Medicare can cover home health care services when you need skilled nursing or therapy to recover from an illness, injury, or surgery, and you prefer to heal at home rather than in a hospital or facility. This benefit helps millions of older adults and people with disabilities stay safe and independent while receiving professional care. Coverage includes intermittent skilled nursing, physical therapy, occupational therapy, speech-language pathology, medical social services, and limited home health aide support.
Qualifying isn’t automatic. You must meet strict Medicare criteria, and your doctor must certify that the services are medically necessary. Many people assume Medicare pays for long-term custodial care or help with daily activities like bathing and dressing, but those services generally fall outside standard Medicare home health benefits.
Knowing the exact rules saves time, reduces frustration, and helps families plan effectively. This article explains the current 2026 requirements, common qualifying conditions, documentation needed, and what happens if you don’t meet the criteria.
Medicare Home Health Care Basics
Medicare Part A and Part B together cover eligible home health services when all qualifying conditions are met. Part A handles the skilled nursing and therapy components, while Part B covers medical social services, home health aide visits, and durable medical equipment ordered by the home health agency.
There is no deductible for home health care under Medicare when services are covered. You pay nothing for approved visits as long as the agency accepts Medicare assignment. This makes the benefit one of the most valuable parts of Original Medicare for people recovering at home.
Coverage is time-limited and intermittent. Medicare does not pay for 24-hour care, full-time aides, or services that are primarily custodial (help with daily living without skilled need).
How to Qualify for Home Health Care Under Medicare
Medicare requires four main conditions to be met at the same time for home health coverage:
You must be homebound. This means it takes considerable effort or help from another person or assistive device to leave home, and you leave mainly for medical appointments or short, infrequent absences for non-medical reasons (church, family events, haircuts). You are still considered homebound if you can drive short distances occasionally or leave with help for short periods.
Your doctor must certify that you need skilled care. Skilled services include intermittent skilled nursing (wound care, IV therapy, injections), physical therapy to restore function, occupational therapy, or speech therapy. The need must be specific, measurable, and require the skills of a licensed professional.
A Medicare-certified home health agency must provide the care. The agency develops a plan of care based on your doctor’s orders and conducts regular assessments. Only agencies approved by Medicare can bill for covered services.
The care must be part-time or intermittent. Medicare defines this as skilled nursing or therapy visits up to 28 hours per week combined, with home health aide services up to 35 hours per week in limited circumstances. Full-time or continuous care is not covered.
The Homebound Requirement Explained
Being homebound does not mean you are bedridden or never leave the house. Medicare considers you homebound if leaving requires a taxing effort, such as needing help from another person, using a walker or wheelchair, or experiencing significant pain or fatigue.
Acceptable absences include attending religious services, going to adult day care, getting a haircut, or attending family gatherings for short periods. Driving yourself short distances occasionally does not disqualify you if the effort to leave home remains taxing.
The home health agency documents your homebound status at the start of care and during recertification periods (every 60 days). Your doctor must recertify the need for home health services and homebound status at these intervals.
Skilled Care Requirement in Detail
Medicare only covers services that require the skills of a licensed professional. Examples include:
- Skilled nursing: wound dressing changes, teaching injection techniques, managing IV medications, assessing unstable conditions.
- Physical therapy: therapeutic exercises to restore mobility after a stroke or hip fracture.
- Occupational therapy: training in adaptive equipment or energy conservation techniques after a neurological event.
- Speech therapy: exercises to regain swallowing or communication skills after a stroke.
Custodial care—help with bathing, dressing, eating, or toileting—is not covered unless it is incidental to skilled services. If skilled needs end, coverage stops even if you still need help with daily activities.
Doctor Certification and Plan of Care
Your doctor must certify in writing that you meet all four qualifying criteria: homebound status, need for skilled intermittent care, care provided by a Medicare-certified agency, and part-time/intermittent services. The certification must be signed before or shortly after the start of care.
The home health agency creates a detailed plan of care that outlines the specific services, frequency, duration, and goals. Your doctor reviews and signs off on this plan. Recertification occurs every 60 days, with the agency submitting updated documentation showing continued need.
If the doctor or agency does not complete certification or recertification properly, Medicare denies coverage for those services.
Comparison of Medicare Home Health Coverage vs. Other Common Options
Medicare home health differs from long-term care services and private-pay options. Here is a comparison table:
| Coverage Type | Who Qualifies | Skilled Care Covered? | Custodial Care Covered? | Cost to You (2026) | Duration Allowed | Key Limitation |
|---|---|---|---|---|---|---|
| Medicare Home Health | Homebound + skilled need + doctor certification | Yes | Only if incidental to skilled | $0 for approved visits | Intermittent/part-time only | No 24/7 care; must be skilled |
| Medicare Advantage (Part C) | Varies by plan | Usually mirrors Original | Varies (some add limited) | Often $0 copay | Varies by plan | May have network restrictions |
| Medicaid Home Care | Low-income + state rules | Yes | Yes (long-term) | Usually $0 | Can be long-term/continuous | Strict income/asset limits |
| Private Pay / Long-Term Care Insurance | Anyone who can pay | Yes | Yes | Full cost ($25–$40/hour+) | As long as needed | Very expensive without insurance |
| Veterans Affairs Home Care | Eligible veterans | Yes | Yes (limited) | Usually $0 or low copay | Varies by priority group | Must meet VA eligibility criteria |
Medicare home health is strong for short-term skilled recovery but does not replace long-term custodial support.
Common Qualifying Conditions and Examples
Medicare approves home health most often after major events that require skilled intervention at home:
- Recent hospitalization for hip fracture, stroke, or heart failure needing physical therapy and nursing monitoring.
- Chronic wound care (e.g., diabetic ulcers, surgical wounds) requiring skilled dressing changes.
- Post-surgical recovery with IV antibiotics or pain management.
- Neurological conditions (e.g., Parkinson’s, multiple sclerosis) needing therapy to maintain function.
- Congestive heart failure exacerbations requiring teaching on medication management and daily weights.
Coverage is not automatic even with these conditions. The doctor must document the specific skilled services needed and why they cannot be managed through outpatient visits.
What Medicare Home Health Does Not Cover
Medicare does not pay for 24-hour-a-day care at home. Full-time aides, homemaker services, or companions fall outside the benefit. Meals-on-wheels, transportation, or home modifications are also excluded.
Custodial care—help with bathing, dressing, toileting, eating, or mobility when no skilled need exists—is not covered. If skilled services end, home health coverage stops even if you still need daily assistance.
Blood draws, injections, or catheter changes may be covered only if they require skilled nursing judgment. Routine foot care or simple medication reminders do not qualify.
Steps to Get Started with Medicare Home Health
Talk to your doctor about whether home health services are appropriate. The doctor must document the skilled need, homebound status, and order specific services.
Your doctor refers you to a Medicare-certified home health agency. The agency conducts an in-home assessment, develops a plan of care, and submits it to your doctor for signature.
The agency begins services once Medicare approves the plan. You receive intermittent visits from nurses, therapists, or aides according to the schedule. The agency recertifies need every 60 days with your doctor’s approval.
Summary
Medicare covers home health care when you are homebound, need intermittent skilled services (nursing or therapy), have a doctor’s certification, and use a Medicare-certified agency. Coverage is $0 for approved visits, but it is limited to part-time skilled care—not 24/7 help or custodial support. Common qualifying scenarios include recovery from surgery, stroke, fractures, or managing chronic wounds and unstable conditions.
The process starts with your doctor’s assessment and referral to a certified agency. Strict documentation of homebound status and skilled need is required for approval and continued coverage. If you do not meet the criteria, explore Medicaid, long-term care insurance, or private-pay options for additional support.
FAQ
What are the four main requirements to qualify for Medicare home health care?
You must be homebound (leaving home requires considerable effort), need intermittent skilled care (nursing or therapy), have a doctor certify the need, and receive services from a Medicare-certified agency. All four must be met simultaneously.
Does Medicare cover 24-hour home health care or full-time aides?
No. Medicare covers only intermittent or part-time skilled services (up to 28 hours/week of skilled nursing/therapy combined). Full-time aides or 24-hour care is not covered, even if you need help with daily activities.
Is home health care free under Medicare if I qualify?
Yes, approved home health visits have no cost to you when provided by a Medicare-certified agency that accepts assignment. There is no deductible or coinsurance for covered home health services.
How long can I receive Medicare home health care?
Coverage continues as long as you meet all four qualifying criteria and your doctor recertifies need every 60 days. There is no strict time limit, but services must remain skilled and intermittent.
Can I get home health care if I live alone?
Yes, living alone does not disqualify you. You are still considered homebound if leaving requires considerable and taxing effort, even without help. The agency assesses safety and support needs during the initial visit.
What happens if I no longer need skilled care but still need help at home?
When skilled needs end, Medicare home health coverage stops. You can transition to private-pay aides, Medicaid long-term services (if eligible), or long-term care insurance for custodial help with daily activities.
How do I find a Medicare-certified home health agency?
Ask your doctor for a referral, search the Medicare.gov Care Compare tool, or call 1-800-MEDICARE. The agency must be Medicare-certified to bill Medicare for covered services.
Dr. Hamza is a medical content reviewer with over 12+ years of experience in healthcare research and patient education. He specializes in evidence-based health information, medications, and chronic conditions. His reviews are grounded in trusted medical sources and current clinical guidelines to ensure accuracy, transparency, and reliability. Content reviewed by Dr. Hamza is intended for educational purposes and is not a substitute for professional medical advice.