Medicare home health care: what it covers and what it costs

Covered services include:

• Skilled nursing care (wound care, injections, monitoring complex conditions)
• Physical therapy, occupational therapy, and speech-language pathology
• Medical social services related to the illness or injury
• Home health aide services, but only when skilled nursing or therapy is also part of the plan of care

Medicare does not cover 24-hour home care, meal delivery, homemaker services, or custodial care (bathing, dressing, and similar tasks) when that is the only need. If skilled care ends but the physician continues to certify a maintenance therapy need, occupational and physical therapy can continue under a separate maintenance standard.

What "homebound" means in practice

To qualify, you must be homebound. That means leaving home requires considerable effort, a condition, illness, or injury that restricts mobility, and that absences are infrequent, brief, or for medical appointments and adult day care. You do not have to be bedridden. A person who can walk to a car with difficulty and attends a weekly medical appointment can still qualify.

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A physician, nurse practitioner, physician assistant, or clinical nurse specialist must certify that you need skilled care and are homebound before an agency begins services. The clinician must see you in person within 90 days before or 30 days after care starts; that face-to-face requirement documents the medical necessity.

Once certified, care is delivered in 60-day episodes called certification periods. The agency reassesses and the certifying clinician recertifies at each period if care continues to be necessary. There is no hard limit on the number of episodes.

Which part of Medicare pays

Part A pays when home health follows a qualifying inpatient hospital or skilled nursing facility stay. Part B pays in all other situations, including when home health is the first point of contact with Medicare for that episode of care. Both parts cover the same scope of services; the distinction affects which deductible and cost-sharing pool the care draws from.

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For covered home health services, Medicare pays 100% of the approved amount. You pay nothing for skilled nursing visits, therapy visits, or home health aide visits that are part of a certified plan of care.

There is one exception: durable medical equipment (a hospital bed, wheelchair, or walker, for example) ordered as part of home health follows the standard Part B cost-sharing structure. In 2026, the annual Part B deductible is $283. After the deductible, Medicare pays 80% of the approved amount and you pay 20%, with no annual cap on that 20%.

If the home health agency is not Medicare-certified, Medicare will not pay at all, and you bear the full cost. Verifying certification before services begin is straightforward at medicare.gov/care-compare.

How Medicare Advantage handles home health

Medicare Advantage (MA) plans, sometimes called Part C, must cover all Original Medicare home health benefits. Plans may offer additional home-support benefits beyond the Original Medicare scope, though those extra benefits vary by plan. Under federal rules effective in 2026, if you need prior authorization for a home health service, a standard decision must come within 7 calendar days and an expedited decision within 72 hours. In 2026, the federal in-network maximum out-of-pocket (MOOP) cap for MA plans is $9,250, according to KFF, and the enrollment-weighted average in-network MOOP is $5,421. Once you reach your plan's MOOP limit, covered services cost you nothing more for the rest of the year.

To find out more about coverage under a specific plan, please contact us to discuss plan options.

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Personal care without skilled need. If you need help bathing or dressing but do not have a concurrent skilled nursing or therapy need, Medicare home health will not cover it. Medicaid, if you qualify, may cover this through home and community-based waiver programs.

Observation status. Patients placed on observation status rather than formally admitted to a hospital are billed under Part B, not Part A. Observation status does not count toward the 3-day inpatient stay needed to qualify for Medicare-covered skilled nursing facility care, and it can affect which part of Medicare handles any subsequent home health episode.

Hospice and home health. Once you elect the Medicare hospice benefit, routine home health services related to the terminal diagnosis shift to the hospice benefit. Home health for unrelated conditions can continue under Part A or Part B separately.

Medigap and home health. Medigap (Medicare Supplement Insurance) policies help with Original Medicare cost-sharing. Because covered home health itself has no cost-sharing beyond equipment, Medigap's primary value here is covering the 20% coinsurance on any durable medical equipment billed through Part B. The one guaranteed-issue Medigap window is 6 months, starting the month you are 65 and enrolled in Part B; outside that window, medical underwriting may apply in most states, though some states offer additional protections.

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