Home health care is skilled care at home that a doctor orders: nursing, physical, occupational and speech therapy, and related help. Medicare pays for it, at no cost to you, when you meet its rules. You must need part-time or intermittent skilled care, be homebound, and get the care from a Medicare-certified home health agency after a doctor or other provider has seen you in person and ordered it.
This guide explains what home health care is, who qualifies, what the nurses and therapists do, how it differs from home care, how it is paid for and how to choose an agency. It describes how the benefit works in plain terms. It is not medical advice and not a coverage decision. The doctor, the agency and Medicare decide what applies to you. Carevo is a directory. It does not provide care or vouch for any agency.
What home health care is
Medicare.gov says home health care helps with an illness or injury and can help you recover, maintain your condition or function, or slow decline. Care is delivered at home by a home health agency, and the agency coordinates with your doctor on a care plan and keeps them updated on progress.
What Medicare.gov lists as covered:
- Skilled nursing. Part-time or intermittent, medically necessary care, including wound care, patient and caregiver education, IV or nutrition therapy, injections, and monitoring of serious illness or unstable health.
- Therapy. Physical, occupational and speech-language pathology, if you meet certain conditions.
- Medical social services.
- Home health aide. Part-time or intermittent help with things like walking, bathing, grooming, changing linens and feeding, but only while you also receive skilled nursing or therapy.
- Durable medical equipment and medical supplies for use at home.
- Injectable osteoporosis drugs for women who meet certain criteria.
After a referral, Medicare.gov says the agency schedules an assessment of your needs and health, and staff visit as often as your provider orders.
Who qualifies under Medicare
Medicare.gov sets out the conditions. You need all of them:
- Skilled care need. You need part-time or intermittent skilled services. You do not qualify if you need more than part-time or intermittent skilled care.
- Homebound. Both parts of the test: leaving home is not recommended because of your condition, or you have trouble leaving without help (such as a cane, wheelchair or another person) due to illness or injury, and you are normally unable to leave home and leaving takes a lot of effort. Short, infrequent absences for medical care or for non-medical reasons such as religious services are allowed, and attending adult day care does not disqualify you.
- An order. A doctor or other health care provider, such as a nurse practitioner, must see you in person, confirm you need home health care and order it.
- A Medicare-certified agency. The care must come from a Medicare-certified home health agency.
For occupational therapy, Medicare.gov says a provider must first order it alongside nursing, physical therapy or speech-language pathology, and you can then continue occupational therapy alone.
The Medicare home health checker lays out these questions so you can take them to a doctor. It does not decide eligibility.
What the nurse, therapist and aide do
In plain terms:
- A nurse carries out the medical tasks the doctor has ordered, such as changing wound dressings, giving injections or IV therapy, checking on how an illness is progressing and teaching you and your family how to manage at home.
- A physical, occupational or speech therapist works with you on movement, daily tasks or speech and swallowing, and shows you exercises and techniques to use between visits.
- A home health aide helps with personal tasks such as bathing, grooming and walking, while you are also receiving skilled care.
- Medical social services are also on Medicare's list. Ask the agency what they involve.
The visits are part-time or intermittent. They are not someone staying with you. If you also need regular help with daily life, you will probably need separate home care or personal care.
Home health care compared with similar services
- Home care is non-medical help with daily life. Medicare does not pay for it as the only care you need.
- Private duty nursing is nursing in longer shifts for complex medical needs. It is a different service from Medicare home health visits.
- In-home physical therapy is therapy at home. Under Medicare it is covered as part of home health when you meet the rules.
- Hospice is comfort care for a terminal illness.
- Nursing homes provide nursing care in a facility instead of at home.
What it costs and how it is paid for
Medicare. Medicare.gov says covered home health services cost nothing, though other costs may apply. For Medicare-covered medical equipment, after the Part B deductible you pay 20% of the Medicare-approved amount. Visits are unlimited if you qualify. Skilled nursing and aide services combined typically total up to 8 hours a day and 28 hours a week, and for a short time more frequent care, under 8 hours a day and up to 35 hours a week, may be allowed if your provider decides it is necessary.
What Medicare.gov says home health does not cover: 24-hour-a-day care at home, home-delivered meals, homemaker services such as shopping or cleaning unrelated to your care plan, and custodial or personal care when it is the only care you need. If you have a Medicare Advantage plan, check with the plan about home health benefits. If you have Medigap or other coverage, tell your provider so bills are processed correctly. See the Medicare guide.
Medicaid. Federal Medicaid rules at 42 CFR 440.70 say home health services include nursing, home health aide services, and medical supplies, equipment and appliances, with therapy and audiology optional. They are ordered by a physician, nurse practitioner, clinical nurse specialist or physician assistant, and home health services cannot be limited to people who are homebound. For this purpose, a person's home does not include a hospital or nursing facility. Your state sets the details. See Medicaid and long-term care and the state programs.
VA. VA lists Skilled Home Health Care, short-term care delivered by a community home health agency under contract with VA, for Veterans who are homebound or live far from VA. VA also lists home-based primary care, Homemaker and Home Health Aide care, and telehealth. Ask a VA social worker. See VA benefits.
Long-term care insurance and private pay. Some policies pay for skilled care at home. Check yours, and see long-term care insurance and private pay.
Before care starts: ask about cost in writing
Medicare.gov gives specific advice:
- Before care starts, ask the agency how much Medicare will pay and what you will owe, both verbally and in writing.
- Expect an Advance Beneficiary Notice (ABN) before you receive services or supplies Medicare will not cover.
- Ask your doctor what services will cost and why they are recommended, since some may not be covered or may be ordered too often.
- Your doctor should give you a list of agencies serving your area, and must tell you if their organization has a financial interest in an agency on it.
How to choose a home health agency
- Get the list from your doctor or hospital. Ask whether they have a financial interest in any agency on it.
- Use Medicare Care Compare. Medicare.gov points to Care Compare for finding agencies. CMS publishes two kinds of home health star ratings. The quality of patient care rating draws on assessments and Medicare claims data and covers measures such as timely start of care, and improvement in walking, bed transfers, bathing, shortness of breath and managing oral medicines. The patient survey rating comes from the Home Health CAHPS patient survey. Ratings need enough data. They tell you about past results, not about the nurse who will come to your home. Browse home health agencies on Carevo by state and city, with the CMS ratings shown where CMS publishes them.
- Call two or three agencies. Confirm they are Medicare-certified, that they serve your address, and when they could start.
- Ask your questions (below), and get the cost answers in writing.
- Say what matters to you. Visit times, language, who the team is.
- Report problems. Medicare.gov points to Medicare's complaint process for quality concerns.
Read more in Medicare star ratings for home health, hospice and nursing homes and home health care vs home care.
Questions to ask
- Are you Medicare-certified? Are you certified for Medicaid?
- Can you start within the time my doctor wants? What is the first visit like?
- Who will come: a nurse, a therapist, an aide? Will it be the same people?
- How often will they visit, and how long does each visit last?
- How do you coordinate with my doctor, and how will you keep us informed?
- What will Medicare pay, what will I owe, and will you put that in writing? Will I get an ABN if something is not covered?
- What do I do if I have a problem after hours?
- What happens when my home health ends? Can you help me set up ongoing help?
- How do I make a complaint?
Red flags
- No Medicare certification, or an unwillingness to show it.
- Promises of unlimited or 24-hour care under Medicare.
- Pressure to accept services your doctor has not ordered.
- No written explanation of what you might owe.
- Missed visits with no call, or no way to reach a nurse after hours.
When home health ends
Home health depends on you continuing to meet the rules and on what your doctor orders. When it ends, you may still need ongoing help with daily tasks. Plan for that early, and ask the agency to help you line up home care, personal care or adult day care. If the person is also coping with memory loss, see dementia care at home.
Next steps
- Ask your doctor whether home health fits, using the Medicare home health checker to prepare.
- Get the agency list and compare ratings.
- Plan for what happens after. Use the care cost comparison for longer-term care.
- Tell us what you need and we will show agencies that serve your area. You decide who to call.