The short answer: yes, if you qualify
Medicare does pay for home health care. Both Medicare Part A and Part B can cover it, and for eligible patients, Medicare pays the full cost of covered home health services. You pay nothing for the visits themselves. The main out-of-pocket cost is 20% of the Medicare-approved amount for durable medical equipment, after the Part B deductible.
The catch is eligibility. Medicare home health is a medical benefit for people who need skilled care at home and have difficulty leaving the house. It is not a long-term caregiving benefit. Understanding that distinction is the key to knowing whether Medicare will pay.
Who qualifies for Medicare home health care
To qualify, you must meet all of these conditions:
You are homebound. Medicare.gov describes this as meeting two conditions. Leaving home is not recommended because of your condition, or you need help to leave, such as a cane, walker, wheelchair, special transportation or another person. And you are normally unable to leave home, and leaving takes a lot of effort.
You need part-time or intermittent skilled care. That means skilled nursing, physical therapy, speech-language pathology or continuing occupational therapy.
A doctor or allowed provider orders your care. A physician, nurse practitioner, clinical nurse specialist or physician assistant must certify that you need home health and set up a plan of care.
You had a face-to-face visit. A doctor or allowed provider must see you, in person or through allowed telehealth, within 90 days before or 30 days after home health starts, for the reason you need care.
A Medicare-certified home health agency provides the care.
Being homebound does not mean you can never leave. You can still go to medical appointments, attend religious services, get a haircut or visit adult day care. Those short, infrequent absences do not cancel eligibility.
What Medicare covers at home
Medicare-covered home health services include:
Skilled nursing care on a part-time or intermittent basis. Examples include wound care, IV or nutrition therapy, injections, patient and caregiver teaching, and monitoring a serious or unstable condition.
Physical therapy, occupational therapy and speech-language pathology, when you meet the conditions.
Medical social services to help with social and emotional concerns related to your illness.
Home health aide care for bathing, grooming, walking help and similar personal care, but only if you are also getting skilled care.
Injectable osteoporosis drugs for women who meet certain criteria.
Durable medical equipment such as walkers or hospital beds, and medical supplies for use at home.
If you qualify, there is no limit on the number of home health visits, as long as you continue to meet the requirements.
What “part-time or intermittent” means
Medicare limits how much care you can get at home. In most cases, part-time or intermittent means skilled nursing and home health aide services combined for up to 8 hours a day and a maximum of 28 hours a week. Your provider can approve more frequent care for a short period, less than 8 hours a day and up to 35 hours a week, when it is necessary.
If you need more care than that, Medicare home health is not designed to provide it. Families in that situation usually combine Medicare-covered visits with privately paid care, Medicaid programs or other support.
What Medicare does not pay for
Medicare does not cover:
24-hour-a-day care at home.
Home meal delivery.
Homemaker services such as shopping, cleaning and laundry that are unrelated to your care plan.
Custodial or personal care, such as help with bathing, dressing or using the bathroom, when that is the only care you need.
This is the most common source of confusion. Many families assume Medicare pays for an in-home caregiver for an aging parent. It does not, unless the parent also needs skilled care and meets the homebound rule.
What you pay for home health under Medicare
Item | Original Medicare cost to you |
|---|---|
Covered home health visits (nursing, therapy, aide, social work) | $0 |
Durable medical equipment | 20% of the Medicare-approved amount after the Part B deductible |
Services Medicare does not cover | Full cost, after you receive written notice |
Before care starts, the agency should tell you how much Medicare will pay. If the agency plans to provide something Medicare will not cover, it should give you an Advance Beneficiary Notice (ABN) in writing first, so you can decide whether to accept and pay for it.
How Medicare pays the agency
Behind the scenes, Medicare pays home health agencies a fixed amount for each 30-day period of care under the Patient-Driven Groupings Model (PDGM). For 2026, the national standardized 30-day rate is $2,038.22 before adjustments for the patient's clinical needs and local wages. Your doctor certifies care in 60-day periods, and the plan can be renewed if you still qualify.
This matters to patients in one practical way: agencies must document carefully that you meet every requirement. That is why your nurse or therapist may ask detailed questions about how hard it is to leave home or why a skilled service is needed.
Medicare Advantage and home health
Medicare Advantage plans (Part C) must cover home health services that Original Medicare covers, but the rules can look different. Plans may require prior authorization, use a network of approved agencies and charge copayments for some services. Some plans offer extra in-home support benefits that Original Medicare does not, such as limited personal care or meal benefits.
If you have a Medicare Advantage plan, call the plan before starting care to confirm which agencies are in network and what approvals are needed.
Does Medicare pay for maintenance care?
Yes, in the right circumstances. Following the Jimmo v. Sebelius settlement, Medicare clarified that coverage does not depend on whether you are improving. Skilled therapy or nursing can be covered to maintain your condition or slow decline when the skills of a professional are needed to do it safely and effectively.
Review Choice Demonstration states
If you get home health care in Florida, Illinois, North Carolina, Ohio, Texas or Oklahoma, your agency participates in Medicare's Review Choice Demonstration. Agencies in these states may submit records to Medicare before or after billing to confirm coverage. This usually happens behind the scenes, but it is one reason agencies in these states are especially careful with paperwork.
Other ways to pay for home care
When Medicare does not cover what you need, these options may help:
Medicaid, including home and community-based services waivers, which can cover personal care for people who qualify financially.
Long-term care insurance, which often covers custodial care at home.
Veterans benefits through the Department of Veterans Affairs, such as Homemaker and Home Health Aide care or Aid and Attendance.
Private pay for non-medical caregivers.
How to find a Medicare-certified agency
Use Medicare's Care Compare tool to search agencies by ZIP code and compare star ratings, patient survey results and quality measures. Your doctor should give you a list of agencies that serve your area and must disclose any financial interest in an agency on that list.
For agencies: accurate billing protects patient access
From the agency side, Medicare coverage only works when the claim matches the chart. Every eligibility element, from homebound status to the face-to-face date, has to be documented and coded correctly. Agencies that struggle with denials often bring in professional home health billing services so clinicians can focus on care instead of paperwork.
Agencies comparing home health billing companies in USA should look for teams that understand both Original Medicare and Medicare Advantage authorization rules. Regional knowledge helps too. Providers seeking home health billing in Palm Springs serve many retirees enrolled in Medicare Advantage. Agencies focused on home health billing in Houston operate under the Texas Review Choice Demonstration. And home health billing companies in NYC must coordinate Medicare with New York Medicaid for dual-eligible patients.
The Trucare Home health billing service checks eligibility, homebound documentation and face-to-face timing before claims go out, which helps agencies keep Medicare-covered care flowing for their patients.
FAQs
Does Medicare pay for home health care after a hospital stay? Yes, if you meet the eligibility rules. A prior hospital stay is not required for Medicare home health.
How long will Medicare pay for home health care? There is no fixed limit. Care is certified in 60-day periods and can continue as long as you remain eligible.
Does Medicare pay for a caregiver at home? Not for custodial care alone. Aide services are covered only alongside skilled care.
Do I need Part A and Part B? Home health can be covered under either Part A or Part B, depending on your situation.
Sources: Medicare.gov: Home health services; CMS Review Choice Demonstration for Home Health Services; IHA CY 2026 HH PPS final rule summary.
