Medicare planning
What Home Health Services Does Medicare Cover?
Medicare can cover qualifying skilled home health services when specific requirements are met, but it is not a general long-term custodial-care benefit. Coverage focuses on medically necessary, part-time or intermittent skilled care ordered and reviewed by an authorized practitioner and delivered by a Medicare-certified home health agency.
Call Gala Health · 934-222-5466Basic eligibility
A practitioner must certify that you need eligible skilled services and that you are homebound under Medicare’s definition. Being homebound does not mean you can never leave home; it generally means leaving requires considerable effort or assistance and trips are infrequent or for medical care, religious services, or limited nonmedical reasons.
Services that may be covered
Qualifying care can include skilled nursing, physical therapy, speech-language pathology, occupational therapy in certain circumstances, medical social services, and limited home health aide care when skilled care is also being received.
What is generally not covered
Medicare does not cover 24-hour home care, meal delivery, unrelated homemaker services, or custodial personal care when that is the only care needed.
Before services begin
Ask the agency for its care plan, visit schedule, Medicare certification, and written notice of services it believes Medicare will not cover. Medicare Advantage members should also check plan procedures.
Before home health services begin
Use information for the correct plan year and service area.
Confirm important details directly with the plan, provider, employer, or supplier.
Keep copies of notices, confirmations, and cost estimates.
Ask the certifying practitioner and Medicare-certified agency to explain the plan of care and any service they expect Medicare not to cover.
Medicare’s current home health rules
Review Medicare’s current home health coverage guidance. Ask the agency for the plan of care, visit schedule, certification status, and written notice of services it believes Medicare will not cover. Medicare generally does not cover 24-hour home care, meal delivery, unrelated homemaker services, or personal care when that is the only care needed.
Educational information only; not legal, tax, medical, or financial advice.
Organize your home health coverage questions
Gala Health can help you compare represented plan rules while your practitioner and home health agency determine clinical eligibility and services.
Request a plan review