Does Medicare cover home healthcare?

Skilled home healthcare includes a wide range of services that are provided in your home to help you manage a chronic condition or recover from an injury, illness, surgery or hospitalization. Services may include:¹

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Physical or occupational therapy
• Injections
• Monitoring patients whose condition is unstable

Note: If you need full-time skilled nursing care for a long time, it’s unlikely that you’ll be eligible for home healthcare services.²

Depending on your personal situation, you may get home healthcare coverage from either Medicare Part A or Part B—or sometimes from both.

A doctor or other healthcare provider (like a nurse practitioner) must have a face-to-face visit with you before certifying that you need home health services. In addition, a Medicare-certified home health agency must provide healthcare in your home.
 

Who’s eligible for home healthcare services?

You may be eligible if:²

1. You’re under the care of a doctor and get services under a plan of care created and reviewed by a doctor.
2. You need, and a doctor must certify that you need, 1 or more of these services:
   1. Intermittent skilled nursing care (other than drawing blood)
   2. Physical therapy
   3. Speech-language pathology
   4. Continued occupational therapy
3. A doctor can certify that you’re homebound. This means that, due to your illness or injury, you have trouble leaving your home without using a cane, walker, crutches or wheelchair, or that you require help from another person and/or need special transportation. 
4. The home health agency caring for you is approved by Medicare.

Which home healthcare services are covered by Medicare?

If you’re eligible for Medicare-covered home healthcare, services covered may include:³

• Part-time or intermittent skilled nursing care
• Physical therapy
• Occupational therapy
• Speech-language pathology services
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)
• Injectable osteoporosis drugs for women

Note: Original Medicare will not pay for 24-hour-a-day care or meals delivered to your home. It also won’t cover homemaker, custodial or personal care if that’s the only care you need.³ Some Medicare Advantage plans may include coverage for in-home help with daily living activities, meal preparation or mobility issues.

What is the cost of home healthcare?

All eligible Medicare recipients pay the following for skilled home health services:³

• $0 for home health services
• 20% of the Medicare-approved amount for durable medical equipment (DME) like a walker, wheelchair or hospital bed

Before home healthcare begins, your home health agency should explain your bill. This includes what Medicare will help cover, what Medicare won’t cover and how much they anticipate you’ll owe (if anything). The details of what isn’t covered by Medicare must be given to you in an Advance Beneficiary Notice (ABN) before you receive any uncovered items or services.³

Learn more about Medicare coverage

For information on prescriptions, home health services and more, check out what Medicare does and doesn’t cover.