Understanding Medicare Home Health Care

Home Health Care Covered by Medicare

For older adults and people with disabilities who have limited mobility, home health care—a wide range of health and social services delivered in their home—is a necessity. Medicare covers home health care when specific requirements are met:

1. You are homebound, meaning that it is very difficult for you to leave home, and you need help to do so.

2. You need skilled nursing or therapy services on an intermittent basis. This is care that is provided by a skilled professional or under their supervision, and includes physical, speech, and occupational therapy. These services must be needed at least once every 60 days to at most once a day for up to three weeks.

3. You have a face-to-face meeting (in an office or hospital, or via video) with a doctor no more than 90 days before starting care or within 30 days of the first day you receive care.

4. Your doctor signs a certification confirming your eligibility and need for home health care, and affirms that they have approved a plan of care for you.

5. You receive care from a Medicare-certified Home Health Agency (HHA).

In these circumstances, Medicare-covered home health care can be available. Most home health care is covered under Part B, but in certain situations following a qualifying three day hospital stay or covered Skilled Nursing Facility (SNF) stay, Part A may also cover home health care. Medicare Advantage beneficiaries may have different rules for accessing coverage and additional costs in the form of copayments, and they may have to use their plan’s network of home health care providers.

Only certain home-based services can be covered by Medicare. Skilled nursing, skilled therapy services, a home health aide, medical social services, certain medical supplies, and durable medical equipment (DME) can be covered under the home health care benefit. Services that are not covered include: 24-hour care, prescription drug coverage (though coverage under Part D is still available to those getting home health care services), meal delivery, and custodial care (like laundry or meal preparation) unless those services are performed as part of a skilled nursing or therapy visit.

Medicare Home Health Care Is Not Medicaid HCBS

Despite their similar names, the Medicare home health care benefit is different from Medicaid’s Home- and Community-Based Services (HCBS) coverage. Eligibility and benefits are not the same across the two programs.

Medicare’s home health care coverage is not generally long-term care.

Medicare home health care covers skilled nursing and therapy care, and unless an individual is receiving hospice care, custodial and around-the-clock care are not included. Medicare’s coverage is not generally long-term care: A home health plan of care and certification is valid for a finite period—60 days—and can be renewed by a doctor for additional 60-day periods as needed. Medicaid HCBS, on the other hand, is a long-term care benefit funded by state-level Medicaid waiver programs. HCBS may be available to Medicaid beneficiaries and dual-eligible Medicare-Medicaid beneficiaries depending on state rules.

Advocating for Expansion

As it currently stands, Medicare’s coverage of home health care is very limited and does not meet the full needs of many older adults and people with disabilities. The many remaining gaps in more robust and comprehensive home health care coverage leave people with unaffordable and inadequate options and drive expensive nursing home admissions even where people would prefer to remain in their homes. Recent surveys have found that there is high demand for home-based care, with long waiting lists for Medicaid HCBS in most states.

Medicare’s coverage of home health care is very limited and does not meet the full needs of many older adults and people with disabilities.

Even with coverage, finding and accessing home health care can be a challenge. Rates of home health care completion have dropped among Medicare beneficiaries whose doctors recommended home-based care after hospitalization. The number of home health agencies (HHAs) has consistently decreased since 2013, with research indicating that economically disadvantaged areas have even more limited access to home health resources and Medicare-covered home health care providers.

Improving access to home health care under Medicare can advance equity and lower barriers to care where Medicaid is limited due to variations among state policies and restrictive income limits. Expanding the home health benefit supports not only Medicare beneficiaries, but also their families, caregivers, and communities.

Medicare Rights has supported previous initiatives to expand the Medicare home health care benefit, and we know that the freedom to age in place and within one’s own community is important to many people with Medicare. We will continue to advocate for Medicare policies that expand home health care and ensure equity and dignity for older adults and people with disabilities.