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Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services if you meet all of these conditions:

  • You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.

  • You must need, and a doctor must certify that you need, one or more of these:

    • Intermittent skilled nursing care (other than drawing blood)

    • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe, and an effective treatment for your condition. The amount, frequency, and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).

    • You must be homebound, and a doctor must certify that you're 

      homebound.

You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.

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Your costs in Original Medicare

  • You pay nothing for all covered home health visits.

  • You pay 20% of the Medicare-approved amount, and the Part B deductible

     applies, for Medicare-covered medical equipment.

  • Eligible home health services include:

  • Part-time or intermittent skilled nursing care

  • Part-time or intermittent home health aide care

  • Physical therapy

  • Occupational therapy

  • Speech-language pathology services

  • Medical social services

  • Medicare doesn't pay for:

  • 24-hour-a-day care at home

  • Meals delivered to your home

  • Custodial or personal care (help bathing, dressing, and using the bathroom) when this is the only

  • care you need

  • Homemaker services

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  • Things to know

  • Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren't covered by Medicare, and how much you'll have to pay for them. This should be explained by both talking with you and in writing. The home health agency should give you a notice called the "Advance Beneficiary Notice of Noncoverage" (ABN) before giving you services and supplies that Medicare doesn't cover.

  • You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care. 

  • Home health services may also include medical supplies for use in your home, durable medical equipment, or injectable osteoporosis drugs.

How to Qualify for Home Health

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