Medicare & Home Care

What Does Medicare Cover for Care at Home?

Original Medicare may cover medically necessary home health services when a person meets Medicare’s requirements. It generally does not pay for ongoing nonmedical help or round-the-clock care at home.

What Home Health Services May Medicare Cover?

• Part-time or intermittent skilled nursing care
• Physical therapy, speech-language pathology, and qualifying occupational therapy
• Medical social services
• Part-time home health aide services when the patient is also receiving qualifying skilled care
• Certain medical supplies used at home
• Durable medical equipment, such as some walkers or wheelchairs, when Medicare requirements are met

Who Qualifies?

Coverage generally requires all of the following:

• A doctor or another allowed healthcare professional evaluates the patient and orders a home health plan of care.
• The patient needs qualifying skilled nursing or therapy on a part-time or intermittent basis.
• The patient is homebound under Medicare’s definition—leaving home is difficult, requires help, or is not recommended because of the person’s condition.
• The care is provided by a Medicare-certified home health agency.

Being homebound does not mean a person can never leave home. Limited trips for medical treatment, religious services, or short infrequent outings may still be permitted.

What Does Medicare Usually Not Cover?

• 24-hour care at home
• Meal delivery
• Shopping, cleaning, and homemaker services when they are unrelated to the medical care plan
• Ongoing personal or custodial care—such as bathing, dressing, or toileting—when that is the only care needed
• Long-term nonmedical supervision or companionship

What Will the Patient Pay?

Under Original Medicare, qualifying home health services generally have no copayment. For Medicare-covered durable medical equipment, the patient generally pays 20% of the Medicare-approved amount after the Part B deductible. Medicare Advantage plan networks, authorizations, and cost-sharing can differ, so members should contact their plan before care begins.

Questions to Ask Before Care Starts

• Has the healthcare provider ordered home health care?
• Is the agency Medicare-certified?
• Which services are covered, how often will they be provided, and for how long?
• Will anything be billed privately?
• Will the agency give written notice before providing a service Medicare may not cover?

Official Sources

Review the current rules on Medicare.gov’s home health services page and in the Medicare and Home Health Care booklet. For personal coverage questions, call 1-800-MEDICARE or contact the member’s Medicare Advantage plan.

This article provides general educational information and is not personal medical, insurance, or legal advice. Medicare rules and individual coverage can change. Confirm benefits directly with Medicare, the health plan, and the healthcare provider.