Medicare · Supporting
Medicare home health care: who qualifies, what's covered, and how to start
Last reviewed September 3, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team
Medicare covers home health care with no copayment for the approved services themselves, but four federal criteria must all be satisfied before that coverage begins.
Who qualifies for Medicare home health care
First, a physician, nurse practitioner, physician assistant, or clinical nurse specialist must certify that you are homebound and order the care. According to CMS, "homebound" means leaving home requires a considerable and taxing effort because of your medical condition. You do not have to be bedridden. If you need help from another person or a device such as a wheelchair or walker to get out, or if leaving exhausts you because of illness or injury, you meet the homebound standard. Brief, infrequent trips for medical care, adult day programs, or occasional outings for religious services do not disqualify you.
Second, the services you need must be skilled. That means skilled nursing care, physical therapy, or speech-language pathology. Occupational therapy can continue once another skilled service has established your home health eligibility, but it cannot open a new episode on its own.
Third, you must receive care from a Medicare-certified home health agency. CMS maintains a searchable directory at medicare.gov/care-compare.
Fourth, the certifying clinician must document a face-to-face encounter with you before the agency can bill Medicare for most home health services.
What Medicare covers, and what it costs
When the eligibility criteria are satisfied, Medicare covers the following services with no copayment and no coinsurance:
- Skilled nursing care: wound care, IV medications, monitoring of serious illness, patient education
- Physical therapy
- Speech-language pathology
- Occupational therapy
- Home health aide services (personal care such as bathing and dressing), only when a skilled service is also being delivered at the same time
- Medical social services
There is no set limit on the number of visits. If your condition continues to meet the skilled-care criteria, coverage continues.
One cost does apply: durable medical equipment (DME) ordered as part of your home health plan, such as a hospital bed or oxygen equipment, is covered under Part B. In 2026, the annual Part B deductible is $283; after meeting that deductible, you pay 20% of the Medicare-approved amount for equipment, with no annual cap on that 20%.
Coverage is available through Part A or Part B depending on your situation. Either way, the out-of-pocket cost for the home health services themselves is the same: nothing for covered visits.
What Medicare does not cover
Medicare home health care is intended for skilled, medically necessary services, not long-term custodial care. That distinction has real consequences.
Medicare will not pay for:
- Around-the-clock home care or full-time home nursing
- Meal delivery or grocery services as a standalone benefit
- Homemaker services such as cleaning, shopping, or laundry when that is the only help you need
- Personal care by a home health aide (bathing, dressing, grooming) when no skilled service is also being delivered
- Custodial care alone, meaning ongoing help with daily activities when there is no accompanying skilled medical need
When your covered services are ending because your skilled need has resolved, the home health agency must give you advance written notice using the Home Health Advance Beneficiary Notice (HHABN) before stopping. That notice explains your right to appeal if you disagree with the decision.
Covered vs. not covered
Covers
- Skilled nursing care (wound care, IV medications, monitoring)
- Physical therapy
- Speech-language pathology
- Occupational therapy, when another skilled service is also active
- Home health aide personal care, when a skilled service is also being delivered at the same time
- Medical social services
Does not cover
- Around-the-clock home care or full-time home nursing
- Meal delivery or grocery services as a standalone benefit
- Homemaker services such as cleaning, shopping, or laundry when that is the only help needed
- Personal care by a home health aide when no skilled service is also being delivered
- Custodial care alone, meaning ongoing help with daily activities when there is no skilled medical need
Coverage turns on whether a skilled service is part of your active care plan.
Home health care under Medicare Advantage
Medicare Advantage (MA) plans, also called Part C, must cover every service Original Medicare covers, including home health care under the same federal eligibility rules. Many MA plans also provide supplemental home-support benefits that go beyond those rules, such as personal care aide hours, home-safety equipment, or meal delivery after a hospitalization. These supplemental amounts and durations are set at the plan level, so you will need to check your specific plan to find your coverage.
In 2026, the federal in-network maximum out-of-pocket (MOOP) cap for MA plans is $9,250, according to KFF. Once your covered cost-sharing reaches that limit, the plan pays 100% of in-network covered costs for the rest of the year.
If your MA plan requires prior authorization for home health visits, CMS rules that took effect January 1, 2026 (CMS-0057-F) require standard decisions within 7 calendar days and expedited decisions within 72 hours, with a specific written reason for any denial.
To find out more about coverage, please contact us to discuss plan options.
Federal cap on in-network cost-sharing for MA plans
How to start home health care through Medicare
Getting home health care through Medicare requires a clear sequence of steps, and skipping any one of them can delay or block your coverage.
- Talk with your doctor or specialist about whether you meet the homebound criteria and what skilled services your condition requires. Be specific about what you can and cannot do independently.
- Get a written order and a certified plan of care. The certifying clinician must document the face-to-face encounter in your medical record.
- Choose a Medicare-certified home health agency. The CMS Care Compare directory at medicare.gov/care-compare lists agencies by location alongside quality ratings based on patient outcomes.
- If you are enrolled in a Medicare Advantage plan, confirm prior-authorization requirements with your plan before the agency begins visits.
- Review the plan of care with the agency nurse or therapist. You have the right to know which services are planned, how long they are expected to last, and who to contact with concerns or complaints.
If Medicare denies coverage or the agency notifies you that covered visits are ending sooner than expected, you may appeal. The agency must give you written notice, called a Notice of Medicare Non-Coverage, and instructions for requesting a review by a Qualified Independent Contractor at no cost to you.
Steps to get Medicare home health care
Skipping any step can delay or block your coverage.
Common questions about IRMAA appeals
Quick answers, fast .
Tap any question to expand. Each links to a fuller standalone answer.
Does Medicare pay for hearing aids
Original Medicare does not cover hearing aids or fittings.
Some Medicare Advantage plans may include a hearing benefit, but what they cover varies by plan.
Does Medicare cover ambulance services?
Yes, in limited situations.
Medicare Part B covers emergency ambulance transportation when traveling any other way could endanger your health, taking you to the nearest appropriate hospital or facility. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026. Air ambulance is covered only when ground transport cannot reach you or would take too long. Non-emergency ambulance trips, for example to dialysis, are covered only when a doctor provides a written order stating they are medically necessary. Medicare does not cover ambulance rides taken purely for convenience.
Does Medicare cover skilled nursing facility care?
Yes, on a short-term basis.
Medicare Part A covers skilled nursing facility (SNF) care after a qualifying inpatient hospital stay of at least 3 days, when you need daily skilled care like nursing or therapy. In 2026 you pay $0 for days 1 through 20 of each benefit period, $217 per day for days 21 through 100, and all costs after day 100. Coverage is for skilled care while you recover, not for long-term or custodial care (help with daily activities like bathing or dressing), which Medicare does not cover. Long-term nursing home care is generally paid through Medicaid or private funds.
Does Medicare cover physical therapy?
Yes.
Medicare Part B covers outpatient physical therapy that is medically necessary to treat your condition. You pay 20% of the Medicare-approved amount after the yearly Part B deductible ($283 in 2026). There is no longer a hard dollar cap on therapy, but once your physical and speech therapy together pass $2,480 in 2026, your therapist must add a note (called a KX modifier) confirming you still need care. Claims above $3,000 may be reviewed for medical necessity. Part A covers physical therapy you receive as a hospital inpatient or in a skilled nursing facility. A doctor or therapist must set up and regularly review your plan of care.
Does Medicare cover mental health services?
Yes.
Medicare covers mental health care across its parts in 2026. Part B covers outpatient services like therapy, counseling, and visits with psychiatrists, psychologists, and clinical social workers, and since 2024 it also covers marriage and family therapists and mental health counselors. You pay 20% of the Medicare-approved amount after the $283 deductible, and one depression screening each year is free. Part A covers inpatient mental health care, with a lifetime limit of 190 days in a freestanding psychiatric hospital. Part D covers most mental health medications. Many of these services are also available by telehealth, and Medicare Advantage plans cover at least the same benefits.
Does Medicare cover chiropractic care?
Partly.
Medicare Part B covers one specific chiropractic service: manual manipulation of the spine to correct a subluxation (when one or more bones of the spine are out of position) that a doctor confirms is medically necessary. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026. Medicare does not cover other services a chiropractor might offer, such as X-rays, massage therapy, acupuncture, or routine wellness visits, so you would pay the full cost for those. Some Medicare Advantage plans include extra chiropractic or wellness benefits beyond this.
Does Medicare cover home health care?
Yes, when you qualify.
Medicare Parts A and B cover home health care if a doctor certifies that you are homebound (leaving home takes a major effort) and need part-time skilled care, such as skilled nursing, physical therapy, occupational therapy, or speech therapy. A Medicare-certified home health agency must provide the care under a plan your doctor reviews. You pay $0 for covered home health visits in 2026, and 20% for any durable medical equipment. Medicare does not cover 24-hour home care, meal delivery, or homemaker services like cleaning when that is the only care you need.
Does Medicare cover vision care?
Mostly no for routine care.
In 2026, Original Medicare does not cover routine eye exams for glasses or contact lenses, and it does not pay for the glasses or contacts themselves. It does cover some medical eye care: yearly glaucoma screenings for people at high risk, diabetic retinopathy exams, treatment for eye diseases, and cataract surgery (including one pair of standard glasses or contacts afterward). For those covered services you pay 20% after the $283 Part B deductible. Many Medicare Advantage plans add a routine vision benefit covering eye exams and an allowance for glasses.
Does Medicare cover hearing aids?
Original Medicare does not cover hearing aids or the exams used to fit them.
Some Medicare Advantage plans include a hearing benefit, but coverage varies by plan.
Does Medicare cover diabetes supplies and testing?
Yes.
In 2026 Medicare covers most diabetes care across two parts. Part B (outpatient care and equipment) covers blood sugar monitors, test strips, lancets, and continuous glucose monitors (CGMs) as durable medical equipment, plus diabetes screenings and a self-management training program. You pay 20% of the Medicare-approved amount after the $283 Part B deductible. Part D (drug coverage) covers insulin and related supplies like syringes, and in 2026 your insulin is capped at $35 for a month's supply. If you have a Medicare Advantage plan, it covers at least the same diabetes benefits, sometimes with added extras.
Does Medicare cover durable medical equipment?
Yes.
Medicare Part B covers durable medical equipment (DME): reusable medical gear your doctor prescribes for use at home, such as wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and blood sugar monitors. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026, and Medicare pays the other 80%. To be covered, the item must be ordered by a Medicare-enrolled doctor and supplied by a Medicare-enrolled supplier, and some items are rented rather than bought. Equipment meant mainly for use outside the home, or only for comfort or convenience, is not covered.
Which is better, Medigap or Medicare Advantage?
Neither is better for everyone; they suit different needs.
Medigap (also called Medicare Supplement, a private policy that pairs with Original Medicare) lets you see any doctor nationwide who accepts Medicare with no network and very predictable out-of-pocket costs, but you pay a monthly Medigap premium and add a separate Part D drug plan. Medicare Advantage (Part C, your Medicare benefits through a private plan) often has a lower or $0 plan premium, bundles drug coverage and extras like dental and vision, and caps your yearly out-of-pocket costs, but uses provider networks and may require prior approval. People who travel, want maximum doctor freedom, and prefer steady costs often lean Medigap; people who want low premiums, extras, and a network they are comfortable with often lean Medicare Advantage. With both, you still pay the Part B premium ($202.90 per month in 2026). To find out which fits your situation, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
References
- Medicare home health services coverageMedicare.gov's official page on eligibility requirements, covered services, and patient costs for Medicare-covered home health care.
- CMS home health quality and certificationCMS resource on home health agency certification standards, quality measures, and the Care Compare rating framework.
- Medicare Advantage in 2026: premiums, out-of-pocket limits, supplemental benefits, and prior authorizationKFF analysis of 2026 MA cost-sharing caps, supplemental home-support benefits, and CMS-0057-F prior-authorization rule changes.