Medicare & Medicaid
Last checked: May 2026
Medicare home health care can help after an illness, injury, surgery, hospital stay, or health change.
But it is not long-term home care. It does not pay for round-the-clock help, meals, housework, or personal care when that is the only help needed.
This guide explains what Medicare may cover, who may qualify, where to start, what papers to ask for, and what to do if visits are denied or cut.
Quick answer
Medicare may cover home health care when the person needs skilled care, is homebound, has a doctor or allowed provider order, has a care plan, and uses a Medicare-certified home health agency.
Covered care may include part-time skilled nursing, physical therapy, speech therapy, occupational therapy, medical social services, and limited home health aide help. Medicare explains these services on its home health services coverage page.
Medicare usually does not pay for long-term daily help at home. It does not pay for 24-hour care at home, meals, shopping, cleaning, laundry, or personal care when bathing, dressing, or bathroom help is the only care needed. Medicare lists these limits in the Medicare & Home Health Care booklet.
Who this helps
This guide is for a caregiver trying to get help at home through Medicare.
It may help if your parent, spouse, or loved one:
- just left the hospital or a skilled nursing facility;
- needs nursing visits or therapy at home;
- has wounds, new weakness, falls, or unstable symptoms;
- was denied home health care;
- had visits cut before you think it is safe;
- needs help telling Medicare home health from long-term home care.
If the need started during a hospital stay, also read our guide to hospital discharge rights.
What may pay or help
Several paths may help. They do not pay for the same things.
| Path | What it may help with | Main limit |
|---|---|---|
| Original Medicare | Skilled home health care from a Medicare-certified agency. | Not long-term personal care or 24-hour home care. |
| Medicare Advantage | The Medicare home health benefit, often through plan network agencies. | You may need plan approval or an in-network agency. |
| Medicaid home and community-based services | Longer-term personal care or home support in some states. | Rules, waitlists, and services vary by state. |
| Local aging services | Meals, rides, respite, homemaker help, or caregiver support. | Programs vary by county and funding. |
For Medicare basics, see our guide to what Medicare covers. If the person needs long-term bathing, dressing, meal help, or supervision, Medicare may not be the main payer. Start with our guide to Medicaid HCBS waivers.
What Medicare home health care may cover
Medicare home health is health care at home. It can help treat an illness or injury, help the person get better, help the person keep current function, or slow decline when skilled care is needed.
Skilled nursing
This may include wound care, injections, IV or nutrition therapy, caregiver teaching, and monitoring a serious or unstable health problem.
Therapy
Medicare may cover physical therapy, speech-language therapy, and occupational therapy when Medicare rules are met.
Home health aide help
Aides may help with walking, bathing, grooming, dressing, toileting, feeding, or bed linens. This help is limited and must be tied to skilled care from the home health agency.
Medical social services
This may include counseling or help finding community resources when the person is also getting skilled care.
Medicare may also cover medical supplies used at home, such as wound dressings, when ordered as part of the care. Durable medical equipment, such as walkers, wheelchairs, or oxygen equipment, is usually billed under Medicare equipment rules. Medicare says the person may pay 20% of the Medicare-approved amount for covered durable medical equipment after the Part B deductible.
Ask for the care plan in plain words
Ask the agency: “What services are in the plan of care? How often will each person come? What problem is each visit treating?”
What Medicare home health care does not cover
Medicare home health is not a general home care benefit. It does not become daily household help just because the person is old, weak, unsafe alone, or hard to bathe.
⚠️ Common misunderstanding
Medicare may cover limited aide help if the person is also getting skilled care. It does not cover personal care by itself when that is the only care needed.
Medicare does not pay for:
- 24-hour-a-day care at home;
- meals delivered to the home;
- shopping, cleaning, and laundry;
- custodial or personal care when bathing, dressing, or bathroom help is the only care needed;
- care from an agency that is not Medicare-certified;
- care that is not ordered and kept in the plan of care.
If the real need is daily supervision, dementia help, bathing help, meal help, or caregiver relief, look at Medicaid, VA benefits, local aging services, respite care, and private pay options. Our care cost calculator may help you compare care costs.
Who may qualify
For Medicare to cover home health care, several rules must fit at the same time.
The usual Medicare test
- The person is under the care of a doctor or allowed provider.
- The provider orders home health care.
- The provider certifies that the person is homebound.
- The person needs part-time or intermittent skilled care, physical therapy, speech-language therapy, or continuing occupational therapy.
- The care is part of a plan of care that the provider reviews.
- A Medicare-certified home health agency gives the care.
What homebound means
Homebound does not always mean the person never leaves home. Medicare says the person must have trouble leaving home without help, or leaving home must take a major effort. The person can still leave for medical care. Short, rare non-medical trips may also be allowed.
What part-time or intermittent means
Medicare says that in most cases, skilled nursing and home health aide services together may be up to 8 hours a day, for a maximum of 28 hours a week. More frequent care may be covered for a short time if the provider says it is needed. Long-term full-time skilled nursing at home usually does not fit the home health benefit.
Where to start first
The first call depends on where the person is now.
If the person is still in the hospital or rehab
- Ask the discharge planner if the doctor will order Medicare home health.
- Ask for the skilled reason in writing, such as wound care, therapy, medication teaching, or monitoring.
- Ask for a list of Medicare-certified agencies that serve the home address.
- If the person has Medicare Advantage, call the plan and ask which agencies are in network.
If the person is already home
- Call the doctor or allowed provider who treats the condition.
- Ask for a home health evaluation and order.
- Explain why leaving home is hard.
- Explain the skilled need, such as wound care, therapy, falls, or unstable symptoms.
You can compare Medicare-certified home health agencies at Medicare Care Compare. The person has a say in which agency is used, but choices may be limited by staffing, services, insurance coverage, and availability.
☎️ Call script for the doctor or discharge planner
Hello, my name is [name]. I help care for [person’s name]. We need to know if Medicare home health can be ordered.
They have trouble leaving home because [short reason]. The skilled need is [wound care, therapy, medication teaching, weakness, falls, or other issue].
Can the provider document the homebound status, skilled need, and order a Medicare-certified home health agency evaluation?
If the answer is no, can you tell me what rule is not met and what other service we should call?
📄 What documents may be needed
Keep a folder. Paperwork matters when home health is approved, denied, reduced, or stopped.
- Medicare card and any Medicare Advantage plan card;
- hospital or rehab discharge papers;
- doctor visit notes related to the home health need;
- medication list;
- wound care orders, therapy notes, fall history, or symptom log;
- proof that leaving home is hard, such as walker, wheelchair, oxygen, or help from another person;
- home health order and plan of care;
- visit schedule and missed-visit notes;
- any ABN, HHCCN, NOMNC, or DENC notice;
- notes from calls with the agency, doctor, Medicare, plan, SHIP, or BFCC-QIO.
Our caregiver checklists can help you keep care details in one place.
Notices and denials: what the papers mean
Do not rely only on a phone call. Ask for the notice in writing.
| Notice | When you may see it | What to do |
|---|---|---|
| Advance Beneficiary Notice of Noncoverage | The agency thinks Medicare probably will not pay for a service or supply. | Read it before signing. It may mean you agree to pay if Medicare does not cover it. |
| Home Health Change of Care Notice | The agency will reduce or stop an item or service in the plan of care. | Ask what changed, who changed it, and whether the doctor agrees. |
| Notice of Medicare Non-Coverage | All covered home health services are ending. | Read the deadline. It tells you how to ask for a fast appeal. |
| Detailed Explanation of Non-Coverage | You asked for a fast appeal after getting a Notice of Medicare Non-Coverage. | Use it to see the exact reason coverage is ending. |
CMS posts the Home Health Change of Care Notice and the NOMNC and DENC notice rules.
What to do if visits are cut or care is ending
Act fast. Appeal deadlines can be short.
Do this the same day
- Ask if the agency is reducing one service or ending all Medicare-covered home health services.
- Ask for the correct written notice.
- Ask for the current plan of care.
- Call the doctor and ask if home health is still medically needed.
- If all covered care is ending, follow the fast appeal directions on the Notice of Medicare Non-Coverage.
Medicare says that outside the hospital, the Notice of Medicare Non-Coverage should usually be given at least 2 days before covered services end. Medicare’s fast appeals page says to follow the notice instructions no later than noon the day before the termination date.
A fast appeal goes to an independent reviewer called a Beneficiary and Family Centered Care Quality Improvement Organization. Read Medicare’s page on fast appeals.
If you need help, call your local State Health Insurance Assistance Program. SHIP gives free Medicare counseling. Start at SHIPhelp.org or call 1-800-MEDICARE and ask for your SHIP contact. Also see our guide to appealing a Medicare denial.
☎️ Call script when visits are being cut
Hello, I am calling about [person’s name]. We were told home health visits are being reduced or ended.
Please tell me which written notice applies: ABN, HHCCN, NOMNC, or DENC.
Please send the current plan of care and the reason for the change. If all covered services are ending, I need the fast appeal instructions today.
What usually goes wrong
- The family asks for “home care,” but Medicare needs a skilled medical reason. Ask the doctor to document the skilled need.
- The person is not documented as homebound. Tell the provider what it takes to leave home.
- The agency says staffing is not available. Ask the doctor or discharge planner to send the referral to more agencies.
- The family expects an aide every day. Medicare aide help is limited and tied to skilled care.
- The person has Medicare Advantage, but the agency is out of network. Call the plan and ask for in-network agencies.
- The family misses the fast appeal deadline. Read every notice the same day.
What to do if the first path does not work
If Medicare home health is denied, cut, or not enough, ask what kind of no it is.
If the doctor will not order home health
- Ask what Medicare rule is not met.
- Ask whether a follow-up visit could document the need.
- Ask whether outpatient therapy, equipment, or another service fits better.
If no agency accepts the case
- Ask if the reason is staffing, insurance, service area, safety, or care needs.
- Ask the referral source to try more agencies.
- If the person has Medicare Advantage, ask the plan for available in-network agencies.
If the real need is long-term help
- Call your state Medicaid agency and ask about long-term services and supports.
- Ask about Medicaid home and community-based services, personal care, and waiver waitlists.
- Use the Eldercare Locator to find your local Area Agency on Aging.
- If the person is a veteran, ask the VA about home and community care and see our VA Aid and Attendance guide.
Medicaid.gov explains that home and community-based services can let some Medicaid beneficiaries receive long-term services and supports at home or in the community. But states set many details. Check your state Medicaid site.
If you need a short break, see our guide to respite care for caregivers.
State and plan rules can change the next step
- If they have Original Medicare, start with the doctor, discharge planner, Medicare-certified agency, Medicare, and SHIP.
- If they have Medicare Advantage, call the plan. Ask about network agencies, plan steps, denials, and appeals.
- If they need long-term personal care, call the state Medicaid agency. Medicaid home care rules vary by state.
- If they need local support, call the Area Agency on Aging through the Eldercare Locator.
Official sources used and what we checked for this update
For this May 2026 update, we checked these official sources:
- Medicare.gov: Home health services coverage
- Medicare.gov: Medicare & Home Health Care booklet
- Medicare.gov: Medicare’s Home Health Benefit
- CMS: Home Health Services provider guidance
- CMS: Home Health Change of Care Notice
- CMS: NOMNC and DENC notices
- Medicare.gov: Fast appeals
- SHIP: Free local Medicare counseling
- ACL Eldercare Locator
- Medicaid.gov: Home and community-based services
We checked covered services, homebound rules, skilled care rules, aide limits, what Medicare does not cover, how agencies start care, notices, fast appeals, and local routing for help beyond Medicare.
Resumen en español
Medicare puede pagar cuidado de salud en el hogar si la persona necesita cuidado médico especializado, está limitada para salir de casa, tiene una orden del doctor o proveedor autorizado, y usa una agencia certificada por Medicare.
Puede cubrir enfermería especializada, terapias, servicios sociales médicos, y ayuda limitada de un asistente de salud en el hogar.
Medicare normalmente no paga cuidado de 24 horas, comidas, limpieza, compras, lavandería, ni ayuda personal si bañarse, vestirse o ir al baño es la única ayuda que se necesita.
Si le cortan las visitas o terminan todos los servicios, pida el aviso por escrito. Si recibe un Notice of Medicare Non-Coverage, lea la fecha límite y pida ayuda de SHIP o Medicare de inmediato.
About This Guide
CaregiverBenefits.org writes for family caregivers who need benefit steps, coverage rules, documents, calls, and appeal paths.
This guide focuses on Medicare home health care. It is meant to help you ask the right person, get the right paper, and act before a denial or cut becomes harder to fix.
Plain disclaimer
This guide is general information, not legal, medical, or financial advice. Medicare, Medicaid, plan, and state rules can change. Confirm details with Medicare, your Medicare Advantage plan, your state Medicaid agency, SHIP, the doctor, or the home health agency.
FAQ
Does Medicare pay for home health care?
Yes, Medicare may pay for home health care if the person meets Medicare rules. The person must need skilled care, be homebound, be under a provider’s care, have a care plan, and use a Medicare-certified home health agency.
Does Medicare pay for a home health aide?
Sometimes. Medicare may cover part-time or intermittent home health aide help if the person is also getting skilled care from the home health agency. Medicare does not cover aide help when personal care is the only need.
Does Medicare cover 24-hour home care?
No. Medicare does not pay for 24-hour-a-day care at home under the home health benefit.
Does Medicare pay for help with bathing and dressing?
Medicare may cover limited aide help with bathing or dressing if the person also needs skilled home health care. It does not pay for bathing and dressing help by itself when that is the only care needed.
Who orders Medicare home health care?
A doctor or allowed provider, such as a nurse practitioner, clinical nurse specialist, or physician assistant, must order home health care and certify that Medicare rules are met.
What should I do if the agency says visits are ending?
Ask for the written notice. If all covered services are ending, ask for the Notice of Medicare Non-Coverage and follow the fast appeal directions by the deadline on the notice.
What if Medicare home health is not enough?
Ask about Medicaid home and community-based services, local Area Agency on Aging programs, respite care, VA benefits if the person is a veteran, and private pay options.
