What Home Health Services Does Medicare Cover? Costs and Hours

Medicare covers a defined set of home health services at no cost to patients who qualify: skilled nursing, physical therapy, occupational therapy, speech-language pathology, part-time home health aide help, medical social services, and routine medical supplies. Durable medical equipment is also covered, but with a 20% coinsurance under Part B. To receive any of these home health services Medicare covers, you must be certified as homebound, need part-time or intermittent skilled care, and use a Medicare-certified home health agency working from a signed plan of care.¹

Who Qualifies for the Benefit

Three conditions have to line up. A health care provider must certify that you are homebound. You must need part-time or intermittent skilled nursing care or skilled therapy. And the care must be delivered by a Medicare-certified home health agency under a plan of care your provider establishes.¹

What Homebound Means

You are considered homebound if leaving the house requires a considerable and taxing effort because of illness or injury. That may mean you need a wheelchair, walker, cane, or crutches, or help from another person or special transportation. It can also mean a doctor has advised you not to leave home because of your condition.¹ Homebound does not mean housebound. Occasional outings for medical treatment, religious services, adult day care, or infrequent personal errands like a haircut or a funeral do not disqualify you.²

Face-to-Face Encounter and the Plan of Care

Before services begin, a physician or authorized practitioner (a nurse practitioner, clinical nurse specialist, or physician assistant) must see you in person or by telehealth. That encounter has to happen within 90 days before care starts or within 30 days after it begins.³ The certifying practitioner documents your clinical condition, confirms you are homebound, and states that skilled services are needed.² A signed plan of care must be in place before the agency can bill Medicare, and it must be reviewed and re-signed at least every 60 days if care continues.

Skilled Nursing Care

Medicare pays for skilled nursing when a registered nurse or a licensed practical nurse under RN supervision provides medically necessary care ordered in the plan. Covered tasks include wound care for pressure sores or surgical wounds, IV therapy, tube feedings, injections, patient and caregiver education such as diabetes management, and monitoring of serious or unstable health conditions.¹⁴ Tasks that could safely be handled by someone without medical training are not covered as skilled nursing.

Physical, Occupational, and Speech Therapy

Physical therapy, occupational therapy, and speech-language pathology are all covered. Therapy must be provided or supervised by a licensed therapist and must address a skilled need, whether the goal is restoring function, maintaining it, or slowing decline.¹ There are no specific dollar or visit caps under the home health benefit as long as the care remains medically necessary and you continue to meet the eligibility rules.⁵

One rule catches many families off guard. Occupational therapy alone cannot open the door to home health services. You must initially qualify through a need for skilled nursing, physical therapy, or speech-language pathology. Once one of those qualifying services is in place, occupational therapy can be added. If the qualifying service later ends, occupational therapy can continue on its own so that coverage does not stop.⁶

Home Health Aide Help

Medicare covers part-time or intermittent home health aide care, but only while you are also receiving a qualifying skilled service such as nursing or therapy. Aides can help with bathing, grooming, walking, feeding, and changing bed linens.¹ They are not licensed nurses; they provide personal care that complements the skilled plan.⁷ If you only need personal care and no skilled service, Medicare will not pay for aide visits.

Medical Social Services

A medical social worker can be included in your plan to help with social and emotional issues tied to your illness. That may mean counseling, connecting you and your family to community resources, or working through barriers to recovery such as financial pressure or inadequate support at home.⁵ Like aide care, medical social services depend on your also receiving a qualifying skilled service. Help completing a Medicaid application is not covered.⁸

Medical Supplies and Equipment

Medical supplies used at home, like wound dressings and catheters, are included in the home health payment at no cost to you. Durable medical equipment such as wheelchairs, walkers, and hospital beds is also covered when prescribed, but it is billed separately under Part B. After you meet the annual Part B deductible, you pay 20% of the Medicare-approved amount for the equipment.⁹ The equipment has to come from a Medicare-enrolled supplier.¹⁰

Injectable Osteoporosis Drugs

Medicare covers injectable osteoporosis drugs for women who meet three conditions: they qualify for home health services, they have a bone fracture certified by a doctor as related to postmenopausal osteoporosis, and a doctor certifies that neither they nor their family or caregivers can administer the injection.¹¹ The Part B deductible and 20% coinsurance apply.¹² Other prescription drugs taken at home are not part of the home health benefit.

Telehealth Visits

Home health agencies can build telehealth visits and remote patient monitoring into your care plan. Since July 2023 they have been required to report use of these technologies on their claims. That includes live video visits, audio-only phone visits, and remote collection of vital signs and other health data. Documentation has to show how the technology supports the goals in your plan of care.¹³

How Many Hours You Can Get

Home health care has to be “part-time or intermittent.” In practice, combined skilled nursing and home health aide services are limited to fewer than 8 hours a day and no more than 28 hours a week. A provider can authorize a short-term bump to 35 hours a week when medically necessary.¹ For skilled nursing on its own, “intermittent” means care needed fewer than 7 days a week, or daily for less than 8 hours a day for up to 21 days, with extensions possible in exceptional circumstances.⁴

There is no fixed limit on how many months or years you can receive home health services. As long as you keep meeting the eligibility rules and your plan of care is recertified every 60 days, coverage can continue.¹⁴

What Medicare Will Not Pay For

Several common types of home care fall outside the benefit:

24-hour care at home.
Custodial or personal care alone, with no skilled service also needed.
Homemaker services like cleaning, laundry, and shopping unrelated to the care plan.
Home-delivered meals.
Most prescription drugs taken at home, aside from the narrow osteoporosis exception described above.

These exclusions come from Medicare.gov and CMS guidance.¹¹⁵

What You Pay Out of Pocket

For covered home health services themselves, you pay nothing. No copay, no coinsurance, no deductible for skilled nursing visits, therapy, aide care, medical social services, or medical supplies furnished under the plan of care.¹⁶ The one cost-sharing item is durable medical equipment, which carries a 20% coinsurance after the Part B deductible.¹

If a home health agency believes Medicare will not cover a particular item or service, it has to give you a written Advance Beneficiary Notice. At that point you decide whether to accept the item and pay out of pocket or turn it down.¹

You Do Not Have To Be Getting Better

A persistent misconception holds that Medicare will only pay for home health care if you are expected to improve. That is not the law. The 2013 settlement in Jimmo v. Sebelius confirmed that Medicare covers skilled services when they are needed to maintain your current condition or to prevent or slow further decline, not only when improvement is anticipated.¹⁷ A person with a chronic, stable condition can still qualify if skilled care is necessary to manage that condition safely. CMS built the standard into its Medicare Benefit Policy Manual and trained contractors on it, though advocacy groups report that some beneficiaries are still wrongly denied on the basis of a perceived improvement requirement.¹⁸

If You Have Medicare Advantage

Medicare Advantage (Part C) plans have to cover the same home health services as Original Medicare. Access looks different in practice. Plans may require you to use an in-network home health agency, get prior authorization before care begins, or pay a copayment for visits.¹⁹ A University of Washington analysis of 2019 through 2022 data found that Medicare Advantage patients received fewer nursing, therapy, and aide visits than patients in Original Medicare and had modestly lower odds of improving in mobility and self-care, even after adjusting for medical complexity.²⁰ If no in-network agency will provide medically necessary care, the plan must cover an out-of-network provider.

If Coverage Is Denied or Cut

You have the right to appeal when Medicare refuses to cover home health services or a home health agency says it will stop or reduce care. The process depends on the situation.

Services ending too soon: the agency must give you a written notice at least two days before the last day of covered care. To challenge it, contact the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO) by noon of the day after you receive the notice. The QIO issues a decision within 72 hours.²¹
Services being reduced: the agency should give you a Home Health Advance Beneficiary Notice. You can request a “demand bill,” asking the agency to continue care and bill Medicare. If Medicare denies the claim, you can file a formal appeal.²²
Later appeal levels: if the initial decision goes against you, further steps include reconsideration by a Qualified Independent Contractor, a hearing before an Administrative Law Judge, and additional review. The full process has five levels.²³

Free counseling is available through the State Health Insurance Assistance Program (SHIP) at shiphelp.org, and you can designate a family member or other representative to handle the appeal for you.²³

Finding a Certified Agency

Medicare’s Care Compare tool at medicare.gov lets you search for certified home health agencies by location and compare them using quality ratings. Agencies receive a Quality of Patient Care Star Rating based on eight measures of clinical processes and outcomes, plus a separate patient survey rating that reflects care from the patient’s perspective.²⁴

When Medicaid Fills the Gaps

Medicare’s limits are real. It does not pay for custodial care alone, round-the-clock help, homemaker services, or meal delivery. For people who need those supports to stay at home, Medicaid is often the answer. Medicaid is the largest single payer for long-term care in the United States and covers roughly two-thirds of all home care spending.²⁵

Through Home and Community-Based Services (HCBS) waivers, states can cover personal care attendants, homemaker services, adult day care, respite care, home modifications, case management, and other non-medical supports that help people avoid institutional placement.²⁶ Eligibility is based on both functional need and financial criteria that vary by state, and many states maintain waiting lists because demand exceeds available slots.²⁵ If you qualify for both Medicare and Medicaid, Medicare typically pays first for skilled medical services and Medicaid covers remaining costs and non-medical care.²⁷

1
Medicare.gov. Home Health Services
2
CMS. Home Health Benefit Highlights
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CGS Medicare. Home Health Certification Requirements
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Medicare.gov. Medicare and Home Health Care
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MedicareInteractive.org. Home Health Covered Services
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Center for Medicare Advocacy. Medicare Home Health Coverage: Reality Conflicts With the Law
7
CMS. Home Health Benefits
8
CGS Medicare. Medical Social Services Coverage Guidelines
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Medicare.gov. Durable Medical Equipment Coverage
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Medicare.gov. Medicare Coverage of DME and Other Devices
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Medicare.gov. Osteoporosis Drugs
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CMS. Transmittal 26 – Osteoporosis Drug Benefit
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CMS. Telehealth and Remote Monitoring
14
Center for Medicare Advocacy. When Should Medicare Cover Home Health Care
15
MedicareInteractive.org. Services Excluded From Home Health Coverage
16
Medicare.gov. Medicare Costs
17
CMS. Jimmo v. Sebelius Settlement
18
Center for Medicare Advocacy. The Improvement Standard
19
MedicareInteractive.org. Medicare Advantage and Home Health
20
University of Washington. Analysis: Medicare Advantage Limits Home Health Care
21
Center for Medicare Advocacy. Self-Help Packet for Expedited Home Health Care Appeals
22
MedicareInteractive.org. Appealing a Reduction in Home Health Care
23
Medicare.gov. Medicare Appeals
24
Medicare.gov. Care Compare: Home Health
25
KFF. What Is Medicaid Home Care (HCBS)
26
Medicaid.gov. Home and Community-Based Services 1915(c)
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MedicareInteractive.org. Medicaid Eligibility for Medicare Beneficiaries Who Need Long-Term Care