Medicare & Home Health Care
What Is Medicare Home Health Care?
Medicare may cover medical care you receive in your home if you meet certain rules. This care is meant to help you recover from illness or injury and stay safely at home.
Coverage is available through Original Medicare (Part A and/or Part B).
Who Can Get Medicare Home Health Care?
You may qualify if ALL of the following apply:
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- You have Medicare Part A or Part B (or both)
- Your doctor orders home health care
- You need skilled care (nursing or therapy)
- Care is part-time or intermittent
- You are considered homebound
- Care is provided by a Medicare-certified home health agency
Homebound means leaving home is difficult and requires effort or help. You can still leave home occasionally for:
- Medical appointments
- Religious services
- Short family or personal events
What Services Does Medicare Cover?
If medically necessary, Medicare may cover:
- Skilled nursing care
- Physical therapy
- Occupational therapy
- Speech therapy (speech language pathology)
- Home health aide services
(only if you’re also receiving skilled care) - Medical social services (if ordered)
- Medical supplies (such as wound care supplies)
Wheelchairs, walkers, and other medical equipment are covered separately.
What Is NOT Covered?
Medicare does not cover:
- 24-hour or live-in care
- Meals delivered to your home
- Housekeeping or shopping only
- Personal care alone (bathing or dressing) without skilled care
What Will I Pay?
Most people pay $0 for covered home health services. You may pay some costs for medical equipment or non-covered items. Medicare pays the home health agency directly
How Does Care Work?
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- Your doctor creates a plan of care
- Care is provided in 30-day periods
- Services must be reviewed and approved regularly
- Care continues only if it remains medically necessary
Choosing a Home Health Agency
You may choose any Medicare-certified agency in your area if you have Original Medicare. Agencies must meet federal quality standards. Medicare Advantage plans may limit which agencies you can use.
Know Your Rights
You have the right to:
- Be informed about your care and costs
- Help make decisions about your care
- Receive respectful and private treatment
- File complaints or appeals
Call our Appointment Hotline at (408) 350-3288, or visit our Appointments page to view available in-person counseling sites throughout Santa Clara County.
This project was supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $432,451.00 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government. Support provided by the California Department of Aging.
CA Health Insurance Counseling & Advocacy Program (HICAP) 1.800.434.0222
Sourcewise 3100 De La Cruz Blvd, Suite 310, Santa Clara, CA 95054