These services aim to help beneficiaries recover from an illness or injury, manage a chronic health condition, or maintain independence at home. Here are the eligibility requirements, covered services, and out-of-pocket cost information for in-home care under Medicare.
Eligibility Requirements
To qualify for home health services under Medicare:
- Doctor’s Certification.Your doctor must certify that the patient is homebound and needs one or more covered services.
Homebound Status: The patient must have difficulty leaving home due to a medical condition and require assistance, special transportation, or a mobility aid to do so because of an illness or injury.
You can also qualify as homebound if leaving your home isn’t medically recommended because of your condition, or if you’re normally unable to leave your home because of the major effort involved. - Eligible Providers. Services must be provided by a Medicare-certified home health agency.
- Plan of Care. The patient’s doctor must develop and review a care plan regularly.
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Covered Services
Medicare covers the following home health services under Part A (Hospital Insurance) or Part B (Medical Insurance):
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Skilled Nursing Care
Part-time or intermittent nursing care provided by a licensed nurse is covered under Medicare Part A if you’re receiving it as part of a home health care plan after a qualifying hospital stay.
Under Medicare Part B, it is covered without the hospital stay requirement if deemed medically necessary. Beneficiaries pay no out-of-pocket costs for the nursing care itself under Original Medicare.
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Therapy Services
Physical therapy, speech-language pathology, and occupational therapy are covered under Medicare Part B.
These services are subject to the Part B deductible ($257 for 2025) and beneficiaries are responsible for 20% coinsurance of the Medicare-approved amount.
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Home Health Aide Services
Personal care assistance, such as help with bathing and dressing, is covered under Medicare Part A or Part B as part of a broader care plan.
However, these services are only covered when they support a skilled care need. There are no out-of-pocket costs for eligible services under Original Medicare.
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Medical Social Services
Counseling and assistance in finding community resources for emotional and social support are covered under Medicare Part A or Part B when ordered by a doctor as part of a care plan.
These services typically have no out-of-pocket costs for beneficiaries.
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Durable Medical Equipment (DME)
Medicare Part B covers durable medical equipment such as wheelchairs, walkers, and oxygen equipment, provided they are medically necessary and prescribed by a doctor.
Beneficiaries are responsible for 20% coinsurance of the Medicare-approved amount, and the Part B deductible applies ($257 for 2025).
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Wound Care and Medication Administration
These specialized medical services are typically covered under Medicare Part A if provided as part of a home health care plan following a qualifying hospital stay, or under Part B if ordered independently.
Out-of-pocket costs depend on whether Part A or Part B applies, but most beneficiaries incur no costs for wound care under the home health benefit.
Cost Considerations
- Medicare covers 100% of approved costs for skilled nursing, therapy, and home health aide services under Part B.
- Beneficiaries pay 20% of the Medicare-approved amount for durable medical equipment. However, if you have a Medicare supplement (Medicare) plan.
- There is no limit on the duration of covered services as long as the care remains medically necessary.
Home Health Benefits Under Medicare Advantage Plans
Medicare Advantage (Part C) plans often include additional home health benefits beyond what Original Medicare provides.
Offered by private insurance companies, these plans bundle Part A and Part B coverage and may include extra services like:
- Expanded Home Health Services: Some plans cover more frequent or longer-duration visits than Original Medicare
- Meal Delivery: Temporary meal services for individuals recovering from surgery or illness
- In-Home Support Services: Assistance with housekeeping, meal preparation, or medication reminders
- Telehealth Monitoring: Remote patient monitoring and virtual consultations with healthcare providers
Medicare Advantage plans can vary widely in the services they offer, so it’s essential to compare options carefully. A Medigap Advisors Personal Benefits Manager can help identify plans that include comprehensive home health benefits.
Learn More: Medicare Advantage Special Needs Plans
Home Health Services During Hospice Care
Home health services play a crucial role in hospice care, which is covered under Medicare Part A.
Hospice care focuses on providing comfort and quality of life for individuals with a terminal illness. The focus is on palliative care, not curative care.
Hospice Home Health Services:
- Palliative Nursing Care: Pain and symptom management provided by skilled nurses
- Home Health Aides: Assistance with personal care and activities of daily living
- Respite Care: Short-term inpatient care to give family caregivers a break
- Counseling Services: Emotional and spiritual support for both the patient and their family
- Medical Supplies: Coverage for equipment and medications related to symptom control and palliative care
While receiving hospice care, beneficiaries are no longer eligible for curative treatments related to their terminal illness. However, they can still receive unrelated medical care under Medicare Part B.
Note: You can withdraw from hospice care at any time, and once again be eligible for curative care.
From Our Newsletter: Ensuring Comfort at the End: A Comprehensive Guide to Medicare Hospice Benefits
Choosing the Right Coverage for Your Needs
Home health benefits under Medicare can be invaluable for maintaining independence and receiving quality care at home.
However, the scope of coverage varies significantly between Original Medicare and Medicare Advantage plans. Understanding your options is essential to making the right choice for your health and financial needs.
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Take the Next Step
If you’re considering home health services under Medicare, a Medigap Advisors Personal Benefits Manager can guide you through the options.
Schedule a free consultation today to find a plan that includes the home health benefits you need. Whether you’re managing a chronic condition, recovering from surgery, or caring for a loved one on hospice, the right plan can make all the difference.
For Further Reading:
Tom Lockwood is a Personal Benefits Manager at MediGap Advisors. Tom has a passion for bringing clarity to those confused about Medicare. He is an authority on Medicare, Medicare supplement plans, Medicare Advantage plans, and Part D prescription drug plans. Read more about Tom on his Bio page.