If you need medical care or therapy and are homebound, you may qualify for home healthcare services through Medicare.

Home healthcare benefits include skilled nursing care, physical therapy, and occupational therapy. Original Medicare pays for 100% of home healthcare visits that meet specific requirements.

If you qualify - or take care of someone who qualifies - Medicare covers these services for as long as necessary.

What is home healthcare?

There are two types of home-based services: home healthcare and home care.

Home healthcare services are given in your home for an illness or injury. Home care services are given in your home to help you with the activities of daily living related to personal care. Home care is also referred to as custodial care. Medicare doesn't cover home care unless you're also receiving home healthcare.

Examples of home healthcare services include:

• Injections

• IV or nutrition therapy

• Patient and caregiver education

• Wound care for surgical wounds or pressure sores

• Monitoring unstable health status and serious illness

Examples of home care services include:

• Bathing

• Dressing

• Cooking

• Eating

• Laundry

• Shopping

Home healthcare typically involves short-term services that help you get well and become self-sufficient. Home care usually involves long-term services that serve your physical or emotional needs.

How much does home healthcare cost?

For home care, homemaker services cost a monthly median of $5,720, while home health aides cost $6,292 monthly. That's according to the 2023 Genworth Cost of Care Survey.

For home healthcare, the price depends on which services you need and how often you need them. For example, skilled nursing care for 5 hours a week is less expensive than 15 hours a week. Costs also depend on your location and home healthcare agency.

What home healthcare is covered by Medicare?

Medicare Part A covers home healthcare after hospitalization or a stay in a skilled nursing facility. Medicare Part B covers home healthcare services for medical issues outside a hospital or a skilled nursing facility. Medicare Advantage plans also cover home healthcare because they have the same benefits as original Medicare. But there may be different costs and rules.

As long as you're eligible and care is reasonable and necessary to treat your injury or illness, Medicare covers the following home healthcare services:

Note: Medicare covers durable medical equipment (DME) differently from medical supplies.

For DME, you typically pay 20% of the Medicare-approved amount for walkers, wheelchairs, and oxygen equipment after you meet your Part B deductible.

Medicare doesn't cover the following home healthcare services:

• Home-delivered meals

• 24-7 home care

• Chores such as laundry, cleaning, and shopping

• Personal care, such as bathing, dressing, and bathroom use (if it's the only care required)

Vice President Kamala Harris recently proposed an expansion of Medicare coverage to provide home healthcare to older adults and those with disabilities who are struggling with the costs of long-term care. This initiative, known as Medicare at Home, aims to help families afford the cost of in-home care, such as health aides, which is often more affordable than nursing homes. Under this plan, Medicare will assess enrollees to determine if they need assistance with daily activities, like bathing and eating, or if they have cognitive impairments. Qualified caregivers, such as home health aides and personal care attendants recognized by the state, would provide the necessary care.

Will Medicare pay for home healthcare by family members?

Medicare home healthcare coverage pays only for services provided by a home health agency. This restriction means coverage doesn't include family caregivers. But if you also have Medicaid, you could be eligible for self-directed Medicaid services. This program allows beneficiaries to choose and hire their caregivers. The National Family Caregiver Support Program is another entity that helps family and informal caregivers.

Does Medicare cover home healthcare for dementia?

If you have dementia and meet the criteria for home healthcare, Medicare extends the part-time or intermittent requirement. Homebound dementia patients can get up to 35 hours a week of covered home healthcare services.

How to qualify for home healthcare under Medicare

To qualify for Medicare home healthcare, you must meet the following five requirements:

1. You receive care from a healthcare professional through an established and regularly reviewed plan.

2. Your primary care provider certifies that you need one or more of the following services:

   • Intermittent skilled nursing care (not just drawing blood)

   • Speech-language therapy

   • Occupational therapy

   • Physical therapy

3. Your home health agency is approved by Medicare.

4. Your primary care provider (or a healthcare professional working with them) documents that they've met with you face-to-face within certain time frames and that the meeting was related to your need for home healthcare.

5. Your primary care provider certifies that you're homebound, which means you can't leave home without assistance.

Note: You can be classified as homebound but still leave your residence for medical treatment or short absences, such as getting a haircut or attending a wedding. You can also get home healthcare if you attend religious services or adult day care.

How long will Medicare pay for home healthcare?

As long as you meet the criteria for home healthcare, Medicare pays for your services. But skilled nursing care and home health aide services must be part-time or intermittent. Besides the limit on hours per day and week, these services must also be given:

• Less than 7 days a week

• Less than 8 hours a day for 21 days

Therapy services aren't required to be part-time or intermittent.

Medicare pays your home health agency a set amount for every 30 days you need care. The payment is based on the type of healthcare most people would need in your situation. You can have more than one 30-day period or episode that requires care.

Your home health agency may deny, stop, or cut back care if the organization thinks Medicare won't pay for your services. In this case, the agency must send you a Home Health Advance Beneficiary Notice. This document should explain why the organization believes Medicare won't cover your costs and that you may have to pay.

If your primary care provider thinks you still need home healthcare and Medicare should continue coverage, you may request an official decision from Medicare. The beneficiary notice should give you instructions on this process and how to appeal if your coverage is denied.