As people age or manage chronic illnesses, receiving medical support in the comfort of their own home becomes not just a convenience—but often a necessity. For millions of Americans, home health care provides a lifeline to recovery, independence, and improved quality of life. Fortunately, Medicare covers certain health care services delivered at home, but there are specific requirements patients must meet to qualify.
In this article, we’ll break down how Medicare defines home health care, the eligibility criteria, and what services are included.
What Is Home Health Care?
Home health care refers to a range of medical and support services provided in a patient’s home, typically after hospitalization, injury, or due to a chronic condition. Unlike personal or custodial care (like help with bathing or cooking), home health care is medical in nature and must be prescribed by a physician.
Covered services under Medicare may include:
- Skilled nursing care
- Physical, occupational, or speech therapy
- Medical social services
- Home health aide services (if also receiving skilled care)
- Durable medical equipment (like wheelchairs or walkers)
Who Qualifies for Home Health Care Under Medicare?
To qualify for home health care under Medicare Part A and/or Part B, patients must meet the following conditions:
- Be under the care of a doctor and receiving services under a care plan established and regularly reviewed by a physician.
- Need one or more of the following services:
- Intermittent skilled nursing care (not full-time)
- Physical therapy
- Speech-language pathology services
- Ongoing occupational therapy
- Be homebound, meaning that leaving home requires considerable effort and assistance due to illness or injury. Occasional outings (like to church or short walks) are allowed, but regular trips out of the home may disqualify someone.
- Receive care from a Medicare-certified home health agency. Not all providers qualify—so it’s important to verify that the agency meets Medicare standards.
- Be certified as homebound by a doctor, typically through a face-to-face encounter that occurs within 90 days before or 30 days after starting home health care.
What Medicare Covers (and Doesn’t)
If you qualify, Medicare typically covers 100% of approved home health care services, including:
- Part-time skilled nursing care
- Physical and occupational therapy
- Medical supplies for home use
- Social work support
However, Medicare does not cover:
- 24/7 home care
- Meals delivered to the home
- Homemaker services (e.g., cleaning or shopping)
- Personal care if it’s the only care needed
This distinction is important: Medicare pays for medical services, not general caregiving.
Steps to Get Started
Here’s a simple step-by-step process to qualify for and start receiving Medicare-covered home health care:
- Talk to your doctor about your condition and whether home health care is appropriate.
- If eligible, your doctor will create a plan of care and refer you to a Medicare-certified home health agency.
- The agency will evaluate your needs and work with your doctor to finalize the care plan.
- Services will begin and continue as long as they are medically necessary and meet Medicare requirements.
Recertification and Duration of Care
Medicare home health benefits are not unlimited. Care plans must be reviewed and re-certified every 60 days. If continued care is required, your doctor must verify that the services are still medically necessary and that you remain homebound.
It’s important to note that intermittent care means care that’s needed fewer than seven days per week or less than eight hours per day over a period of 21 days (or potentially longer in exceptional cases).
Why It Matters
Access to health care that supports aging in place is a major priority for both families and policymakers. Home-based care can be less expensive than institutional settings and is often preferred by patients. Medicare’s home health benefit is a crucial part of this system—but understanding the rules and requirements is essential to taking full advantage of it.
Final Thoughts
Knowing how to qualify for home health care under Medicare can help you or a loved one receive essential medical services without needing to leave home. With the right care plan, physician involvement, and a Medicare-certified provider, you can maintain dignity, independence, and quality of life—all from the comfort of your home.
