Yes, Medicare covers home health care when a doctor certifies that you need part-time skilled nursing or therapy and you meet Medicare’s definition of “homebound.” Original Medicare pays the full cost of covered home health visits, with no deductible and no coinsurance for the visits themselves. The main exception is durable medical equipment, which carries a coinsurance charge after the Part B deductible is met.
This guide walks through who qualifies, exactly which services are included, what Medicare won’t pay for, what it costs, and how to get started, so you can make an informed decision about care for yourself or an aging parent.
What Is Home Health Care?
Home health care refers to skilled medical services delivered in a patient’s own home instead of a hospital, clinic, or skilled nursing facility. It’s built for people recovering from surgery, managing a chronic illness, or dealing with an injury that makes leaving home difficult or unsafe. Unlike non-medical caregiving, which focuses on companionship and daily task assistance, home health care is ordered by a physician and delivered by licensed clinicians, including registered nurses, physical therapists, occupational therapists, and speech-language pathologists.
For families weighing their options, our overview of skilled home health care services breaks down which clinicians typically visit, how often, and what a plan of care looks like day to day.
Does Medicare Cover Home Health Care?
Yes. Original Medicare, made up of Part A (hospital insurance) and Part B (medical insurance), covers medically necessary home health services for beneficiaries who meet specific eligibility rules. Depending on your situation, coverage may come from Part A, Part B, or a combination of both; either way, your out-of-pocket cost for covered visits is the same. A plan of care and certification is valid for a 60-day period and can be renewed by your doctor for additional 60-day periods for as long as you continue to meet the criteria.
Medicare Advantage (Part C) plans are required to cover at least the same home health benefits as Original Medicare, though some plans may require prior authorization or ask you to use an in-network agency. If you have a Medicare Advantage plan, confirm the specifics with your plan administrator before services begin.
Who Qualifies for Medicare Home Health Care?
To qualify for Medicare-covered home health care, you generally need to meet all of the following conditions:
- You need medically necessary, part-time or intermittent skilled nursing care, physical therapy, occupational therapy, or speech-language pathology services.
- You’re under the ongoing care of a doctor or allowed practitioner who creates and regularly reviews a written plan of care for you.
- Your doctor certifies, following a face-to-face assessment, that you’re “homebound.”
- You receive services from a Medicare-certified home health agency.
What does “homebound” actually mean? It doesn’t mean you’re confined to the house at all times. Medicare considers you homebound if leaving home requires considerable and taxing effort due to your condition, or if your doctor has advised against it. You can still qualify if you occasionally leave for medical treatment, religious services, or a licensed adult day care program.
What Home Health Services Does Medicare Cover?
Once you’re approved, Medicare-covered home health services can include:
- Skilled nursing care, such as wound care, injections, IV or nutrition therapy, and monitoring of a serious or unstable condition
- Physical therapy, when it’s provided as in-home physical rehabilitation under a certified plan of care
- Occupational therapy, including activities of daily living training that help patients relearn daily living tasks
- Speech-language pathology services for communication, cognition, or swallowing difficulties
- Medical social services, such as counseling or help connecting to community resources
- Part-time home health aide care, but only when it’s provided alongside skilled nursing or therapy
- Injectable osteoporosis drugs for women who meet specific criteria
- Durable medical equipment and medical supplies used as part of your treatment
What Medicare Does Not Cover
Medicare’s home health benefit is intentionally focused on short-term, skilled, medically necessary care. It does not pay for:
- 24-hour-a-day care at home
- Home-delivered meals
- Homemaker services, like shopping or cleaning, that aren’t tied to your care plan
- Custodial or personal care, like help bathing or dressing, when that’s the only kind of help you need
This is one of the most common points of confusion for families researching care options, and it’s worth exploring in more depth, including the difference between home health care and long-term custodial home care and how Medicare Advantage plans handle supplemental home care benefits — two topics we’ll cover in upcoming articles.
How to Get Started: A Step-by-Step Process
- Talk to your doctor about your condition and whether home health care is appropriate.
- Complete a face-to-face assessment, in person or by video, within the required timeframe.
- Receive a physician’s order and an approved plan of care outlining the services you need.
- Choose a Medicare-certified home health agency to provide your care.
- Begin services, with your care team coordinating visit frequency directly with your doctor.
Not every service requires this exact path. In California, for example, licensed physical therapists can evaluate and treat patients under direct access rules, which changes mobile outpatient rehabilitation without a referral for patients who aren’t pursuing the Medicare home health benefit specifically.
How Much Does Medicare Home Health Care Cost?
- You pay nothing out of pocket for Medicare-covered home health visits — no deductible, no coinsurance.
- After you meet the annual Part B deductible, you pay 20% of the Medicare-approved amount for durable medical equipment, like a walker or hospital bed.
- If you qualify, there’s no limit on the number of home health visits you can receive, though “part-time or intermittent” generally caps combined nursing and aide care at a set number of hours per day and per week unless your provider determines more is medically necessary.
Because deductible amounts are updated annually, always confirm the current-year figures directly with Medicare.gov or 1-800-MEDICARE before budgeting for care.
Home Health Care vs. Other Care Options
| Care Type | Where It Happens | Medicare Coverage | Referral Needed? |
| Home health care | Patient’s home | Covered at $0 if criteria are met | Yes, physician order |
| Outpatient therapy at home | Patient’s home | Covered under Part B, subject to deductible/coinsurance | Not always required |
| Assisted living | Residential facility | Generally not covered | No |
Home Health Care vs. Outpatient Therapy at Home
These two benefits are often confused because both can bring a therapist to your door. Home health physical or occupational therapy is part of a broader, physician-certified plan that typically starts after a hospitalization, surgery, or significant health event, and it requires homebound status. Outpatient therapy at home, by contrast, is available to patients who are mobile enough to leave the house but simply prefer, or benefit more from, one-on-one sessions in a familiar setting.
Many families don’t realize how much senior rehabilitation and functional independence can be supported at home, even outside a formal home health care episode. Understanding the distinction helps you and your doctor choose the right clinical pathway from the start.
Common Conditions That May Qualify for Home Health Care
Home health services are frequently ordered following a hospital stay, a joint replacement or other surgery, a stroke, a fall, or the worsening of a chronic condition such as heart failure, COPD, or diabetes. Cognitive conditions like dementia can also qualify for skilled nursing or therapy in the earlier stages, though as needs shift toward full-time supervision, families often need to look beyond Medicare’s home health benefit.
If you’re trying to understand what’s driving a loved one’s decline, our breakdown of chronic conditions affecting seniors’ independence is a useful starting point, and for families weighing whether a residential setting makes more sense, we’ve also compared aging in place versus assisted living communities so you can match the level of support to the level of need.
Frequently Asked Questions
What counts as "homebound" under Medicare's rules?
Homebound means leaving your home requires considerable and taxing effort because of an illness or injury, or that your doctor has advised against it. Occasional trips for medical care, religious services, or adult day care don't disqualify you.
How much does Medicare pay for home health care?
Medicare pays 100% of the cost for covered home health visits when you meet eligibility rules. You typically only pay 20% coinsurance for durable medical equipment after meeting your Part B deductible.
Who is eligible for Medicare home health services?
You're eligible if a doctor certifies that you need part-time or intermittent skilled nursing or therapy, you're homebound, you have a physician-approved plan of care, and you receive services from a Medicare-certified agency.
How long can you receive Medicare home health care?
There's no fixed limit on the number of visits, but your plan of care must be recertified by your doctor every 60 days for as long as skilled care remains medically necessary.
What is the difference between home health care and home care?
Home health care is skilled, medical, physician-ordered care, such as nursing or therapy. Home care (sometimes called custodial or personal care) covers non-medical help with daily tasks like bathing or meal prep, and Medicare generally doesn't cover it on its own.
Why would Medicare deny a home health claim?
Common reasons include insufficient documentation of homebound status, care that isn't considered medically necessary, missing physician certification, or using an agency that isn't Medicare-certified.
How do you find a Medicare-certified home health agency?
You can search Medicare's Care Compare tool online, or ask your doctor for a list of certified agencies that serve your area, along with any financial relationships they may have with those agencies.
What happens after the 60-day certification period ends?
If you still meet the criteria, your doctor can recertify your plan of care for another 60-day period. If your needs have changed, your care team will adjust the plan or help you transition to a different type of support.
Navigating Medicare's home health rules can feel overwhelming, especially while managing a recovery or caring for a loved one. If you're in the Los Angeles area and want help figuring out what's covered for your specific situation, Medicare-certified home health agency in Los Angeles can walk you through eligibility, coordinate with your physician, and get skilled care started in your home as quickly as your plan allows.