Home Health Care for Seniors on Medicare

💡 Key Takeaways: Short Answers to Big Questions

• Does Medicare cover home health care? Yes — but only specific “skilled” services, not everyday personal care.
• Do you pay anything out of pocket for covered visits? No, for most covered home health services you pay $0.
• Will Medicare pay for 24-hour care or meals at home? No. This is one of the biggest and most misunderstood gaps.
• Can you be covered even if you leave home sometimes? Yes — attending church, medical appointments, or adult day care does not disqualify you.
• What happens if Medicare says your services are ending too soon? You have the legal right to appeal — immediately, within strict timelines.
• Are family members paid as caregivers through Medicare? No. But Medicaid and state programs sometimes allow this.
• Is there free help navigating all of this? Yes — through SHIP counselors and your local Area Agency on Aging, completely free of charge.

You Qualify for Medicare Home Health Care If Your Doctor Says So — Here’s Exactly What That Means

This is where most people get confused, and the confusion costs them real care.

Medicare considers you “homebound” if you need the help of another person or medical equipment — like a walker or wheelchair — to leave your home, or if your doctor believes your health could get worse if you leave your home, and it is difficult for you to leave so that you typically cannot do so. A doctor must evaluate and certify this condition in writing.

Here’s what most articles won’t tell you plainly: “homebound” does not mean you’re locked inside. You may leave home for medical treatment, or for short, infrequent absences for non-medical reasons like attending religious services. You can still get home health care if you attend adult day care.

Beyond being homebound, you must also need skilled care — meaning services that legally require a licensed professional to perform them. Once those two boxes are checked, your doctor places a formal order, and a Medicare-certified home health agency takes over your care plan.

Medicare Covers These Services for Free — No Copay, No Deductible

For all covered home health services, you pay nothing. That’s a powerful sentence that deserves to sink in. When Medicare covers your skilled home health visits, you do not owe a single dollar in copayment or coinsurance for those visits.

What’s actually covered includes intermittent skilled nursing care (wound care, injections, IV medications, catheter changes), physical therapy, occupational therapy, speech-language therapy, part-time home health aide services (only when you’re already receiving skilled care), and medical social services.

In most cases, skilled nursing care and home health aide services are covered up to 8 hours a day combined, for a maximum of 28 hours per week. You may be able to get more frequent care for a short time — less than 8 hours each day and no more than 35 hours each week — if your provider decides it’s necessary.

The one area where cost sharing applies: durable medical equipment. After you meet the Part B deductible — $257 in 2025 — you pay 20% of the Medicare-approved amount for durable medical equipment like a walker, wheelchair, or hospital bed.

Medicare Will NOT Pay for These — and This Is Where Most Seniors Get Blindsided

This is the section that nobody talks about enough, and it causes enormous financial and emotional pain for families who assume Medicare covers “everything at home.”

Medicare doesn’t cover 24-hour home care, homemaker services, meal preparation (unless part of a skilled care plan), transportation to medical appointments, or companion care services. These services, while absolutely essential for aging in place safely, fall outside Medicare’s medical model of care.

Services that are not covered include: 24-hour care, prescription drug coverage through the home health benefit, meal delivery, and custodial care (like laundry or meal preparation) unless those services are performed as part of a skilled nursing or therapy visit.

To be brutally clear: if bathing, dressing, or using the bathroom is the only help you need — Medicare does not pay for it. A home health aide can assist with these tasks only if you are also simultaneously receiving skilled nursing or therapy under an active plan of care.

Your Coverage Restarts Every 60 Days — and Most Seniors Don’t Know to Ask for Re-Certification

Here’s something buried deep in Medicare’s fine print that can absolutely make or break your continued care.

Medicare covers an initial 60-day episode of home health services. After that, your loved one’s doctor must review the plan of care and recertify the need for ongoing services. If skilled care is still needed, Medicare may continue coverage in 30-day increments.

This means that every 60 days, your continued care depends on your doctor re-signing documentation that you still qualify. If that paperwork is delayed, missed, or forgotten, your coverage can be interrupted — even if you medically still need it. You must be your own advocate here. Put a reminder on your calendar two weeks before your 60-day mark and proactively call your home health agency to confirm re-certification is in process.

If Medicare Says Your Care Is Ending, You Have 48 Hours to Fight It — Here’s How

This is one of the most urgently important things in this entire article. Most seniors don’t know this right exists.

When a home health agency plans to reduce or stop your services, they must give you a written notice. You have the right to file an appeal if a claim is submitted and Medicare denies payment.

The specific notice you’ll receive is called a Home Health Advance Beneficiary Notice (HHABN) or a Home Health Change of Care Notice (HHCCN). Do not ignore these documents. Do not just sign them and move on. Read every word.

Unless the services are excluded from Medicare coverage entirely, there is often a good chance of success through the appeals process. Many seniors and families give up because they assume the appeal is futile — but that assumption is wrong and it costs real care.

Your appeal goes to a Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) — there are two organizations depending on your state: Kepro (now Acentra Health) and Livanta. These are independent organizations that review Medicare care decisions. A good practice is to examine the reason for denial included on the Medicare Summary Notice to see if it accurately describes the circumstances — for example, if the service was denied as not medically reasonable or necessary, additional supporting documentation from your doctor can strengthen your appeal significantly.

Medicare Advantage May Cover What Original Medicare Won’t — But Only If You Read the Fine Print

Some Medicare Advantage plans offer expanded home health services beyond what Original Medicare provides, including additional home health aide hours, custodial care services, or 24-hour home care options for qualifying members. Many plans also offer supplemental benefits that can support home care, including transportation services, meal delivery, and home safety modifications.

This is genuinely significant. If you’re on Original Medicare and desperately need meal delivery, transportation, or more personal care aide hours, a Medicare Advantage plan might be worth exploring during the next open enrollment period (October 15 to December 7 each year).

In 2025, more than three-quarters of enrollees in individual Medicare Advantage plans with prescription drug coverage pay no premium other than the standard Part B premium, with the estimated average plan costing $17 per month. The out-of-pocket limit for Medicare Advantage in 2025 is capped at $9,350 for in-network services.

And starting in 2025, a major win: all Part D and Medicare Advantage plans now have a $2,000 annual cap on out-of-pocket prescription drug costs, previously as high as $8,000. This is the biggest prescription drug cost change in Medicare’s recent history.

Medicare Will Never Pay Your Family Member to Care for You — But These Programs Might

This is one of the most painful misunderstandings families encounter. Someone sacrifices their job or time to care for a parent or spouse, assuming Medicare will eventually reimburse them. Medicare does not pay family caregivers. Period.

However, several alternative programs may provide compensation to family caregivers. Many states have Medicaid programs that allow beneficiaries to hire and pay family members as caregivers. Requirements vary by state, but typically involve enrollment in a self-directed care program.

Programs to look into right now include your state’s Medicaid Home and Community Based Services (HCBS) Waiver, the Veterans Aid and Attendance Benefit (if your loved one served), and your local Area Agency on Aging’s caregiver support programs, which can also provide respite care, training, and counseling at no cost to families.

Free Expert Help Exists and Most Seniors Have No Idea — Here’s Where to Get It

This section could save you thousands of dollars and enormous frustration. There is an entire nationwide infrastructure of free, unbiased Medicare counseling that is funded by the federal government specifically to help you.

The State Health Insurance Assistance Program (SHIP) is available in every single state. SHIP counselors are certified, do not sell insurance, earn no commissions, and exist only to help you understand your options. They can review your plan, help you appeal denials, identify billing errors, and find programs you qualify for. SHIP counseling is completely free.

Your local Area Agency on Aging (AAA) is another powerhouse resource that most people have never heard of. These agencies can connect you to meal delivery, transportation, caregiver support, legal help, and benefits screening — often at no cost to you.

The ABN Form Can Protect You or Trap You — Know the Difference Before You Sign

Before any home health agency provides a service they think Medicare won’t cover, they are legally required to give you an Advance Beneficiary Notice (ABN), also called Form CMS-R-131. Most people sign it without reading it and later get a bill they didn’t expect.

Here’s what the three options on that form actually mean in plain English:

Option 1 — You want the service, you want Medicare billed anyway, and you’ll pay out of pocket if Medicare denies it, but you keep your right to appeal. This is almost always the right choice.

Option 2 — You want the service but tell them not to bill Medicare. You pay out of pocket and give up your right to appeal entirely. Almost never a good idea.

Option 3 — You decline the service. No cost, but no care either.

A beneficiary can appeal even if they signed an Advance Beneficiary Notice, as long as Medicare was billed and the beneficiary received a denial. Keep a copy of all documents sent and received, and when possible, send appeals via certified mail.

A Few Pro Tips That Could Change Everything for Your Situation

Document everything. Keep a running log of every home health visit, every conversation with your agency, and every piece of paperwork. This documentation becomes your ammunition in an appeal.

Ask for your care plan in writing. You have a legal right to see it. Review it to make sure the services ordered actually match what Medicare covers, and confirm that your doctor has signed off.

Use the “demand bill” option if an agency refuses. If your home health agency tells you Medicare won’t cover something and refuses to submit a claim, you can formally demand that they bill Medicare anyway — this is your legal right. Once they bill and Medicare denies it, you can appeal the decision through the BFCC-QIO.

Dual-eligible seniors have expanded options. As of 2024, 13.7 million Americans were enrolled in both Medicare and Medicaid. If you qualify for both, Medicaid can fill in many of the gaps that Medicare leaves open — including 24-hour care, personal care aides, and homemaker services — through your state’s HCBS waiver program. This combination is genuinely powerful when navigated correctly.

Never let a denial be the last word. The appeals process exists specifically because denials happen that shouldn’t. Bring your doctor into the fight with a detailed letter explaining your medical necessity, and do not stop at the first level of appeal if you believe coverage was rightfully yours.