Does Medicare cover home health care?

Yes, Medicare provides some coverage for home health care, but you must meet specific criteria, particularly if you’re mostly or entirely confined to your home. Medicare will cover part-time or intermittent skilled nursing care, therapy and other aid that’s determined to be medically necessary and that your doctor orders.

But Medicare won’t pay for care to help you with activities of daily living, such as bathing, dressing, eating or going to the bathroom if that’s the only care you need.

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How do I qualify for Medicare home health benefits?

For you to be eligible for home health benefits, Medicare must approve the home health agency providing care and you must:

• Be homebound. That means you’re unable to leave home without considerable effort, the aid of another person or a device such as a walker or wheelchair.

• Have certification from a physician or other health care provider, such as a nurse practitioner, identifying that you need intermittent occupational therapy, physical therapy, skilled nursing care and/or speech-language therapy. This certification entails a documented face-to-face encounter with a doctor or medical professional occurring no more than 90 days before or 30 days after the start of your home health care.

• Be under a plan of care that a doctor or other health care provider establishes and reviews regularly. That plan should note all services needed and how often, which health care professionals should give the services, required supplies and the results your doctor anticipates. The doctor and home health team must review and recertify the care plan at least once every 60 days.

What Medicare home health benefits are available?

If you qualify for home health benefits, Medicare may cover the following services:

• Home health aides to help with personal activities such as bathing, dressing or going to the bathroom, if such help is necessary because of your illness or injury. Medicare covers these services only if you’re also receiving skilled nursing or therapy.

• Medical social services, like counseling for social or emotional concerns related to your illness or injury if you’re receiving skilled care. It also covers help in finding community resources if you need them.

• Occupational, physical and speech therapy with professional therapists to restore or improve your ability to perform everyday tasks, speak or walk after an illness or injury, or to prevent your condition from getting worse.

• Skilled nursing care on a part-time or intermittent basis that requires more active care, such as changing wound dressings, assisting with feeding and injecting medicine through a feeding tube. Medicare stipulates the care must be provided fewer than seven days each week or daily for less than eight hours each day for up to 21 days.

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Medicare may extend that limit if your doctor can predict when your need for daily skilled nursing care will end. Full-time or long-term nursing care typically wouldn’t qualify for home health benefits.

If you qualify, you pay nothing for home health care services from a home health agency. Other medical services, such as visits to your doctor, are covered under your other Medicare benefits.

You may also have coverage for some supplies, such as catheters and wound dressings related to your condition when your home health agency provides them. This might include durable medical equipment from the home health agency like walkers or wheelchairs.

Medicare Part B covers equipment and supplies. But you’ll have to pay the Part B coinsurance, which is 20 percent of the Medicare-approved amount, after you pay your $240 Part B deductible for 2024.

What home health care services won’t Medicare cover?

• 24-hour at-home care

• Custodial or personal care for help with daily living activities — if that’s the only care you need

• Household services, such as shopping, cleaning and laundry when they’re not related to your care plan

• Meal delivery to your home

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How do I find Medicare-covered home health care?

Medicare.gov has a search and comparison tool to help you find certified home health agencies in your area that Medicare covers.

If you have coverage from a private Medicare Advantage plan, rather than original Medicare, you may have to use an agency that works with that plan. Some plans also provide in-home support services to help with activities of daily living.

Before you start receiving care, the agency should let you know, both verbally and in writing, of services Medicare won’t cover and what you can expect to pay for them.

Keep in mind

You may be able to get additional caregiving support through local and state programs, such as adult day programs, equipment, meal delivery, respite care for caregivers and transportation. You can find out more about programs in your area through your Area Agency on Aging. Type your zip code or city and state into the U.S. Administration on Aging’s Eldercare Locator, or call 800-677-1116, to find contact information for your local agency or other resources.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at Kiplinger’s Personal Finance and has written for The Washington Post and Boston Globe. She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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