- Talk to your doctor. Explain that leaving home is difficult and describe the help you need.
- Have the face-to-face visit. Your doctor or another allowed provider must see you and document your need.
- Get a referral. Your doctor orders home health care and signs the plan of care.
- Choose a certified agency. If you have a Medicare Advantage plan, choose one in network and confirm authorization.
- Have the first visit. A nurse or therapist assesses your needs and starts your care.
- Review progress. Your plan of care is reviewed and recertified as needed, usually every 60 days.
When Medicare Home Health Care Ends
Home health care usually ends when you no longer need skilled care, when you are no longer homebound, or when you reach your goals. The agency must give you written notice at least 2 days before your covered services end.
If you disagree, you can ask for a fast appeal. The notice explains how. If you need more help than Medicare home health care provides, ask about other options, such as Medicaid home care programs, long-term care insurance benefits or skilled nursing care. Our guide to Medicare nursing home coverage explains when a facility stay is covered.
Tips for family caregivers
- Be at the first visit if you can. The nurse or therapist will review medications, home safety and goals, and your input helps.
- Keep a simple log. Note each visit, who came and what they did. This helps if there is ever a question about care or billing.
- Ask to be taught. Teaching family members is a covered part of skilled nursing, so ask the nurse to show you how to change a dressing or use equipment.
- Make the home safer. Therapists can suggest grab bars, shower chairs and ways to reduce fall risk.
- Speak up early. If visits are missed or your loved one isn’t improving, call the agency and the doctor right away.
Medicaid Home Care in New York
For long-term personal care at home, Medicaid is often the main source of help. New York Medicaid offers home care programs that can pay for personal care aides for people who qualify based on income, assets and care needs. These programs can cover help that Medicare home health care doesn’t, such as ongoing help with bathing and dressing.
If you have both Medicare and Medicaid, read our guide to dual eligible Medicare and Medicaid.
Medicare Home Health Care Examples
Example 1: Patricia after knee replacement
Patricia, 71, has knee replacement surgery and goes home using a walker. Leaving home takes a lot of effort, so her surgeon orders Medicare home health care. A physical therapist visits three times a week and a nurse checks her incision. She pays $0 for the visits and 20% of the Medicare-approved amount for her walker.
Example 2: George with heart failure
George, 78, lives in Staten Island and has heart failure. After a hospital stay, a nurse visits to check his weight, adjust his medications with his doctor and teach his wife what warning signs to watch for. His Medicare Advantage plan approves the care through a network agency.
Example 3: Helen needs daily help only
Helen, 84, has memory loss and needs help bathing and dressing every day, but she has no skilled medical needs. Medicare won’t pay for an aide on its own. Her family applies for a New York Medicaid home care program and also looks into her long-term care insurance policy.
Common Mistakes With Medicare Home Health Care
- Assuming Medicare pays for daily caregivers. Custodial care alone is not covered.
- Thinking homebound means bedbound. You can still go to medical appointments and church.
- Skipping the face-to-face visit. Without it, Medicare won’t pay.
- Using an agency that isn’t Medicare-certified or isn’t in your plan’s network.
- Not asking about equipment costs. Durable medical equipment usually has a 20% share.
- Ignoring the end-of-care notice. You have a right to a fast appeal.
Frequently Asked Questions About Medicare Home Health Care
How long does Medicare home health care last?
There is no set limit. As long as you remain homebound, need skilled care and your doctor recertifies your plan of care, Medicare can keep paying.
Do I need a hospital stay first?
No. A hospital stay is not required. Your doctor can order home health care if you meet the other conditions.
Does Medicare pay for a home health aide?
Only part-time, and only while you also get skilled nursing or therapy. Medicare doesn’t pay for an aide if that is the only care you need.
What does Medicare home health care cost?
Covered home health services cost $0. You usually pay 20% of the Medicare-approved amount for durable medical equipment after the Part B deductible.
Can I choose my home health agency?
Yes, with Original Medicare you can choose any Medicare-certified agency that serves your area. With Medicare Advantage, you usually need to use an agency in the plan’s network.
Is hospice the same as Medicare home health care?
No. Hospice is comfort care for people with a terminal illness. See our guide to the Medicare hospice benefit.
Get Help Understanding Medicare Home Health Care
When a loved one comes home from the hospital, the right plan can make the transition easier. We can help you understand Medicare home health care, compare Medicare Advantage plans and their network agencies, and find a Medigap plan that helps with equipment costs. Caring Curations is an independent Medicare agency at 26 Bolivar St in Staten Island, New York, and we work with plans from multiple carriers.
Book a free Medicare consultation or call 848-257-9344. We are licensed in 25 states, and our help is always free.
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