If recovering at home sounds better than staying in a facility, you're not alone. More than 12,000 Medicare-certified home health agencies serve over 3.4 million beneficiaries each year, providing skilled care in the comfort and familiarity of your own home. The good news? Medicare covers a comprehensive range of home health services at no cost to you when you meet specific eligibility requirements.

This guide explains everything you need to know about Medicare coverage for home health care in 2026. We'll break down what services are covered, who qualifies, and how to access these valuable benefits to support your recovery at home.

Yes, Medicare Covers Home Health Care Services

Medicare provides extensive home health coverage through both Part A and Part B, with identical benefits regardless of which part you access. The coverage includes skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social services, and home health aide assistance—all delivered in your home by Medicare-certified professionals.

What makes home health coverage particularly valuable is that Medicare pays 100% of costs for covered services. You pay no deductible, no coinsurance, and no copayments for home health care when provided by Medicare-certified agencies. This is one of the few Medicare benefits with zero out-of-pocket costs to beneficiaries.

Eligibility Requirements

To qualify for Medicare home health coverage, you must meet four specific criteria:

You must be homebound. This is Medicare's most important requirement. Homebound doesn't mean you can never leave your house, but leaving must require considerable and taxing effort. You might qualify as homebound if you need assistance from another person or special equipment like a wheelchair or walker to leave home, or if your doctor advises against leaving due to your condition. Short, infrequent absences for medical treatment, religious services, or adult day care don't disqualify you from being homebound.

You must be under a doctor's care. Your physician must certify that you need home health services and must establish a plan of care. This doctor will review your plan of care every 60 days and recertify your ongoing need for services.

You must need skilled services. Medicare covers home health only when you need skilled nursing care on an intermittent basis, or physical therapy, or speech-language pathology services, or continued occupational therapy. Simply needing help with bathing, dressing, or meal preparation doesn't qualify unless you also need skilled services.

You must use a Medicare-certified agency. The home health agency providing your care must be Medicare-approved. Medicare.gov's Home Health Compare tool helps you find and compare certified agencies in your area.

According to Medicare.gov, these requirements ensure that home health benefits go to beneficiaries who genuinely need professional medical care at home rather than just assistance with daily activities.

Covered Services

Once you qualify for home health care, Medicare covers a comprehensive array of services:

Skilled nursing care includes wound care, catheter management, medication administration and monitoring, patient education about disease management, and regular health assessments. Nurses visit as often as your plan of care requires, from daily visits for complex conditions to weekly visits for stable patients needing monitoring.

Physical therapy helps you regain strength, mobility, and independence after surgery, injury, or illness. Your therapist designs exercises to improve balance, reduce fall risk, manage pain, and restore function. Therapy can occur multiple times weekly depending on your needs.

Occupational therapy focuses on helping you perform daily activities like bathing, dressing, cooking, and managing medications. Occupational therapists might recommend adaptive equipment, teach energy conservation techniques, or help you navigate your home safely. Note that occupational therapy alone doesn't qualify you for home health coverage—you must also need skilled nursing, physical therapy, or speech therapy. However, once you qualify, occupational therapy can continue even after other services end if you're still making progress.

Speech-language pathology treats communication and swallowing disorders. Speech therapists help you regain speech abilities after a stroke, manage swallowing difficulties safely, and communicate effectively. Like physical therapy, speech therapy can qualify you for home health coverage on its own.

Medical social services help you cope with the emotional and social challenges of illness. Medical social workers assess your needs, connect you with community resources, provide counseling, and assist with advance care planning. This service is covered but requires that you also receive skilled nursing or therapy services.

Home health aide services assist with personal care like bathing, toileting, dressing, and light housekeeping related to your care. Medicare covers these services only when you're also receiving skilled nursing or therapy services. Home health aides work under the supervision of your skilled care team.

What Medicare Does NOT Cover

Understanding Medicare's limitations helps you avoid surprise costs and plan for additional needs:

24-hour care isn't covered. Medicare covers intermittent visits—part-time nursing or therapy services—not around-the-clock supervision or care.

Custodial or personal care alone doesn't qualify. If you only need help with bathing, dressing, or meal preparation without any skilled services, Medicare won't cover home health care.

Meal delivery and homemaker services like routine housekeeping, laundry, or shopping aren't covered medical services, though some Medicare Advantage plans offer these as supplemental benefits.

Prescription drugs delivered to your home are covered under Part D, not under home health benefits. Your home health nurse can't provide medications as part of home health coverage.

Medical equipment and supplies may be partially covered, but not all items. Durable medical equipment like hospital beds, wheelchairs, and walkers are covered under Part B as DME with 20% coinsurance. Routine medical supplies for home care are covered, but you might pay for some items.

What Parts of Medicare Cover Home Health Care?

Understanding which Medicare parts provide home health coverage helps you know what to expect and how services coordinate with your other benefits.

Medicare Part A Coverage

Medicare Part A covers home health care if your home care needs follow a qualifying hospital stay of at least three days as an admitted patient. If you're discharged from the hospital and your doctor orders home health care, Part A handles the coverage for the first 100 days of home health services related to your hospital stay.

Importantly, Part A home health coverage is completely free—no deductible, no coinsurance, no copayments. This is different from skilled nursing facility coverage, which charges daily copayments after day 20.

Medicare Part B Coverage

Medicare Part B covers home health care when you don't have a qualifying hospital stay or when your care extends beyond Part A coverage. Most Medicare home health care is actually covered under Part B rather than Part A because the hospital stay requirement often doesn't apply.

Part B home health coverage is also completely free with no cost-sharing. You don't pay the Part B deductible, no 20% coinsurance applies, and no copayments are required. This makes Part B home health coverage one of the most generous benefits in Medicare.

The one exception: if your home health agency provides you with durable medical equipment (like a walker or shower chair) as part of your home care, you'll pay 20% coinsurance for the equipment under Part B's standard DME coverage rules.

Medicare Advantage (Part C) Coverage

Medicare Advantage plans must cover all home health services that Original Medicare covers, and many plans enhance these benefits with additional services. Enhanced benefits commonly include:

Expanded personal care hours beyond what Original Medicare allows. Some plans cover more home health aide visits for personal care assistance.

Meal delivery programs providing medically tailored meals after hospital discharge or during illness recovery. Medicare Advantage plans often include 1-2 weeks of meals to support healing.

Transportation assistance for medical appointments and pharmacy visits. This helps homebound beneficiaries access necessary care outside the home.

Homemaker services like light housekeeping, laundry, and grocery shopping that Original Medicare doesn't cover.

Transition care with extra nursing visits or phone check-ins during the first few weeks after hospital discharge to prevent readmissions.

Check your specific Medicare Advantage plan for details about enhanced home health benefits. You must use in-network home health agencies for coverage, and prior authorization might be required before services begin.

Medicare Part D Coverage

While Part D doesn't cover home health services themselves, it covers prescription medications your home health nurse might deliver to you. If you need pain medications, antibiotics, or other prescriptions while receiving home health care, Part D handles medication costs according to your plan's formulary and cost-sharing structure.

Your home health nurse can coordinate with your doctors to ensure you have necessary medications but can't prescribe them—prescriptions must come from your physician.

Understanding Your Costs for Home Health Care in 2026

One of the most attractive aspects of Medicare home health coverage is its low cost to beneficiaries.

Original Medicare Costs

With Original Medicare, you pay $0 for all covered home health services. This includes:

• Skilled nursing visits: $0

• Physical therapy sessions: $0

• Occupational therapy sessions: $0

• Speech-language pathology: $0

• Medical social services: $0

• Home health aide visits: $0

You don't pay the Part A hospital deductible, the Part B deductible, or any coinsurance for these services. There are no hidden fees or surprise bills if you use a Medicare-certified home health agency.

The one exception: Durable medical equipment (DME) provided by your home health agency follows standard Part B DME coverage rules. You'll pay 20% coinsurance after meeting your Part B deductible ($240 in 2026) for items like:

• Hospital beds: typically $50-$200 per month rental (your 20% = $10-$40)

• Wheelchairs: $25-$100 per month rental (your 20% = $5-$20)

• Walkers: $40-$100 purchase (your 20% = $8-$20)

• Shower chairs: $50-$150 purchase (your 20% = $10-$30)

Medicare Advantage Costs

Medicare Advantage plans must cover home health services with the same $0 cost-sharing that Original Medicare provides. You won't pay copayments or coinsurance for skilled nursing visits, therapy sessions, or home health aide services.

However, if your plan offers enhanced benefits beyond Original Medicare (like meal delivery or extra personal care hours), verify whether these extra services involve copayments. Most plans provide enhanced home health benefits at no additional cost, but it's worth confirming.

DME provided through your Medicare Advantage plan follows your plan's cost-sharing structure, which might be lower or higher than Original Medicare's 20% coinsurance.

Comparing Costs: Home Health vs. Facility Care

Medicare's generous home health coverage often saves beneficiaries thousands of dollars compared to facility-based care:

Skilled nursing facility: $0 for days 1-20, then $204 per day for days 21-100 in 2026. A 50-day SNF stay would cost you $6,120 out-of-pocket (30 days × $204).

Home health care: $0 for all services regardless of length. Two months of daily nursing visits plus three-times-weekly physical therapy costs you nothing.

This cost difference, combined with the comfort of recovering at home, makes home health an attractive option when you qualify.

How to Start Medicare Home Health Care

Setting up home health services involves several steps, but understanding the process helps ensure you get needed care quickly.

Step 1: Doctor's Orders

Home health care requires a physician's order. Your doctor—either your primary care doctor or a specialist treating your condition—must determine that you need home health services and certify that you're homebound. This usually happens:

After a hospital discharge when your hospital doctors determine you need continued skilled care at home. Discharge planners often coordinate home health setup before you leave the hospital.

During an office visit when your doctor evaluates your condition and determines you need home health services. Your doctor might recognize that you're declining at home and would benefit from nursing visits and therapy.

Through communication with the home health agency after you've contacted an agency directly. You can call a Medicare-certified home health agency, which will then contact your doctor to obtain necessary orders.

Your doctor creates a plan of care specifying:

• What services you need (nursing, physical therapy, etc.)

• How often services should be provided

• Your medical diagnosis justifying services

• Your goals for treatment

• Expected duration of care

Step 2: Choose a Medicare-Certified Agency

Use Medicare's Home Health Compare tool at Medicare.gov to find certified agencies in your area. Compare agencies based on:

Quality ratings from Medicare's five-star system showing how agencies perform on quality measures like patient improvement and patient satisfaction.

Services offered since not all agencies provide all services. If you need specialized wound care, verify the agency has qualified wound care nurses.

Geographic service area to ensure the agency serves your address. Some agencies only cover certain zip codes.

Language capabilities if you prefer care in a language other than English.

Patient reviews from other Medicare beneficiaries who've used the agency.

You can also ask for recommendations from your doctor, hospital discharge planner, or friends who've received home health care.

Step 3: Initial Assessment

Once you've selected an agency and your doctor has sent orders, the agency schedules an initial assessment visit. A registered nurse visits your home to:

• Review your medical history and current health status

• Assess your home environment for safety hazards

• Evaluate what services you need

• Develop a detailed care plan

• Verify that you meet homebound criteria

• Coordinate with your doctor about your plan of care

This assessment typically takes 60-90 minutes. The nurse asks many questions about your abilities, symptoms, medications, and support system to ensure your care plan addresses all your needs.

Step 4: Services Begin

After the initial assessment, your scheduled services begin according to your plan of care. This might include:

Skilled nursing visits ranging from daily to weekly depending on your needs. Each visit lasts 30-60 minutes.

Therapy sessions two to three times per week initially, with frequency adjusted based on your progress. Sessions typically last 45-60 minutes.

Home health aide visits several times per week for personal care assistance, usually 2-3 hour visits.

Care coordination with ongoing communication between your nurse, therapists, doctor, and other providers involved in your care.

Step 5: Ongoing Monitoring and Recertification

Your doctor must recertify your need for home health care every 60 days. Before each certification period ends, your home health agency:

• Assesses your progress toward goals

• Evaluates whether you still meet homebound and skilled service requirements

• Adjusts your plan of care as needed

• Communicates with your doctor about continued need for services

Services continue as long as you remain eligible and are making progress. If you've met your goals or no longer need skilled services, your home health care episode ends, though you can be readmitted later if your needs change.

Common Medicare Home Health Denials and Appeals

While Medicare home health coverage is generous, denials do occur. Understanding common reasons helps you prevent denials or successfully appeal them.

Frequent Denial Reasons

Failure to meet homebound criteria. The most common denial occurs when Medicare determines you're not truly homebound. This might happen if documentation suggests you're leaving home frequently for non-medical reasons or that leaving doesn't require considerable effort.

No need for skilled services. If your home health agency bills for services that don't require a skilled professional—like basic personal care that a family member could provide—Medicare will deny coverage. Skilled services must involve medical expertise beyond what unlicensed caregivers can safely provide.

Services aren't intermittent. Medicare covers part-time or intermittent services, not full-time care. Claims for excessive visits or around-the-clock care will be denied. While there's no specific visit limit, Medicare reviews claims exceeding reasonable norms for your diagnosis.

Maintenance therapy. Once you've plateaued and are no longer improving, continued therapy becomes maintenance care, which Medicare doesn't cover. Physical, occupational, and speech therapy require documented ongoing progress toward functional goals.

Missing physician certification. If your doctor hasn't certified your plan of care or hasn't recertified it timely, claims will deny. Your doctor must review and sign off on your care plan every 60 days.

Using non-certified agencies. Medicare only covers services from Medicare-certified home health agencies. Using agencies without certification results in no coverage, leaving you responsible for all costs.

The Appeals Process

If Medicare denies coverage for home health services, you have strong appeal rights. The appeals process has five levels:

Level 1: Redetermination (within 120 days of denial). Submit a written request to your Medicare Administrative Contractor explaining why services were medically necessary and you met eligibility requirements. Include supporting documentation from your home health agency and doctor.

Level 2: Reconsideration (within 180 days of Level 1 decision). If your first appeal is denied, a Qualified Independent Contractor reviews your case independently. This level has higher success rates.

Your appeal should include:

• Complete home health records documenting your condition and services provided

• Evidence supporting your homebound status (doctor's notes, nursing assessments, functional limitations)

• Documentation of skilled services necessity showing why professional expertise was required

• Your doctor's certification and recertification of your plan of care

• Evidence of progress toward goals for therapy services

Many home health denials are overturned when complete documentation demonstrates you genuinely met eligibility criteria. Your home health agency should support your appeal since they want payment for services rendered.

Preventing Denials

Work with your home health agency to ensure proper documentation:

Verify homebound status. Be honest with your nurse about how often you leave home and why. Your nurse documents your homebound status at every visit, and inconsistencies can trigger denials.

Understand what services are skilled. Ask your nurse or therapist to explain why services require professional skills. This helps you understand coverage and can help with appeals if needed.

Track your progress. Notice improvements in mobility, pain, wound healing, or ability to perform activities. Documented progress supports continued therapy coverage.

Keep appointments. Missing visits without good reason can suggest services aren't truly necessary.

Communicate with your doctor. Ensure your doctor knows about your home health services and provides timely certifications.

How an Aviator Health Advocate Can Help

Navigating home health care—from determining eligibility to coordinating services to managing potential denials—can overwhelm patients and families already dealing with serious health issues. An Aviator Health advocate removes these burdens so you can focus on healing.

Setting Up Services

Your advocate streamlines the process of establishing home health care. They work with your doctor to ensure proper orders and medical necessity documentation, help you select high-quality Medicare-certified agencies using Medicare's data and local knowledge, and coordinate the initial assessment scheduling to get services started quickly.

If you're being discharged from the hospital, your advocate works with discharge planners to ensure seamless transition to home health care, preventing gaps in care that could lead to complications or readmission.

Understanding Your Eligibility

The homebound requirement confuses many beneficiaries who could benefit from home health services. Your advocate helps you understand whether you meet homebound criteria, prepares you for nursing assessments by explaining what information to share, and ensures proper documentation of your homebound status.

If your mobility improves but you'd benefit from continued services, your advocate helps determine whether you still qualify and works with your care team to justify ongoing need.

Coordinating Care

Home health care involves multiple providers—nurses, therapists, home health aides, your primary care doctor, specialists, and potentially infusion services or equipment suppliers. Your advocate ensures everyone has current information, care plans align across providers, appointments are scheduled efficiently, and nothing falls through the cracks.

For complex patients with multiple conditions requiring coordination between home health and other services, your advocate manages the entire care ecosystem, preventing dangerous gaps or duplications.

Appealing Denials

If Medicare denies coverage for home health services, your advocate handles the entire appeals process. They know exactly what documentation Medicare requires to approve coverage and gather compelling evidence from your medical team.

Your advocate submits professionally written appeal letters demonstrating:

• You met homebound criteria based on documented functional limitations

• Services required skilled professional expertise

• Care was medically necessary for your condition

• Treatment followed accepted standards of care

This expertise significantly increases chances of overturning denials, potentially saving you thousands of dollars while ensuring you receive necessary care.

Managing Transitions

When your home health episode ends—either because you've met goals or because you need a different level of care—your advocate manages transitions smoothly. They might help you find outpatient therapy to continue progress, arrange for facility-based care if you need more intensive services, connect you with community resources for ongoing support needs, or set up new home health services if your condition changes later.

Addressing Quality Concerns

If you're unhappy with your home health agency's services, your advocate helps you address concerns and switch agencies if necessary. They file quality complaints with Medicare when appropriate, research alternative agencies, coordinate the transfer of care, and ensure continuity of services during transitions.

Many Medicare beneficiaries find that having an advocate saves them stress, prevents complications from care gaps, and ensures they maximize their home health benefits. Aviator Health advocacy services focus on removing obstacles so you can heal at home successfully.

Frequently Asked Questions About Medicare Coverage of Home Health Care

Do I need to pay anything for Medicare home health care?

No, you pay $0 for all covered home health services including skilled nursing visits, physical therapy, occupational therapy, speech therapy, medical social services, and home health aide assistance. The only exception is durable medical equipment provided by your home health agency, which follows standard Part B DME coverage with 20% coinsurance after your deductible. This makes home health one of Medicare's most generous benefits.

Can I receive home health care without a hospital stay?

Yes, absolutely. While some home health care follows hospital discharge, you don't need a hospital stay to qualify. If your doctor determines you're homebound and need skilled services, you can start home health care directly from home. Common examples include diabetic wound care, COPD management, therapy after falls, or care for progressive chronic conditions—none requiring prior hospitalization.

How long will Medicare pay for home health services?

Medicare covers home health as long as you meet eligibility requirements: homebound status, need for skilled services, under doctor's care, and making reasonable progress. There's no specific time limit. Some patients receive home health for weeks, while others need services for months. Your doctor recertifies your need every 60 days. Services continue until you've met your goals or no longer need skilled care.

Can I choose which home health agency to use?

Yes, you have the right to choose any Medicare-certified home health agency that serves your area and has capacity to accept you. Use Medicare's Home Health Compare tool at Medicare.gov to research agencies. If you have Medicare Advantage, you must choose an in-network agency, which may limit your options. You can also switch agencies if you're unhappy with your current one.

What if I don't think I'm homebound but I need skilled nursing at home?

If you're not homebound, Medicare won't cover traditional home health services. However, you might still receive skilled care through other Medicare benefits. Outpatient therapy at a clinic is covered under Part B for physical, occupational, and speech therapy. Visiting nurse services might be available through some Medicare Advantage plans even without homebound status. Or you could pay privately for nursing visits at market rates (typically $100-$200 per visit).

Can family members provide my care instead of home health services?

Family members can certainly help with personal care, but Medicare only covers services that require skilled professionals. If you need wound care, medication management, injections, or therapy requiring specialized expertise, family members can't provide these services unless they're licensed professionals. Medicare covers skilled services plus home health aide assistance with personal care. Family caregivers remain crucial but can't replace skilled professional care.

Summary

Medicare provides exceptional home health coverage that enables recovery in the comfort and familiarity of your own home. Part A and Part B cover skilled nursing care, physical therapy, occupational therapy, speech therapy, and home health aide services with zero out-of-pocket costs to you—no deductible, no coinsurance, no copayments.

To access these benefits, you must be homebound (leaving requires considerable effort), under a doctor's care, need skilled services on an intermittent basis, and use Medicare-certified home health agencies. These requirements ensure benefits go to those who genuinely need professional medical care at home.

Home health care treats a wide range of conditions from post-surgical recovery to chronic disease management to wound care. Services can last weeks or months depending on your needs, with your doctor recertifying your eligibility every 60 days.

Don't let uncertainty about the homebound requirement or the setup process prevent you from accessing home health care. Medicare designed these benefits to support healing at home, which is often safer, more comfortable, and more cost-effective than facility-based care. If you qualify, take advantage of this valuable coverage.

Whether through family support, your healthcare team, or a patient advocate, you don't have to navigate Medicare's home health benefits alone. Professional guidance can help you access services quickly, ensure quality care, and address any issues that arise. You deserve to recover at home with the skilled support Medicare provides.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.