Understanding Medicare Coverage for Home Health
Medicare coverage for home health care can seem complex, but understanding the basics ensures you get the care you need without unexpected costs. This comprehensive guide breaks down what's covered and how to qualify.
What Medicare Part B Covers
Medicare Part B (Medical Insurance) covers home health services when you meet all four of these conditions:
Covered Services
When you qualify, Medicare covers these home health services at 100% (no copay or deductible):
What's NOT Covered
Understanding what Medicare doesn't cover helps avoid surprises:
The Homebound Requirement
Medicare considers you homebound if:
- • Leaving home requires considerable and taxing effort due to illness or injury
- • You need help from another person or assistive devices to leave home
- • Your doctor believes leaving home is medically contraindicated
Note: You can still attend medical appointments, religious services, or adult day care and remain eligible. Short, infrequent absences for non-medical reasons don't disqualify you.
How to Get Started
Getting Coverage is Simple
- 1. Talk to your doctor - Your physician must order home health services and create a care plan
- 2. Choose a Medicare-certified agency - We handle all Medicare paperwork and billing
- 3. Services begin - Usually within 24-48 hours of physician order
Common Questions
Do I need Medicare Part A to get home health care?
No. Medicare Part B covers most home health services. Part A covers home health care only if you're also receiving skilled care for a related illness or injury after a qualifying hospital stay.
How long can I receive home health care?
As long as you continue to meet Medicare's requirements and your doctor certifies the ongoing need. Care is reviewed every 60 days.
Will I have any out-of-pocket costs?
Medicare covers 100% of approved home health services. You may have costs for durable medical equipment (you pay 20% of the Medicare-approved amount after meeting your Part B deductible).