To qualify for home health care through Medicare, you need to meet three core requirements: you must be homebound, you must need skilled medical services on a part-time basis, and a doctor must certify both of those things in a formal plan of care. Most people searching this question are trying to understand whether they or a family member would be eligible, so here’s exactly how each piece works.
The Homebound Requirement
Medicare considers you homebound if leaving your home is either not recommended because of your condition or requires a major effort. That effort can look different for different people. You might need a cane, wheelchair, walker, or crutches to get around. You might depend on another person to help you leave. You might require special transportation just to get to a doctor’s appointment.
Being homebound doesn’t mean you can never leave your house. You can still attend religious services, go to the barber, or make occasional trips without losing your eligibility. The standard is that leaving home is difficult and taxing, not that it’s impossible. If you can comfortably drive to the grocery store and run errands without assistance, you likely won’t meet the threshold.
You Must Need Skilled Care
Home health isn’t covered for general help around the house. Medicare requires that you need at least one of the following skilled services:
- Skilled nursing care on an intermittent basis, such as wound care, injections, or monitoring a complex medication regimen
- Physical therapy to help you regain strength, mobility, or function after an injury or surgery
- Speech-language pathology for conditions affecting your ability to speak or swallow
These services must be provided by licensed professionals, and they must be medically necessary rather than just convenient. “Intermittent” generally means part-time, not around the clock. If you need full-time skilled nursing over an extended period, Medicare considers that a level of care that belongs in a facility, not in the home.
Occupational therapy has a special rule. It cannot be the sole qualifying service to start home health care. However, once you’ve been admitted based on one of the three services above, occupational therapy can continue even after the original qualifying service ends. So if you initially qualified through physical therapy and your PT goals are met, you can keep receiving occupational therapy as long as there’s still a documented need.
What Your Doctor Needs to Do
A physician or allowed practitioner must formally certify that you meet the homebound and skilled care requirements. This certification includes a plan of care that spells out what services you need, how often you’ll receive them, and what the treatment goals are. Your doctor signs this plan and agrees to periodically review it.
There’s also a face-to-face encounter requirement. Your doctor (or a nurse practitioner, clinical nurse specialist, or physician assistant) must see you in person either within 90 days before home health starts or within 30 days after it begins. If your doctor orders home health for a new condition that wasn’t apparent during a recent visit, the encounter must happen within that 30-day window after admission. The purpose of this visit is to document, in a brief written narrative, how your clinical condition supports both your homebound status and your need for skilled services.
A recent rule change, finalized for 2026, expands who can perform this face-to-face encounter. Previously, the practitioner conducting the encounter had stricter ties to the certifying physician. Now, any qualifying practitioner can perform it regardless of whether they were involved in your prior hospital or facility care. This makes it easier to get the required documentation completed without unnecessary delays.
How Long Coverage Lasts
Home health coverage runs in 60-day episodes. At the end of each episode, your doctor must recertify that you still meet all the eligibility criteria: you’re still homebound and you still need skilled services. There’s no hard cap on the number of episodes you can receive, as long as recertification happens every 60 days and the medical need is documented.
Coverage ends when your goals are met, you no longer need a qualifying skilled service, or you’re no longer homebound. If you’re discharged and your condition later changes, you can be re-evaluated and potentially start a new episode from scratch.
What Home Health Doesn’t Cover
Several types of care fall outside the home health benefit, and misunderstanding this is one of the most common sources of frustration for families. Medicare will not pay for:
- Custodial care alone. Help with bathing, dressing, or getting in and out of bed can be included alongside skilled services, but it can’t be the only reason for home health.
- Household services. Cooking, cleaning, laundry, grocery shopping, and meal delivery exist solely to help someone live at home. They aren’t medical services and aren’t covered.
- 24-hour care. Home health is part-time by definition. If you need someone with you around the clock, that points toward a different level of care.
A home health aide who helps with personal care tasks can be part of your plan, but only when you’re also receiving a qualifying skilled service. The moment skilled care stops and no other qualifying service remains, aide visits end too.
Medicaid and Private Insurance Differences
Everything above applies to Medicare. If you’re covered through Medicaid, the rules can differ significantly because Medicaid is run jointly by the federal government and individual states. Each state sets its own eligibility criteria, and Medicaid often covers services Medicare doesn’t, including long-term personal care and help with daily activities for people with limited income and resources. Some states offer home and community-based waiver programs that provide even broader in-home support.
If you have both Medicare and Medicaid (dual eligibility), Medicare typically pays first for skilled home health services, and Medicaid may fill in gaps for personal care or longer-term needs. Private insurance plans set their own home health criteria, which often mirror Medicare’s standards but can be more or less restrictive depending on the policy. Checking directly with your plan is the most reliable way to know what’s covered.
How the Process Typically Starts
Most people enter home health through one of two paths. The first is a hospital or rehabilitation facility discharge, where a case manager identifies you as a candidate and coordinates the referral before you go home. The second is a referral from your primary care doctor after an illness, injury, or decline in function that makes it hard for you to leave the house for treatment.
Either way, the home health agency will send a clinician to your home for an initial assessment. They’ll evaluate your condition, confirm you meet the homebound criteria, and work with your doctor to finalize the plan of care. Services typically begin within a day or two of that assessment. You should not receive a bill for covered home health services under Medicare Part A or Part B, as there is no copayment for home health visits when you meet the eligibility requirements.