Your father is coming home from the hospital after a stroke. Or your mother's heart failure has worsened, and getting to appointments has become a struggle. Someone mentions that Medicare covers home health care, and you wonder whether that means help at home every day.
The answer is yes, Medicare pays for home health care, but it is narrower than many families expect. Medicare's home health benefit covers skilled, medical care at home for a limited number of hours, not ongoing help with daily life1. Knowing the rules helps you get every bit of care your parent qualifies for and plan for what Medicare won't cover. If you are unsure of the difference between medical and nonmedical help, start with home care vs. home health.
Who qualifies for Medicare home health care
Original Medicare covers home health services under Part A and Part B when all of these are true13:
- Your parent is homebound. See the definition below.
- They need skilled care. Part-time or intermittent skilled nursing, or physical therapy, speech-language pathology or continued occupational therapy.
- A provider has seen them in person. A doctor or allowed provider, such as a nurse practitioner, must have a face-to-face visit related to the reason for home care and certify the need1.
- There is a care plan. The provider orders the care and reviews the plan regularly3.
- A Medicare-certified agency provides it. Your parent can choose among certified agencies that serve the area2.
What does homebound mean?
Medicare considers someone homebound when both of these are true1:
- Leaving home is hard or not advised. Because of illness or injury, they need help to leave home, such as a cane, walker, wheelchair, special transportation or another person, or their doctor advises against leaving.
- Leaving takes a lot of effort. They normally can't leave home, and doing so takes considerable and taxing effort.
Homebound doesn't mean never leaving the house. Your parent can still go to medical appointments, attend religious services, get a haircut or go to adult day care and keep coverage, as long as absences are short and infrequent1. Our guide to adult day care explains that option.
Families sometimes worry that one trip to a grandchild's graduation will end coverage. An occasional special outing is generally allowed. Keep a simple note of outings and why they happened, in case questions come up.
What Medicare home health covers
- Skilled nursing. Part-time or intermittent care such as wound care, injections, IV therapy, teaching and monitoring an unstable condition1.
- Therapy. Physical therapy, occupational therapy and speech-language pathology when your parent meets the conditions.
- Home health aide care. Help with bathing, grooming, walking and feeding, but only while your parent is also getting skilled care1.
- Medical social services. Help with social and emotional concerns related to the illness.
- Medical supplies and equipment. Supplies for home use and durable medical equipment like walkers and hospital beds4.
How many hours does Medicare cover?
There is no limit on the number of home health visits if your parent keeps qualifying. In most cases, part-time or intermittent means up to 8 hours a day of skilled nursing and aide services combined, with a maximum of 28 hours a week. For a short time, a provider may order more, up to 35 hours a week1. In practice, many people get a few visits a week, each lasting an hour or two.
Your parent doesn't have to be improving
Home health can help your parent get better, maintain their current condition or slow decline1. If an agency says coverage must end because your parent has stopped improving, ask whether skilled care is still needed to maintain function. That can be a valid reason to continue.
What Medicare won't pay for
Medicare doesn't pay for1:
- 24-hour care at home. Round-the-clock help isn't covered.
- Meal delivery. Home-delivered meals aren't covered.
- Homemaker services. Shopping, cleaning and laundry unrelated to the care plan.
- Personal care alone. Help with bathing, dressing or using the bathroom when that is the only care needed.
This is the gap many families face. A parent with dementia may need supervision and help every day, but no skilled care, so Medicare home health doesn't apply. Long-term care at home is usually paid for privately, by long-term care insurance, by Medicaid home and community-based services for people who qualify5 (see Medicaid waivers for home care), or through the PACE program in some areas. See long-term care insurance and paying for senior care.
Home health or a skilled nursing facility?
After a hospital stay, some people go home with home health care and others go to a skilled nursing facility for rehab first. Home health works best when your parent is safe at home between visits, with family or hired help to cover the hours no one from the agency is there. If your parent needs nursing care or therapy every day, or can't be left alone, a short facility stay may be safer. Medicare covers that only after a qualifying inpatient hospital stay6. See skilled nursing facility vs. nursing home.
What you'll pay
Your parent pays nothing for covered home health services. After the Part B deductible, they pay 20% of the Medicare-approved amount for durable medical equipment14. Before care starts, the agency should explain what Medicare will pay and give written notice if any item or service won't be covered, using a form called an Advance Beneficiary Notice1.
A Medicare Supplement policy can help with the equipment share. Tell each provider about any other coverage so bills are handled correctly.
Medicare Advantage and home health
Medicare Advantage plans must cover home health care at least as well as Original Medicare, but they may require your parent to use agencies in their network and may need prior approval2. Call the plan before choosing an agency. Some plans also offer extra in-home support, so ask what the plan includes. A free State Health Insurance Assistance Program counselor can help you compare7.
Home health for a parent with dementia
A dementia diagnosis alone doesn't qualify someone for Medicare home health. But people with dementia often qualify because of another skilled need, such as a wound, a new medication that needs monitoring, or therapy after a fall. Many also meet the homebound test, since leaving home can take great effort or require another person1.
When home health is in place, ask the nurse or therapist to teach family caregivers. Caregiver education is a covered skilled service1. Topics might include safe transfers, managing medicines or handling refusal to bathe. For the daily help Medicare won't cover, see memory care vs. home care.
How to get home health care started
- Talk to the doctor. Explain what your parent is struggling with and ask whether home health is appropriate.
- Schedule the in-person visit. The face-to-face encounter can happen in the office, at the hospital or by telehealth in some cases3.
- Choose an agency. The provider should give you a list of agencies. You can compare quality on Care Compare8. Our list of questions to ask a home care agency works for home health too.
- Review the care plan. Ask how often staff will visit, which services are included and when the plan will be reviewed.
- Stay involved. Keep a log of visits and changes, and ask questions at each one.
If your parent is leaving the hospital, ask the discharge planner to arrange home health before discharge. See hospital discharge planning.
Making the most of home health visits
Home health visits are often short, so a little preparation helps. Keep a notebook by the door where you and your parent jot down questions, new symptoms, falls and medication changes between visits. Share it with the nurse or therapist at the start of each visit.
- Ask for a copy of the care plan. It lists the services, how often staff will come and the goals of care2.
- Learn the exercises. Therapists can teach your parent and family exercises to do between visits, which often makes the biggest difference.
- Ask about home safety. A therapist can suggest grab bars, a shower chair or rearranged furniture. See fall prevention.
- Speak up about changes. If your parent is getting worse, tell the agency and the doctor. The care plan can be changed.
If visits are missed or staff seem rushed, call the agency supervisor. Your parent also has the right to switch to another certified agency at any time, after talking with the provider2.
If home health care is ending
When an agency plans to end all covered services, it must give your parent a written notice at least two days before the last visit. That notice explains how to ask for a fast appeal from the Beneficiary and Family Centered Care Quality Improvement Organization2. If you believe your parent still needs skilled care, follow the instructions on the notice and call the number right away.
If your parent no longer qualifies, plan the next step early. Options include private home care, adult day programs, respite care and assisted living. See assisted living vs. home care and respite care.
