[Last updated September 30, 2024]

A senior woman sits at a table in a brightly lit room of her home. She reads a newspaper.

Medicare is the federal health insurance program for people over the age of 65 and some younger people with disabilities. Medicare’s benefits are numerous, and one of those is home health care. However, for Medicare to cover home health care, you must meet specific criteria, and the services will be time-limited. Here, we will discuss when and how Medicare will cover home health care services to help you recover after an accident or illness. 

What is Medicare?

Medicare is a federal health insurance program for people over 65. It also covers some people under 65 who have certain health conditions or disabilities. Medicare comes in several parts, including the two core parts of original Medicare:

  • Part A: Hospital insurance.
  • Part B: Medical insurance.

Other optional parts of Medicare you may get include:

Since Medicare is health insurance, it covers only medically necessary care.

What is home health care? 

Home health care is skilled medical care provided in the home to care for someone with an illness or injury. The purpose of home health care is to help you recover and regain your independence. Family members may decide to hire a home health care worker for a limited time with a doctor’s prescription to assist someone who is recovering from an injury or who has a serious illness like terminal cancer.

Here are some of the more common home health care services:

  • Occupational, physical, and speech therapy.
  • Social work.
  • Skilled nursing care, such as wound care and injections.
  • Memory care.

Home health care services are provided by health care professionals, including:

  • Physicians.
  • Nurses.
  • Social workers.
  • Certified nursing assistants (CNAs).
  • Physical therapists.
  • Mental health therapists.

Home health care is not the same as home care

Note that while home health care and home care sound the same, they have key differences. Home health care refers explicitly to medical care in the home, while home care provides nonmedical assistance.

Nonmedical home care services include:

  • Assistance with activities of daily living (ADLs, such as bathing, dressing, grooming, eating, etc.).
  • Light housekeeping.
  • Transportation.
  • Companionship.
  • Personal care.

Home care aides commonly perform these tasks, and you can hire someone privately or through a home care agency. 

Home care services are typically not covered by Medicare. Since Medicare does not cover it, seniors can hire home care services without a doctor’s order and for longer periods of time than home health care. Most people pay for home care out of pocket.

Does Medicare cover home health care? 

Since home health care is medical care, Medicare provides coverage for some home health care services for a limited time as long as you are primarily homebound and the services are medically necessary. You must be under the care of a doctor who is certified under Medicare, and the doctor must prescribe the home health care services. 

For Medicare to pay for home health care services, you must meet the requirements, which may include having had a three-day inpatient stay at a hospital or having received short-term rehabilitation care in a skilled nursing facility that Medicare covers. Medicare covers home health care for a limited time when you need it intermittently. According to Medicare.gov, “You won’t qualify for the home health benefit if you need more than part-time or ‘intermittent’ skilled care. You may leave home for medical treatment or short, infrequent absences for nonmedical reasons, like attending religious services. You can still get home health care if you attend adult day care.” 

There are no deductibles or coinsurance fees for home health services, although the deductible applies to durable medical equipment. 

Are there any home services that Medicare does not pay for?

Medicare won’t pay for home health care services if your doctor believes you’ll need them 24/7 or long-term.

Medicare will not fund services unless the person is under the care of a doctor and the services are medically necessary. For example, if a person’s only issue is depression and loneliness and needs a companion caregiver, it wouldn’t be covered under Medicare. Most people pay for nonmedical home care out of their pockets. 

Medicare will pay for nonmedical home care services only if you are also receiving medically necessary skilled care nursing services. For example, if a nurse comes to your home for a few hours or days per week to give you medical care, Medicare may also pay to have an aide to help you get to the bathroom, use the bathroom, and shower. In this scenario, Medicare may also pay for an aide who takes care of home tasks such as washing dishes and light housekeeping. 

How do home health care services work? 

If you need home health care services, the providers will ask for your Medicare card and bill Medicare directly for services. Before Medicare ends coverage of your services, your home health agency will give you a written notice called a Notice of Medicare Non-Coverage that advises of the date your services will no longer be covered by Medicare. 

If you think you still need services, you can file a fast appeal by following the instructions on your notice. 

Other resources for covering home health care services

Medicare can be of great value when you need home health services, but it won’t likely cover all of your expenses. You may be able to bill for additional services under Medigap, long-term care insurance, Medicaid, or VA benefits. However, it’s common for people to pay for home health care services out of their personal funds when necessary.