Medicare Home Health Coverage: Eligibility, Services, and Costs

Adapted from Medicare & Home Health Care, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Medicare Coverage of Home Health Care

Who’s eligible?

If you have Medicare, you can use your home health benefits if you’re under the care of a doctor or allowed provider (including a nurse practitioner, a clinical nurse specialist, or physician assistant), and you’re getting services as part of a care plan that they’ve established and review regularly.

You can use your home health benefits if your doctor or allowed provider can certify you need one or more of these:

• Intermittent skilled nursing care (other than drawing blood)
• Physical therapy
• Speech-language pathology services
• Continued occupational therapy
• A home health agency that is Medicare certified
• A doctor or allowed provider who certifies that you’re homebound

Who’s homebound?

If you’re homebound, you have trouble leaving your home without help, or it requires a major effort to leave your home. You’re normally unable to leave your home, or it isn’t recommended because of an illness or injury. You may need help like using:

• A cane
• A wheelchair or walker
• Crutches
• Special transportation
• Help from another person

You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like an occasional trip to the barber, a walk around the block, or attendance at a family reunion, funeral, graduation, or other infrequent or unique event. You can still get home health care if you attend adult day care or religious services.

Your doctor or allowed provider documents that they’ve had a face-to-face encounter with you (like an appointment with your primary care doctor) within required timeframes and that the encounter was related to the reason you need home health care.

If you need more than “intermittent” skilled nursing care, you don’t qualify for home health services. Medicare defines “intermittent” as skilled nursing care that’s needed:

• Fewer than 7 days each week.
• Daily for less than 8 hours each day for up to 21 days. Medicare may extend the 3-week limit in exceptional circumstances.

If you’re expected to need full-time skilled nursing care over an extended period, you won’t usually qualify for home health benefits.

How Medicare pays for home health care

Medicare pays your Medicare-certified home health agency one payment for the covered services you get during a 30-day period of care. You can have more than one 30-day period of care. Payment for each 30-day period is based on your condition and care needs.

Getting treatment from a home health agency that’s Medicare-certified can reduce your out-of-pocket costs. A Medicare-certified home health agency agrees to:

• Be paid by Medicare
• Accept only the amount Medicare approves for their services

Medicare’s home health benefit only pays for services you get from the home health agency. Other medical services and equipment are generally still covered as part of your other Medicare benefits.

Check your “Medicare & You” handbook at Medicare.gov/publications for information on how Medicare covers these services.

You can also call 1-800-MEDICARE (1-800-633-4227) if you have questions about your Medicare benefits. TTY users can call 1-877-486-2048.

What’s covered

The home health agency must perform an initial assessment of all your care needs and must communicate those needs to the doctor or allowed provider responsible for your plan of care. After that, the home health agency must routinely assess your needs. The home health agency is responsible for meeting all of your medical, nursing, rehabilitative, social, and discharge planning needs, as noted in your home health plan of care.

If you’re eligible for home health care (page 5), Medicare covers these services if they’re reasonable and necessary to treat your illness or injury.

Skilled nursing care: Medicare covers skilled nursing care when the services you need:

• Require the skills of a nurse.
• Are reasonable and necessary to treat your illness or injury.
• Are provided on a part-time or intermittent basis (Medicare won’t cover a visit if you’re only having blood drawn.) “Part-time or intermittent” means you may be able to get home health aide and skilled nursing services (combined) any number of days per week as long as the services are provided:
• Fewer than 8 hours each day.
• 28 or fewer hours each week (or up to 35 hours a week in some limited situations).
• Come from a registered nurse or a licensed practical nurse. If you get services from a licensed practical nurse, a registered nurse will supervise your care. Home health nurses provide direct care and teach you and your caregivers about your care. They also manage, observe, and evaluate your care.

Examples of skilled nursing care include: giving certain IV drugs, certain injections, or tube feedings; changing dressings; and teaching about prescription drugs or diabetes care. Skilled nursing care doesn’t include services you could get safely and effectively from a non-medical person (including yourself) without the supervision of a nurse.

Physical therapy, occupational therapy, and speech-language pathology services: Medicare considers your therapy services reasonable and necessary in the home setting if:

• They’re a specific, safe, and effective treatment for your condition.
• They’re complex enough that you can only get them safely and effectively from a qualified therapist (or under the supervision of a qualified therapist).
• Your condition requires one of these:
• Therapy to restore or improve functions affected by your illness or injury.
• A skilled therapist or therapist assistant to safely and effectively perform therapy to help you maintain your current condition or prevent your condition from getting worse.
• The amount, frequency, and duration of the services are reasonable.

Home health aide services: Medicare will pay for part-time or intermittent home health aide services (like personal care), if you need them to maintain your health or treat your illness or injury. Medicare only covers home health aide services if you’re also getting skilled care, like:

• Skilled nursing care
• Physical therapy
• Speech-language pathology services
• Continuing occupational therapy, if you no longer need any of the above

Medical social services: Medicare covers these services when a doctor or allowed provider orders them to help you with social and emotional concerns that may interfere with your treatment or how quickly you recover. This might include counseling or help finding resources in your community. Medicare only covers medical social services if you’re also getting skilled care, like the services listed above.

Medical supplies: Medicare covers supplies (like wound dressings) when your doctor or allowed provider orders them as part of your care.

Medicare pays for durable medical equipment separately from your home health care. The equipment must meet certain criteria, and your doctor or allowed provider must order it. Medicare usually pays 80% of the Medicare-approved amount for certain medical equipment, like a wheelchair or walker. If your home health agency doesn’t supply durable medical equipment directly, the home health agency staff will usually arrange for a supplier to bring you the items.

What isn’t covered

Medicare doesn’t pay for:

• 24-hour-a-day care at home
• Meals delivered to your home
• Services like shopping, cleaning, and laundry
• Custodial or personal care like bathing, dressing, and using the bathroom (when this is the only care you need)

Talk to your doctor (or allowed provider) or the home health agency if you have questions about what’s covered. You can also call 1-800-MEDICARE.

Note: If you have a Medicare Supplement Insurance (Medigap) policy or other health coverage, be sure to tell your health care provider so your bills get paid correctly.

What you pay

You may have to pay for:

• Services and supplies that Medicare never pays for, like routine foot care.
• Services and supplies that Medicare usually pays for, but won’t pay for in this situation, because you’ve agreed to pay for them. The home health agency must give you a notice called the “Advance Beneficiary Notice of Noncoverage” (ABN) in these situations.
• 20% of the Medicare-approved amount for Medicare-covered durable medical equipment, like wheelchairs, walkers, and oxygen equipment.

Note: Before your home health care begins, the home health agency should tell you how much of your bill Medicare will pay. The agency should also tell you if Medicare doesn’t cover any of the items or services they give you, and how much you’ll have to pay for them. They should explain it to you both verbally and in writing.

“Advance Beneficiary Notice of Noncoverage” (ABN)

The home health agency must give you a written notice called an “Advance Beneficiary Notice of Noncoverage” (ABN) before giving you a home health service or supply that Medicare probably won’t cover for any of these reasons:

• The care isn’t medically reasonable and necessary.
• The care is only nonskilled personal care, like help with bathing or dressing.
• You aren’t homebound.
• You don’t need skilled care on an intermittent basis.

When you get an ABN, the notice should describe the service and/or supply, and explain why Medicare probably won’t pay. The ABN gives clear directions for getting an official decision from Medicare about payment for home health services and supplies and for filing an appeal if Medicare won’t pay.

In general, to get an official decision on payment, you should:

• Keep getting the home health services and/or supplies if you think you need them. The home health agency must tell you how much they’ll cost. Talk to your doctor or allowed provider about this decision.
• Understand you may have to pay the home health agency for these services and/ or supplies.
• Ask the home health agency to send your claim to Medicare so that Medicare will make a decision about payment. You have the right to have the home health agency bill Medicare for your care.
• If Original Medicare pays for your care, you’ll get back all your payments, except for any applicable coinsurance or deductibles, including any coinsurance payments you made for durable medical equipment.

Home Health Change of Care Notice (HHCCN)

The home health agency must also give you a “Home Health Change of Care Notice” (HHCCN) before they reduce or stop providing any home health services or supplies that change your plan of care.

Examples:

• The home health agency makes a business decision to reduce or stop giving you some or all of your home health services or supplies.
• Your doctor or allowed provider has changed or hasn’t renewed your orders.

Your right to a fast appeal

Your home health agency should give you a written notice called the “Notice of Medicare Non-Coverage” (NOMNC) at least 2 days before they end your services. If they don’t give you a notice, ask for it. Read the notice carefully. It contains important information about:

• The date all your covered services will end
• How to ask for a fast appeal
• Your right to get a detailed notice about why your services are ending
• Any other information Medicare requires

When all your covered home health services are ending, you may have the right to a fast appeal if you think these services are ending too soon. During a fast appeal, an independent reviewer called a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) looks at your case and decides if you need your home health services to continue.

If you ask for a fast appeal, the BFCC-QIO will ask why you think coverage of your home health services should continue. The BFCC-QIO will also look at your medical information and talk to your doctor or allowed provider. You should expect a response from the BFCC-QIO generally no later than 3 days after the effective date of the NOMNC.

If the BFCC-QIO decides your home health services should continue, Medicare may continue to cover your home health care services, except for any applicable coinsurance or deductibles.

If the BFCC-QIO decides that your coverage should end, you’ll have to pay for any services you got after the date on the NOMNC that says when your covered services should end. Your home health agency must give you an ABN with a cost estimate for these services.

You may choose to stop getting services on or before the date given on the NOMNC to avoid paying for any further services. If you don’t ask for a fast appeal and want to continue getting services after the date listed on the NOMNC, your home health agency must give you an ABN to let you know what you’ll pay.

For more information on your right to a fast appeal and other Medicare appeal rights, check your “Medicare & You” handbook or visit Medicare.gov/appeals. You can also call 1-800-MEDICARE.

Source and further reading

Medicare & Home Health Care — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.