Medicare covers home health care at no cost to you, but only when you meet specific eligibility requirements. The key hurdles: you must be considered “homebound,” need skilled medical services on a part-time basis, and have a health care provider certify your need. Understanding exactly what qualifies (and what doesn’t) is the difference between getting approved and paying out of pocket.
The Three Requirements You Must Meet
Medicare will pay for home health services when all three of these conditions are true at the same time:
- You’re homebound. Leaving your home is either medically inadvisable or requires a considerable, taxing effort because of illness or injury.
- You need skilled care. A nurse, physical therapist, speech therapist, or occupational therapist must provide the services. Basic help with daily activities alone doesn’t qualify.
- The care is part-time or intermittent. Medicare does not cover round-the-clock home care. Services must be needed on a limited, scheduled basis.
If you meet all three, Medicare pays 100% of the cost for home health visits. There’s no copay and no deductible for the services themselves. The one exception is durable medical equipment like hospital beds or wheelchairs ordered as part of your care, which typically requires 20% coinsurance after the Part B deductible.
What “Homebound” Actually Means
This is where most confusion happens. Being homebound doesn’t mean you can never leave your house. It means two things must be true: you need help from another person, a wheelchair, walker, cane, crutches, or special transportation to leave, and leaving home requires a considerable and taxing effort because of your condition.
You can still qualify as homebound if you leave home occasionally. Medicare allows absences that are infrequent and short, including trips to receive medical treatment, attend religious services, go to adult daycare, or attend events like a funeral, a graduation, or a haircut. These outings won’t disqualify you. The standard isn’t that you never leave. It’s that doing so is genuinely difficult and uncommon.
A condition like severe arthritis that makes walking to the car exhausting, advanced heart failure that leaves you winded after a few steps, or cognitive impairment that makes it unsafe to leave without supervision can all meet the homebound threshold. The determination is made by your health care provider during a required face-to-face assessment.
What Services Medicare Covers at Home
Once you’re approved, Medicare covers skilled nursing care, physical therapy, occupational therapy, and speech-language therapy in your home. It also covers medical social services and, in some cases, limited home health aide services for personal care like bathing or dressing, but only when you’re also receiving one of the skilled services.
That last point is critical. If all you need is help with cooking, cleaning, bathing, or getting dressed, Medicare will not pay for it. These are considered “custodial care,” and they fall outside the benefit entirely unless they’re paired with active skilled treatment. Similarly, Medicare won’t cover 24-hour home care, meal delivery, or homemaker services on their own.
How to Start the Process
You can’t simply call a home health agency and begin receiving Medicare-covered care. The process requires a specific chain of approvals.
First, your doctor, nurse practitioner, or another qualifying health care provider must see you in person. This face-to-face encounter is a federal requirement, and the provider must document it in your medical record with a clinical note. The visit can happen up to 90 days before home health services start or within 30 days after they begin.
During or after that visit, the provider certifies that you are homebound and need skilled care. They then create or approve a plan of care that spells out what services you need, how often, and for how long. This plan gets sent to a Medicare-certified home health agency, which actually delivers the care.
If you’re being discharged from a hospital or rehab facility, the discharge planning team will typically coordinate this for you. If you’re at home and your condition has worsened, start by talking to your primary care provider about whether you qualify. You can also search for Medicare-certified home health agencies in your area through Medicare’s Care Compare tool online.
Choosing a Home Health Agency
Not every home health agency participates in Medicare, so confirming certification is the first step. Starting in 2025, Medicare-certified agencies are required to publicly disclose accurate information about the services they offer, including any limitations on specialty services, how long they’ll provide care, and how frequently. This rule exists because some agencies have historically been vague about what they will and won’t do.
Agencies must also maintain a written policy for how they decide which patients to accept, based on factors like the patient’s anticipated needs, the agency’s current caseload, staffing levels, and staff competencies. If an agency turns you away, they should be able to explain why based on these criteria. You have the right to choose a different agency.
If You Have Medicare Advantage
Medicare Advantage plans (Part C) must cover everything Original Medicare covers, including home health services under the same rules. However, many Advantage plans add prior authorization requirements, meaning the agency may need approval from your plan before starting care. This can add a few days to the process.
Some Medicare Advantage plans offer supplemental home-related benefits beyond what Original Medicare provides. These can include in-home support services, though this benefit is relatively uncommon: only about 7% of individual Medicare Advantage enrollees are in plans that offer it. Special Needs Plans (SNPs) for people with chronic conditions are somewhat more generous, with 11% offering in-home support. Some plans also cover personal care, home cleaning, or general supports for living like help with utilities, though availability varies widely by plan and region.
If your Advantage plan denies home health services you believe you qualify for, you have the right to appeal. The plan must provide written notice explaining the denial and instructions for how to challenge it.
When Medicare Won’t Pay: Other Options
If you don’t meet the homebound or skilled care requirements, Medicare’s home health benefit won’t apply. But that doesn’t mean you’re out of options.
Medicaid, if you qualify based on income and assets, covers a much broader range of home care in most states, including long-term custodial care, personal attendants, and homemaker services. Eligibility rules vary by state, but Medicaid is the primary payer for ongoing non-skilled home care in the U.S.
The Program of All-Inclusive Care for the Elderly (PACE) is another option worth exploring. PACE combines Medicare and Medicaid funding to provide a comprehensive package of medical and supportive services, including home care, personal care, and adult daycare. To qualify, you must be at least 55, live in an area served by a PACE organization, and be certified by your state as needing a nursing home level of care while still being able to live safely in the community with support. If you have Medicare but not Medicaid, you can still join PACE by paying a monthly premium for the long-term care portion.
Long-term care insurance, if you purchased a policy before needing care, may also cover in-home custodial services. And some veterans qualify for home care benefits through the VA that go well beyond what Medicare offers.