Does Medicare cover home health care? The homebound rule, the 28-hour limit and what Medicare won't pay for

Yes, Medicare covers home health care, but only for people who meet specific conditions, and only for certain services. The rules below come from Medicare.gov and the federal regulation behind it, 42 CFR 409.42.

Who qualifies

The regulation lists five requirements, and a beneficiary must meet each one. You must:

1. Be confined to the home (homebound), as defined below.
2. Be under the care of a physician or allowed practitioner who sets up your plan of care.
3. Need skilled care: at least one of intermittent skilled nursing, physical therapy, speech-language pathology, or, once eligibility has been established through one of those, continuing occupational therapy, as certified by that physician or practitioner.
4. Be under a plan of care that meets Medicare's requirements.
5. Get services from a Medicare-participating home health agency, or under arrangements the agency makes.

Medicare.gov adds that, before you can get home health services, a doctor or other health care provider (like a nurse practitioner) must see you in person, confirm that you need home health care and order it, and a Medicare-certified home health agency must provide it.

What "homebound" means

Medicare.gov says you're homebound if both of these are true:

• Leaving home isn't recommended because of your condition, or you can't leave without help, such as a cane, wheelchair, walker or crutches, special transportation, or another person, because of an illness or injury.
• You're normally unable to leave home, and leaving takes a lot of effort.

How much care

If you qualify, there's no limit on the number of visits. But "part-time or intermittent" care has a ceiling. In most cases, Medicare.gov says, skilled nursing and home health aide services together can run up to 8 hours a day and 28 hours a week. For a short time, if your provider decides it's necessary, you may be able to get up to 35 hours a week, still under 8 hours a day.

What's covered

Medicare.gov lists these covered services: medically necessary part-time or intermittent skilled nursing (such as wound care, patient and caregiver education, IV or nutrition therapy, injections and monitoring a serious illness); physical therapy, occupational therapy and speech-language pathology if you meet certain conditions; medical social services; part-time or intermittent home health aide care, but only if you are also getting skilled nursing, therapy or speech-language pathology at the same time; injectable osteoporosis drugs for women who meet certain criteria; durable medical equipment; and medical supplies for use at home.

What it costs

• Covered home health services: you pay nothing, Medicare.gov says.
• Durable medical equipment: after you meet the Part B deductible, 20% of the Medicare-approved amount.

Before care starts, the agency should tell you how much Medicare will pay, and tell you, verbally and in writing, if Medicare won't pay for any items or services and what you would owe. It should give you an Advance Beneficiary Notice (ABN) before providing services or supplies Medicare doesn't cover.

What Medicare doesn't pay for

• Round-the-clock (24-hour) care at home
• Meal delivery
• Homemaker services, like shopping and cleaning, that aren't part of your care plan
• Custodial or personal care, like help bathing, dressing or using the bathroom, when that's the only care you need

If you have Medicare Advantage

These rules describe Original Medicare. If you're in a Medicare Advantage plan, Medicare.gov says to check with your plan about its home health benefits. Annual open enrollment runs October 15 to December 7 if you're comparing plans.

Related: Medicare open enrollment and home health · Review Choice Demonstration (for agencies in six states)

Sources

• Medicare.gov, Home health services
• 42 CFR 409.42 (eCFR)

Related: our Medicare jurisdictions and MACs guide.

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not medical, billing or legal advice. Check with your doctor, your plan or 1-800-MEDICARE about your own coverage.