Medicare covers home health care under Parts A and B at no cost to the beneficiary when a doctor certifies that the patient is homebound and needs intermittent skilled nursing or therapy. In 2026, covered services include skilled nursing, physical and occupational therapy, speech-language pathology, medical social services, and part-time home health aide care. Medicare does not cover 24-hour care, meal delivery, or homemaker services. Care must be delivered by a Medicare-certified home health agency.
Medicare provides coverage for home health care services when certain conditions are met. Understanding what’s covered, what’s required, and how to access services can help you or your loved one receive quality care at home.
Medicare Coverage Overview
Part A or Part B Coverage
Home health care services can be covered under either Medicare Part A (hospital insurance) or Part B (medical insurance). The coverage is the same regardless of which part covers the services, and you typically won’t pay anything for covered services.
Covered Services Include:
Medicare covers skilled nursing care provided by licensed nurses, physical therapy for mobility and rehabilitation, occupational therapy for daily living skills, speech-language pathology services for communication and swallowing disorders, medical social services for counseling and care coordination, home health aide services on a part-time or intermittent basis for personal care assistance, medical supplies needed for patient care, and durable medical equipment required for treatment.
Eligibility Requirements
Basic Qualifications
To qualify for Medicare home health coverage, you must meet all of the following requirements:
1. Under Doctor’s Care:
You must be under the care of a doctor who oversees your treatment, the doctor must certify you need home health care based on your medical condition, and the doctor must create and regularly review a plan of care that outlines your treatment needs.
2. Need Skilled Services:
You must need skilled nursing care on an intermittent basis, OR need physical therapy for rehabilitation, OR need speech-language pathology services for communication or swallowing disorders, OR continue to need occupational therapy after one of the above services has been provided.
3. Homebound Status:
You must be certified by a doctor as homebound, meaning leaving home requires considerable effort due to your condition, leaving home is medically contraindicated by your doctor, or your condition restricts your ability to leave home safely.
4. Medicare-Certified Agency:
Services must be provided by a Medicare-certified home health agency that has been approved by Medicare and meets Medicare quality standards for patient care and safety.
Covered Services in Detail
Skilled Nursing Care
What’s Covered:
Medicare covers skilled nursing services including wound care and dressing changes to promote healing, medication administration and monitoring for patients who cannot self-administer, IV therapy and injections provided by skilled nurses, catheter care for patients with indwelling catheters, blood pressure and vital signs monitoring to track health status, health assessments that evaluate overall condition, and patient and caregiver education to help manage care at home.
Frequency:
Skilled nursing services are provided on an intermittent or part-time basis rather than continuously. This is not full-time or round-the-clock care, but rather visits scheduled as medically necessary to provide required care, with regular monitoring and assessment to track the patient’s condition.
Physical Therapy
What’s Covered:
Medicare covers physical therapy services including mobility exercises to help patients move more easily, strength training to restore muscle function, balance and coordination therapy to reduce fall risk, pain management through therapeutic exercises, rehabilitation after injury or surgery to restore function, gait training to improve walking ability, and therapeutic exercises tailored to individual needs.
Requirements:
Physical therapy must be medically necessary for the patient’s condition, must be provided by a licensed physical therapist, must be ordered by the patient’s doctor, and must be part of the care plan that outlines treatment goals.
Occupational Therapy
What’s Covered:
Medicare covers occupational therapy including activities of daily living (ADL) training to help patients perform essential tasks, adaptive equipment training to use assistive devices safely, home safety assessments to identify and address hazards, fine motor skills therapy for hand function, cognitive rehabilitation to address thinking and memory issues, and energy conservation techniques to manage fatigue.
Coverage Details:
Occupational therapy can continue even if you no longer need other services, as it’s focused on improving independence and daily function. Home-based assessments are included to evaluate the patient’s living environment, and equipment recommendations are included to suggest helpful assistive devices.
Speech-Language Pathology
What’s Covered:
Medicare covers speech-language pathology services including communication therapy for speech and language disorders, swallowing therapy (dysphagia treatment) to address swallowing problems, cognitive-communication therapy to improve thinking and communication skills, voice therapy for voice disorders, aphasia treatment for language impairments caused by stroke or brain injury, and speech exercises to improve articulation and communication.
Coverage:
Speech therapy is provided when medically necessary for the patient’s condition, must be ordered by the patient’s doctor, is part of the comprehensive care plan, and is focused on rehabilitation to improve communication and swallowing function.
Medical Social Services
What’s Covered:
Medicare covers medical social services including patient and family counseling to help cope with health conditions, care coordination to ensure all providers work together, community resource connections that link patients with support services, support for coping with illness that provides emotional guidance, discharge planning assistance for smooth transitions, and emotional support during difficult times.
Coverage Details:
Medical social services are provided when medically necessary for the patient’s condition, are part of the comprehensive care plan, support overall treatment goals by addressing social and emotional needs, and help with care transitions between settings.
Home Health Aide Services
What’s Covered:
Medicare covers home health aide services including personal care services like bathing, dressing, and grooming for patients who need assistance, assistance with activities of daily living to help patients maintain independence, part-time or intermittent care rather than full-time services, and care that is related to skilled services being provided.
Requirements:
Home health aide services require that the patient is receiving skilled nursing or therapy services, must be part of the care plan developed by the doctor, must be medically necessary for the patient’s care, and are provided part-time or intermittently rather than continuously.
Limitations:
Home health aide services are not covered if that’s the only service needed without skilled nursing or therapy, must accompany skilled services as a supporting service, are provided part-time only and not full-time, and must be related to patient care only rather than general homemaking.
Medical Supplies and Equipment
What’s Covered:
Medicare covers medical supplies needed for patient care, durable medical equipment (DME) required for treatment, wound care supplies for dressing changes and wound management, medication administration supplies needed for injections or IV therapy, with coverage at 80% by Medicare Part B meaning Medicare pays 80% and you pay 20% coinsurance after meeting your Part B deductible.
Durable Medical Equipment:
Durable medical equipment covered includes wheelchairs when medically necessary for mobility, hospital beds for patients who need special positioning, oxygen equipment for respiratory needs, walkers for stability and balance, and other approved DME that is medically necessary and prescribed by a doctor.
What Medicare Does NOT Cover
Excluded Services
Services Not Covered:
Medicare does not cover full-time or round-the-clock care at home that requires constant supervision, meals delivered to your home even if medically necessary, homemaker services like shopping and cleaning that are not related to direct patient care, personal care services when that’s the only service needed without skilled nursing or therapy, 24-hour home care that provides continuous supervision, or services that are not medically necessary for the patient’s condition.
Other Exclusions:
Medicare also excludes custodial care which is long-term care services for daily assistance, services not ordered by a doctor who creates a plan of care, services from non-Medicare-certified agencies that don’t meet quality standards, services for conditions not medically necessary, and experimental or unproven treatments that aren’t recognized as standard care.
Costs and Payment
What You Pay
Covered Services:
For covered home health services, you pay $0 with no copayment required and no deductible for covered services. However, durable medical equipment has 20% coinsurance after your Part B deductible is met, meaning you pay 20% of the Medicare-approved amount for equipment.
Durable Medical Equipment:
For durable medical equipment, Medicare pays 80% of the approved amount, you pay 20% coinsurance as your share of the cost, this applies after your Part B deductible is met, and equipment must be medically necessary and prescribed by your doctor to qualify for coverage.
Out-of-Pocket Costs
Potential Costs:
Potential out-of-pocket costs include 20% coinsurance for durable medical equipment costs, services not covered by Medicare that you receive, additional services beyond what Medicare covers, equipment upgrades that exceed Medicare-approved amounts, and private pay services if you choose to pay out-of-pocket for non-covered care.
How Coverage Works
Initial Certification
First 60 Days:
During the first 60 days of home health care, your doctor certifies you need home health services, creates a plan of care that outlines your treatment, the agency provides services according to the plan, Medicare reviews your care periodically to ensure it remains necessary, and coverage continues if services remain medically necessary for your condition.
Recertification:
Every 60 days if continuing care is needed, your doctor must recertify that you still need home health services, the plan of care is reviewed and updated as needed, Medicare reviews the medical necessity of continuing services, and coverage can continue if you remain qualified and services are medically necessary.
Care Plan Requirements
Doctor Must:
Your doctor must create a written plan of care that details your treatment needs, review the plan regularly at least every 60 days to ensure it remains appropriate, certify medical necessity showing why services are needed, approve services provided by the agency, and supervise care delivery to ensure it meets medical standards.
Agency Must:
The home health agency must follow your doctor’s plan of care exactly as prescribed, provide services as ordered by your doctor, communicate regularly with your doctor about your condition and care, report changes in your condition promptly, and coordinate care with all your healthcare providers.
Accessing Covered Services
Step 1: Talk to Your Doctor
To access Medicare-covered home health services, discuss your need for home health care with your doctor. Your doctor will determine if you qualify based on your medical needs and homebound status, and will create a plan of care if you qualify for services.
Step 2: Choose a Medicare-Certified Agency
Select a home health agency that is certified by Medicare and meets federal quality standards. Your doctor or hospital may recommend agencies, or you can search for certified agencies in your area using Medicare’s Care Compare website.
Step 3: Initial Assessment
The agency will perform an initial assessment to evaluate your medical needs and home environment, determine what services you need based on your condition, and develop a detailed care plan that coordinates with your doctor’s orders.
Step 4: Begin Services
Once your care plan is approved by your doctor and the agency, services will begin according to the schedule in your plan of care, with caregivers visiting your home to provide the necessary medical services.
Step 5: Ongoing Care
Your care plan will be reviewed regularly by your doctor and the agency, services will continue as long as they are medically necessary for your condition, and coverage will be recertified every 60 days if ongoing care is needed.
Tips for Maximizing Coverage
Work with Your Doctor:
To maximize your Medicare coverage, keep your doctor informed of your condition and any changes, follow your doctor’s recommendations for care and treatment, attend follow-up appointments to maintain care continuity, and report changes in your condition promptly so your care plan can be adjusted as needed.
Choose Quality Agency:
When selecting an agency, choose a Medicare-certified agency that meets federal quality standards, check quality ratings available through Medicare’s Care Compare website, verify the services you need are available from the agency, and ensure good communication so you stay informed about your care.
Understand Your Coverage:
To maximize your Medicare coverage, know what’s covered under home health benefits, understand the requirements including homebound status and medical necessity, ask questions when you don’t understand coverage or requirements, and review your Medicare statements to ensure you’re not being charged incorrectly for covered services.
Common Questions
Can I choose my home health agency? Yes, you can choose any Medicare-certified home health agency that serves your area.
How long can I receive home health care? As long as you meet the requirements and care is medically necessary. There’s no set limit.
Will Medicare cover 24-hour care? No, Medicare covers intermittent or part-time care only, not full-time care.
Do I need to pay for covered services? No, covered home health services are provided at no cost to you (except 20% coinsurance for DME).
Medicare home health coverage provides valuable support for patients who qualify, enabling them to receive skilled medical care at home while maintaining independence and comfort.
