Getting home health care starts with a doctor’s order. You cannot simply call an agency and sign up. A healthcare provider must evaluate your condition, determine that you need skilled medical services at home, and formally order those services. The process involves a few specific steps, but most people can have care started within days of that initial order.
Who Qualifies for Home Health Care
To qualify for Medicare-covered home health, you need to meet two main requirements: you must need part-time skilled care, and you must be considered “homebound.” Skilled care means services that require a licensed professional, such as wound care after surgery, physical therapy, injections, or monitoring an unstable health condition. If all you need is help with cooking, bathing, or housekeeping, that falls under a different category called non-medical home care, which Medicare does not cover.
The homebound requirement trips people up because it sounds stricter than it is. You don’t have to be bedridden. You qualify if leaving your home requires considerable effort due to illness or injury, whether that means needing a wheelchair, a walker, special transportation, or another person’s help. You can still leave home for medical appointments, religious services, or occasional short trips. The key is that getting out the door is not easy for you, and you normally stay home because of your condition.
One important limit: Medicare won’t cover home health if you need more than part-time or intermittent skilled care. If your condition requires around-the-clock nursing, a different level of care (like a skilled nursing facility) would typically be recommended instead.
Step 1: Get a Face-to-Face Evaluation
Before home health services can begin, a healthcare provider must see you in person and document why you need care at home. This face-to-face encounter can happen with a doctor, nurse practitioner, physician assistant, or clinical nurse specialist. It must take place either within 90 days before home health starts or within the first 30 days after care begins.
The visit needs to directly relate to the reason you need home health. If you’re recovering from hip surgery, for example, the encounter should address your surgical recovery and mobility limitations. The provider documents your diagnosis, physical findings, and a care plan noting that you need skilled services like nursing or therapy. This documentation is the foundation of your home health referral.
Step 2: Get a Physician’s Order and Plan of Care
After the face-to-face evaluation, a physician (or qualifying provider) must formally certify that you need home health services and establish a plan of care. This plan is built in collaboration with the home health agency and spells out exactly what services you’ll receive, how often, and for how long.
The plan of care must be renewed every 60 days with the physician’s signature. A signature without a date is considered invalid, so make sure your doctor’s office handles the paperwork completely. If someone other than the certifying physician performed your face-to-face encounter, the certifying physician still needs to acknowledge that the visit took place.
Step 3: Choose a Home Health Agency
You have the right to choose which agency provides your care. The agency must be Medicare-certified if you want Medicare to pay for it. To compare agencies in your area, use the Care Compare tool on Medicare.gov. It provides star ratings that summarize each agency’s performance on quality measures and patient satisfaction, making it easier to spot which agencies consistently deliver better care.
Your doctor’s office or hospital discharge planner will often suggest agencies they work with regularly, but you’re not locked into their recommendation. It’s worth checking two or three agencies’ ratings before deciding. Once you pick an agency, they’ll coordinate directly with your physician’s office to finalize the plan of care and schedule your first visit.
What Home Health Services Include
Home health covers a range of skilled services delivered in your home by licensed professionals:
- Skilled nursing: wound care for surgical wounds or pressure sores, IV therapy, injections, nutrition therapy, and monitoring of serious or unstable conditions
- Physical therapy: exercises and mobility training to help you regain strength and function
- Occupational therapy: relearning daily tasks like dressing, bathing, or cooking safely
- Speech-language pathology: therapy for swallowing difficulties or communication problems
- Medical social services: help navigating emotional, social, or financial challenges related to your illness
- Home health aide care: assistance with personal care like bathing, but only if you’re already receiving one of the skilled services listed above
Patient and caregiver education is also covered. A nurse might teach you how to manage a new medication regimen or show a family member how to change a wound dressing properly.
Home Health vs. Non-Medical Home Care
These two services are often confused, and the distinction matters because they’re paid for differently. Home health care is medical. It’s provided by licensed nurses, therapists, and other clinicians who can adjust your treatment, change prescriptions, and manage pain. Non-medical home care is provided by caregivers who help with daily life: bathing, getting dressed, meal preparation, laundry, companionship, and transportation.
A simple way to think about it: a home health nurse changes your therapy if it isn’t working, while a non-medical caregiver encourages you to complete your exercises and alerts the therapist if something seems off. A home health professional manages your prescriptions, while a personal caregiver reminds you to take your pills each day. If you need both types of support, you may end up working with two separate services.
What It Costs
If you have Medicare and qualify, home health services cost you nothing out of pocket. There is no copay and no deductible for covered home health visits. The one exception is durable medical equipment like wheelchairs, walkers, or hospital beds, which carry a 20% coinsurance after Medicare pays its share.
For private insurance, the process is similar but typically requires prior authorization. Your insurance company will review documentation supporting the medical necessity of home health before approving it. This documentation usually includes a dated plan of care, current nursing notes, and a schedule of services. The approval timeline and cost-sharing vary by plan, so check with your insurer about your specific benefits. Medicaid also covers home health in most states, often with no cost to the patient.
If Your Services Are Denied or Discontinued
If a home health agency plans to stop your services because they’re no longer considered medically necessary, they must give you an advance written notice before the non-covered care would have occurred. This notice must explain the reason for the change, be delivered in person when possible, and give you enough time to consider your options.
You have the right to appeal. The notice should explain your appeal rights and any financial liability you might face if you choose to continue receiving care that Medicare no longer covers. If an agency fails to provide this written notice, the agency, not you, may be held financially responsible for any denied payments. Keep copies of all notices and don’t hesitate to ask questions about anything in the document you don’t understand.
Getting Started Quickly
The fastest path to home health is usually through a hospital discharge. If you’re being released after a surgery or serious illness, the discharge planning team will often arrange home health before you leave. They’ll handle the physician’s order, the face-to-face documentation, and the agency referral in one coordinated process. Many patients have their first home visit within 24 to 48 hours of arriving home.
If you’re not in the hospital but think you need home health, call your primary care provider and ask for a referral. Describe your functional limitations clearly: trouble walking, inability to drive to therapy, difficulty managing wounds or medications on your own. The more specific you are about what you struggle with at home, the easier it is for your provider to document your need and get the process moving.