Medicare Home Health Care: What It Covers and How to Qualify

Medicare home health care allows beneficiaries to receive skilled medical services in their own home -- avoiding or shortening hospital and nursing facility stays. It is one of Medicare's most valuable benefits, yet many beneficiaries don't know they qualify. Here is how it works.

To receive Medicare home health benefits, you must meet all four criteria:

1. You must be homebound. Homebound means leaving home requires a considerable and taxing effort. You may still qualify if you occasionally leave home for medical appointments, adult day care, or brief outings -- but leaving home must be difficult.

Examples of homebound conditions: recovering from surgery, severe shortness of breath, significant weakness, cognitive impairment requiring supervision, or use of a wheelchair or walker.

2. You must need skilled care. Medicare home health covers skilled services -- care that requires the training of a licensed professional:

• Skilled nursing (wound care, IV therapy, medication management, monitoring complex conditions)
• Physical therapy
• Occupational therapy
• Speech-language pathology

3. Your doctor must order the services. A Medicare-enrolled physician, nurse practitioner, or physician assistant must certify that you are homebound and need skilled care, and must create a plan of care.

4. You must use a Medicare-certified home health agency. The agency providing your care must be certified by Medicare.

Skilled nursing visits: Registered nurses or licensed practical nurses providing wound care, IV antibiotic administration, catheter care, medication teaching, monitoring of complex conditions, and more.

Physical therapy: Exercises and treatments to restore strength, mobility, and function after illness, injury, or surgery.

Occupational therapy: Training in daily living activities -- bathing, dressing, cooking -- and adaptive equipment to maintain independence.

Speech-language pathology: Treatment for swallowing disorders, speech problems, and cognitive-communication issues.

Home health aide services: Personal care (bathing, grooming, dressing) -- but only when skilled nursing or therapy is also being provided. Aide services alone do not qualify for Medicare home health.

Medical social services: Counseling and assistance with community resources, when related to the medical condition.

Medical supplies: Wound care supplies and other medical supplies used during home health visits.

• 24-hour-a-day care at home
• Meals delivered to the home
• Homemaker services (cleaning, laundry, shopping)
• Personal care (bathing, dressing) when that is the only care needed
• Custodial care without skilled need

Part A or Part B: Home health is covered under both Part A and Part B depending on circumstances. In either case, Medicare covers 100% of approved home health services -- no deductible, no coinsurance for the home health visits themselves.

Exception: 20% coinsurance applies to durable medical equipment provided through the home health agency.

There is no set limit on the number of home health visits Medicare covers -- as long as you remain homebound and continue to need skilled care. Coverage continues visit by visit, with periodic recertification by your doctor.

Use the Home Health Compare tool at medicare.gov/care-compare to find and compare Medicare-certified home health agencies in your area. Look at quality ratings, patient satisfaction scores, and whether the agency specializes in your condition.

We do not offer every plan available in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.