Does Medicare Cover Home Health Care?What You Pay and Who Qualifies

Yes. If you qualify, Original Medicare covers home health care, and you pay nothing for the covered services themselves. Nurses and therapists come to your home a few times a week, ordered by your doctor, at no cost to you.

That surprises a lot of families in Los Angeles. Many people assume "care at home" always means paying an hourly caregiver out of pocket. Home health is different. This guide explains what Medicare covers, what you might still pay, who qualifies, and how to get started.

What Medicare means by "home health care"

Home health care is part-time, skilled medical care at home, ordered by a doctor. Under Original Medicare, covered services include:

• Skilled nursing: wound care, medicine management, injections, and a close watch on your health after surgery, a hospital stay, or a change in your condition.
• Physical, occupational, and speech therapy: strength and balance, daily tasks like bathing and dressing, and help with speaking and swallowing.
• Medical social services: help with the worries an illness brings and with finding programs near you.
• Home health aide visits: a hand with bathing and personal care, covered only while you are also getting skilled care.
• Medical supplies used during your care, such as wound dressings.

Medicare does not pay for 24-hour care at home, meal delivery, homemaker services like shopping and cleaning, or personal care when that is the only help you need. That kind of help is called home care, and it works differently. Our guide on home health vs. home care explains the difference.

What you pay with Original Medicare

For covered home health services, Original Medicare pays the full amount. According to medicare.gov, you pay $0 for covered home health services. There is no deductible or copay for the nursing and therapy visits.

There is one common cost. If you need medical equipment such as a walker, a wheelchair, or a hospital bed, that equipment is covered under Medicare Part B. You usually pay 20% of the Medicare-approved amount after you meet the Part B deductible. Medicare covers the other 80%. The details are on the durable medical equipment page at medicare.gov.

Before care starts, the agency must tell you, in writing and in person, what Medicare will pay for and what you would owe. At Comfort Care Home Health Services, we check your coverage and explain any costs in writing before the first visit.

Medicare Advantage and private insurance

Medicare Advantage plans must cover home health care too, but the rules can differ. Your plan may require you to use an agency in its network, or to get approval before care starts. Some plans have a copay. Private insurance plans set their own rules as well.

The simplest path is to call an agency and ask them to check. We verify Medicare Advantage and private insurance benefits for families across Los Angeles, Orange, Ventura, and San Bernardino Counties.

Who qualifies for Medicare home health

To qualify, all of the following need to be true, based on Medicare's rules:

1. A doctor is treating you. A doctor or another allowed practitioner, such as a nurse practitioner or physician assistant, orders your home health care and reviews your plan of care.
2. You have had a face-to-face visit. The provider must have seen you for the condition that needs care, within a set window around the start of care. A video visit can count.
3. You need skilled care part time. That means intermittent skilled nursing, physical therapy, speech therapy, or continuing occupational therapy.
4. You are homebound. Leaving home takes a big effort, or your doctor advises against it. You can still go to the doctor, to religious services, to adult day care, and on an occasional short trip. Our guide on what homebound means goes into the details.
5. The agency is Medicare-certified. Comfort Care Home Health Services is Medicare-certified and Joint Commission accredited.

A hospital stay is not required. Care can start after a doctor visit, a fall, a new diagnosis, or a change in health.

How long Medicare home health can last

There is no set limit. Medicare pays for care in 30-day periods, and your doctor reviews and recertifies your plan of care at least every 60 days for as long as you still qualify. Care to keep your abilities or slow a decline can be covered too, not only care that improves your condition. CMS explains this in its Jimmo settlement page.

If covered services are going to end, the agency must give you a written notice at least two days before, and you have the right to a fast appeal.

How to start home health care

1. Call an agency, or ask your doctor. You can call us first at (818) 579-4012. We work with your doctor on the order. The doctor decides whether home health is right for you.
2. The agency checks your coverage and explains costs in writing.
3. A nurse comes to your home. At Comfort Care, the first visit usually happens within 24 hours after your doctor or the hospital sends the order. We call before we come.
4. You build a plan of care together with your nurse and your doctor, and regular visits begin.

Families coming home from a hospital in the San Fernando Valley or anywhere in Los Angeles County can also ask for an agency by name. See our hospital discharge checklist for what to ask before you leave.