Given the choice, most people would prefer to recuperate in the comfort of their own home rather than stay in the hospital overnight. Thanks to advancements in medical treatments and care, recovering from surgery at home isn’t just a desire — it’s a real possibility for many Medicare beneficiaries.
Home healthcare offers a cost-effective and convenient alternative to services provided at hospitals or nursing care facilities. What’s key is determining what level of care you need, what Medicare will cover and how to qualify.
[READ: Setting Up Home Health Care After Hospitalization: A Step-by-Step Guide]
What Is Home Healthcare?
Home healthcare refers to short-term medical services provided in the home to promote recovery, maintain independence and restore health or lessen the effects of illness and disability.
Licensed nurses and therapists provide this kind of clinical or skilled care, with the most common services including:
— Occupational therapy, which helps improve your ability to perform daily tasks like dressing or cooking
— Physical therapy, which is important for regaining strength, mobility and balance
— Medical social services, such as connecting seniors to resources, counseling or care planning
— Skilled nursing, such as wound care, medication management, IV therapy and other medical necessities
— Speech-language therapy, such as help with speech, swallowing and communication after a stroke, brain injury or other serious illness
[READ: How Much Does In-Home Care Cost & How to Pay for It]
Home Healthcare vs. Home Care: What’s the Difference?
Despite the abundance of information available, understanding the differences between home healthcare and home care can be challenging.
Below is a chart highlighting the differences and similarities in services covered:
| Home healthcare (skilled care) | Home care (nonskilled care) | |
| Original Medicare-approved | Yes | No |
| Medicare Advantage-approved | Yes, but may vary depending on the insurer | No |
| Medicaid-approved | Depends on the state | Depends on the state |
| Skilled nursing | Yes | No |
| Rehabilitation therapy | Yes | No |
| Meal preparation | No | Yes |
| Activities of daily living (ADLs) | No | Yes |
| Requirements for enrollment | Yes | No, unless you’re enrolling in a Medicaid-funded program |
Source: National Council on Aging
How Do You Qualify for Medicare Home Healthcare?
To qualify for home healthcare services, you must complete a multistep process:
— Meet with your healthcare provider: You must have a face-to-face meeting with your doctor or a qualifying healthcare professional to determine if you meet the criteria, such as being homebound.
— Obtain an official order: If the provider considers in-home care necessary, they will place an order with a home healthcare agency. In addition to being homebound, if you are transitioning from a hospital or skilled nursing facility stay, you must receive home healthcare services within 14 days of your discharge.
— Undergo an initial assessment: The home health agency will visit your home to complete an assessment of all your care needs and share this information with your doctor.
— Receive ongoing evaluations: After the initial review, the agency must regularly reassess your needs. The agency is responsible for addressing all medical, nursing, rehabilitative, social and discharge planning needs outlined in your home healthcare plan.
What Home Healthcare Services Medicare Covers
If you are signed up for original Medicare, which consists of Part A (hospital insurance) and Part B (medical insurance), you can use your benefits to cover certain home healthcare services, such as:
— Visits from a nurse or therapist
— Durable medical equipment, such as canes, walkers and scooters
— Injectable osteoporosis drugs for women
— Medical supplies for use at home, such as blood sugar monitors, test strips and continuous positive airway pressure, or CPAP, machines
— Nutrition support
— Part-time or intermittent home health aide care only if you’re also getting skilled nursing care at the same time
What Medicare Doesn’t Cover
There are several care services that Medicare does not cover, including:
— Continuous daytime care at home
— Meal delivery services to your home
— Homemaker services, such as food shopping and cleaning
— Custodial or personal care that helps you with ADLs — such as bathing, dressing or using the bathroom — when this is the only care you need
[Read: Hiring an In-Home Caregiver: What to Consider]
How Long Will Medicare Pay for In-Home Care?
Medicare covers home healthcare for as long as you continue to meet the eligibility requirements. However, coverage is generally limited to “intermittent” care — meaning fewer than seven days a week and usually less than eight hours a day, for up to 21 days at a time. Extensions are possible if your doctor certifies that you still need it, but this is not a long-term benefit.
If you’re enrolled in a Medicare Advantage plan, you may incur out-of-pocket costs and coverage may be different. Check your plan to determine your specific benefits.
Before your home healthcare starts, the agency should clearly explain both in writing and in person what Medicare will and won’t cover and how much you may need to pay for any services or items.
[READ: 7 Myths About Caregiving and Home Care Costs]
How to Find Home Healthcare
Many hospitals and healthcare systems now offer their own in-house home healthcare services to make it more convenient to find qualified care.
“This can be a tremendous benefit to the patient having their care all within the same system,” Slatton says.
You can only receive care from one home health agency at a time, but you have the right to switch agencies whenever you choose. To do so, you need to inform both the agency you are leaving and the new one you’re joining and secure a new referral from your doctor or a qualified provider.
Frequently Asked Questions
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Does Medicare Cover Home Health Care? originally appeared on usnews.com
Update 06/09/26: This story was published at an earlier date and has been updated with new information.
