Recovering at Home with Medicare: What You Need to Know
Experiencing a health emergency, like an injury from a fall or a heart attack, often requires hospitalization. While your hospital stay may only be for a short time, you may need assistance when you return home. Medicare can provide home health care services to help you during your recovery.
If you’re asking yourself, “Does Medicare cover home health care?”, the answer is yes, but coverage depends on several factors, including your health needs and whether you’re homebound.
Let’s break down everything you need to know.
What Is Home Health Care?
Home health care includes a range of medical and support services delivered in your home to help you recover from illness, injury, or surgery.
Covered services may include:
- Intermittent skilled nursing care
- Physical, occupational, and speech therapy
- Home health aide services (with skilled care)
- Medical social services
- Durable medical equipment (DME), like walkers or wheelchairs
This type of care helps you stay out of the hospital or nursing facility while receiving professional support at home.
Does Medicare Cover Home Health Care Under Part A or Part B?
Yes — Medicare covers home health care under both Part A and Part B, depending on your situation.
| Scenario | Medicare Coverage |
|---|---|
| After a qualifying hospital or skilled nursing facility stay (3+ days) | Part A |
| No prior hospitalization, but you meet home health criteria | Part B |
Here’s an example:
You’re hospitalized after a fall and need knee surgery. After your 3-day hospital stay, you’re discharged home. If your physician states you’re homebound and need short-term skilled care, Medicare will likely cover home health care under Part A. If you weren’t hospitalized but are homebound and require skilled care, Part B may cover your care.
What are Medicare’s criteria for providing in-home nursing care?
1. To qualify for home health care, you must meet the following criteria:
- Be considered homebound based on the Centers for Medicare & Medicaid (CMS) criteria,
- Require skilled care on a part-time or intermittent basis to improve, maintain, prevent, or further slow your health condition,
- Be under the care of a nurse practitioner, clinical nurse specialist, physician’s assistant, or doctor, who completes and documents an in-person visit with you either:
-
- three months before the start of home health care, or
- within one month after the home health care benefit has begun.
- Receive home health care from a Medicare-approved home health agency.
How Long Will Medicare Cover Home Health Services?
As long as it’s medically necessary and you continue to meet eligibility requirements, Medicare will cover home health services.
But it must be:
- Intermittent care (not 24/7 or long-term)
- Reviewed and renewed regularly by your physician
💡 You’re typically not eligible for full-time, long-term skilled nursing under Medicare’s home health benefit.
But what exactly does that mean? Well, let’s say you end up in the hospital after a fall and get surgery on your knee. After spending at least three days in the hospital, it’s time to get discharged, but you have not completely healed. The discharge documents from your physician will include information about you being homebound and needing short-term skilled care.
The documents will also include a plan of care that notifies Medicare and health care agencies of the services and equipment you will need while being cared for. Once this happens, you are now eligible to receive home health care from a Medicare-approved agency. Using a home health agency that’s certified by Medicare can help you reduce your out-of-pocket costs.
What Does Medicare Cover in Home Health Care?
Medicare covers many services when provided through a certified home health agency:
Skilled Services:
- Registered nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology
Additional Services:
- Medical social work
- Home health aide services (only if you’re also receiving skilled care)
- Some telehealth services (expanded under recent laws)
Durable Medical Equipment (DME):
- Medicare covers 80% of approved DME costs
- Examples: wheelchairs, walkers, hospital beds, oxygen
Tip: Your home health agency can help coordinate delivery of equipment to your home.
What Medicare Does Not Cover
It’s important to know what Medicare doesn’t cover under the home health benefit.
Medicare does not pay for:
- 24-hour or round-the-clock home care
- Meal delivery or meal prep
- Housekeeping or homemaker services
- Personal care (bathing, dressing, toileting) unless paired with skilled services
- Long-term nursing home care
If Medicare denies coverage for a service, your agency must provide an Advance Beneficiary Notice (ABN) in writing. You can then choose whether to pay out-of-pocket or appeal the decision.
What Will You Pay for Home Health Care?
Here’s a simple breakdown of costs under Original Medicare:
| Service | Cost to You |
|---|---|
| Home health services | $0 |
| Durable medical equipment | 20% of Medicare-approved amount |
| Doctor or specialist visits | Standard Part B deductible applies |
Ask the home health agency for a written explanation of costs before care begins — especially if they suggest additional services.
Under Medicare’s rules, you qualify for home health services if you need intermittent skilled nursing care. Medicare will continue to cover these services as long as they are deemed medically necessary and you meet the criteria for being homebound. Typically, you are considered homebound if it’s very difficult and tiring for you to leave home. This can include needing help from another person, or using a wheelchair, crutches, or other support devices.
Medicare may cover custodial care (long-term care), or non-skilled personal care, in some cases.
Non-skilled personal care includes help with activities of daily living (ADLs) like bathing, dressing, toileting, and other tasks that don’t require the skills of a registered nurse (RN). Agencies that offer these services are referred to as home care agencies, not to be confused with home health care agencies that offer home health care services. The professionals providing direct care on behalf of these agencies are called home health aides.
Are home care (vs. home health care) services covered by Medicare? If you meet the conditions for home health care and you’re also receiving skilled nursing care or other types of therapy, Medicare will cover home health aide services on a part-time or intermittent basis as part of your overall home care.
Medicare and Custodial Care: What’s the Difference?
Home health care is different from home care or custodial care, which includes non-medical help like bathing, dressing, or cooking.
| Service Type | Covered by Medicare? | Provided by |
|---|---|---|
| Skilled home health care | ✅ Yes | Medicare-approved agency |
| Home care / personal care only | ❌ No (unless part of skilled care) | Home care agency |
Does Medicare Cover Nursing Home Care?
No. Medicare’s home health care benefit is not a long-term services and supports program, and it does not provide unlimited coverage. If your care includes any of the following services: 24-hour care, meal delivery, homemaker services, and/or personal care Medicare will generally not cover the cost.
Medicaid sometimes pays for services to keep seniors in their homes. The services covered and requirements for enrollment vary by each state’s Home and Community Based Services program.
However, Medicaid or state programs may offer:
- Adult day care
- Homemaker services
- Chore assistance
- Personal care vouchers
Explore options using BenefitsCheckUp® or contact your State Health Insurance Assistance Program (SHIP) for free Medicare counseling.
You aren’t typically eligible for Medicare home health benefits if you need full-time skilled nursing care for an extended time period.
If there are any home-based services that Medicare will not cover, your home health agency must advise you in writing through something called an Advance Beneficiary Notice of Noncoverage (ABN). If you disagree with Medicare’s decision to not provide coverage, you may be able to file an appeal.
While you’re recovering at home, you may require certain assistive equipment such as a wheelchair or walker. Medicare also covers durable medical equipment—typically 80% of the Medicare-approved amount—as long as it meets certain criteria. You can often get the equipment you need through your home health agency and get it delivered directly to your door.
If you are enrolled in original Medicare or Medicare Advantage, you pay nothing for home health care services.
But you may be responsible for 20% of the Medicare-approved amount for durable medical equipment and the standard Part B deductible applies.
Ask the home health care agency about what services Medicare will pay for and what is not covered, as some agencies may recommend services not covered by Medicare. Home health agencies must notify you of the cost of services in writing before starting care.
It’s important to know the difference between home health care and home care.
Even with all this information, differentiating between home care and home health care can be confusing. Below is a chart to help highlight some of the major differences and similarities in services covered, enrollment requirements, and payment options.
FAQs About Medicare and Home Health Care
1. Can I get home health care without being hospitalized?
Yes. If you meet Medicare’s criteria under Part B, hospitalization is not required.
2. Does Medicare cover home health aides?
Yes — but only when you’re also receiving skilled services like nursing or therapy.
3. How often can I receive home health care?
As long as care is medically necessary and intermittent, and you continue to meet eligibility.
4. What’s the difference between home care and home health care?
Home care is non-medical help like bathing or meals. Home health care includes skilled nursing and therapy, often covered by Medicare.
5. What if Medicare doesn’t approve my home health services?
You can appeal. The home health agency must give you written notice if services aren’t covered.
Final Thoughts
So, does Medicare cover home health care? Yes — if you meet the eligibility criteria and your care is intermittent and medically necessary. Whether you’re recovering from surgery or managing a chronic illness, Medicare can help you receive safe, professional care from the comfort of your home.
To learn more or get started, contact Eden Health Idaho Falls — your partner in compassionate, Medicare-certified home health care.
