Medicare Home Health Coverage Rules: What's Covered, Limits, and How to Qualify

Covered home-health visits are 100% under Original Medicare — no copays, deductibles, or coinsurance when the eligibility criteria are met. The eligibility rules are strict and confusing, and families routinely miss benefits they are entitled to or lose coverage they thought was guaranteed.

Here is how Medicare home health actually works: who qualifies, what is covered, what is not, and the critical timelines families need to understand.

The coverage percentages below refer to Original Medicare.

The Homebound Requirement

To qualify for Medicare home health, your parent must be enrolled in Part A or Part B, have a physician or allowed practitioner certify the need for care, require intermittent skilled nursing, physical therapy, occupational therapy, or speech-language pathology, be "homebound," and receive services from a Medicare-certified home health agency. Homebound does not mean they can never leave the house. It means leaving home requires a considerable and taxing effort due to their medical condition.

Your parent qualifies as homebound if:

• They need a supportive device (walker, wheelchair, crutches) to leave
• They need the help of another person to leave safely
• Leaving home is medically inadvisable due to their condition
• They are unable to leave without considerable effort due to physical limitations

Your parent can still leave home for medical appointments, religious services, adult day programs, and occasional short non-medical outings (a family dinner, a haircut) without losing homebound status. The key is that these outings are infrequent and short.

Under the Jimmo v. Sebelius settlement, Medicare coverage cannot be denied simply because the patient's condition is not expected to improve. Skilled care to maintain function or prevent deterioration qualifies. If your parent's coverage is denied on "improvement" grounds, this is a basis for appeal.

What Medicare Home Health Covers

Skilled nursing visits. Registered nurses provide wound care, medication management, injection administration, catheter care, vital sign monitoring, and caregiver education. Covered at 100%.

Physical therapy. Mobility training, balance exercises, transfer safety, strength building, and gait training. Covered at 100%.

Occupational therapy. Activities of daily living retraining (dressing, bathing, cooking), home modification recommendations, and adaptive equipment training. Covered at 100%.

Speech-language pathology. Swallowing evaluation and therapy, cognitive rehabilitation, and communication training after stroke. Covered at 100%.

Medical social services. Counseling, community resource referrals, and care coordination. Covered at 100%.

Home health aide services. Help with bathing, dressing, and personal care. Covered only when part of a care plan that includes one of the skilled services above.

How Many Therapy Visits Does Medicare Cover?

There is no fixed visit limit for Medicare home health therapy. Coverage is based on medical necessity, not a predetermined number. As long as the patient remains homebound and continues to need intermittent skilled care, visits continue.

Each 60-day certification period requires a physician or allowed practitioner to recertify that the patient still meets eligibility criteria. The agency submits a CMS-485 Plan of Care that specifies the type, frequency, and duration of each service. Common patterns:

• Physical therapy: 2 to 3 visits per week during active recovery, tapering to 1 per week during maintenance
• Skilled nursing: 1 to 3 visits per week depending on wound complexity and medication changes
• Occupational therapy: 1 to 2 visits per week

There is no fixed visit limit, but Medicare home health remains a short-term, intermittent benefit, typically covering up to 28 hours of skilled nursing per week. Your parent can receive services across multiple certification periods only while they continue to meet the eligibility criteria and the care team documents the ongoing need.

The 100-Day Rule: Skilled Nursing Facilities, Not Home Health

Families frequently confuse the 100-day rule with home health. They are entirely separate benefits:

Medicare Part A skilled nursing facility (SNF) coverage: After a qualifying 3-day hospital stay, Medicare covers up to 100 days in a skilled nursing facility. Days 1 through 20 are fully covered after any applicable Part A deductible. Days 21 through 100 require a daily copay (currently over $200 per day). After day 100, coverage ends completely.

Medicare home health: A short-term, intermittent Part A or Part B benefit. Covered visits have no copay, deductible, or coinsurance when the eligibility criteria are met, and home health is not tied to the SNF 100-day clock or necessarily to a prior hospital stay.

The 100-day clock applies only to SNF stays. A parent who exhausts their SNF days may still qualify for short-term, intermittent home health if the eligibility criteria continue to be met.

How to Get Medicare to Pay for a Hospital Bed

Durable Medical Equipment (DME) like hospital beds is covered under Medicare Part B. The process:

1. Get a physician's prescription. The prescribing doctor must document medical necessity using specific diagnosis codes. For a hospital bed, the patient typically needs to be unable to get in or out of a standard bed safely, require specific positioning for a medical condition, or need elevation that a standard bed cannot provide.

2. Use a Medicare-approved DME supplier. The supplier must be enrolled in Medicare. Check Medicare's Supplier Directory.

3. Understand the cost split. After meeting the Part B deductible, Medicare pays 80%. Your parent pays 20% of the Medicare-approved amount. For planning, a manual hospital-bed purchase is estimated at $500 to $1,160, while an electric hospital-bed rental is estimated at $150 to $500 per month.

4. Rental vs purchase. For capped-rental items such as wheelchairs, Medicare pays the supplier for 15 months, and ownership remains with the supplier. Later costs follow standard biannual maintenance coinsurance. If your parent has a Medicare Supplement (Medigap) plan, it may cover the 20% coinsurance.

Other DME that may be covered under Part B includes wheelchairs, walkers, oxygen equipment, CPAP machines, and blood glucose monitors; coverage depends on the item, medical necessity, and Medicare rules.

What Medicare Home Health Does Not Cover

• 24-hour continuous care
• Home-delivered meals (Meals on Wheels)
• Homemaker services (cleaning, laundry, grocery shopping) when no skilled service is also provided
• Personal care aide services when no skilled service is also provided
• Custodial care (long-term help with daily activities without a skilled component)

For these services, families need Medicaid HCBS waivers, Veterans benefits, or private payment. The Rehab and Recovery at Home Toolkit includes a cross-jurisdictional funding guide that maps every available program — Medicare, Medicaid, VA, and state-specific — to your parent's specific care needs.