Editorial Team · Content Writer
Reviewed by John Brown, CSA®
Updated October 2026 · 7-minute read
Table of Contents
- What Is the Medicare Home Health Benefit?
- Medicare Home Health Eligibility Requirements
- Medicare Home Health Services Covered and Hours Per Week
- Frequently Asked Questions
Last reviewed: October 2026
What Is the Medicare Home Health Benefit?
The Medicare home health benefit helps eligible Medicare beneficiaries receive medically necessary skilled nursing and therapy services at home. It may be covered under Medicare Part A or Part B, depending on the circumstances.
This benefit is intended for people who are homebound and need part-time or intermittent skilled care under a plan ordered and reviewed by a doctor or another Medicare-authorized healthcare provider.
For example, a senior returning home in Kyle after surgery may need nursing visits for wound care and physical therapy. An older adult in Belton may need skilled monitoring and therapy after an illness affected their strength and mobility. A hospital stay is not always required to qualify.
According to Medicare’s official home health coverage information, covered services may include:
- Part-time or intermittent skilled nursing
- Physical therapy
- Occupational therapy under applicable conditions
- Speech-language pathology
- Medical social services
- Certain medical supplies
- Part-time or intermittent home health aide services when the person is also receiving qualifying skilled care
- Certain durable medical equipment
Medicare does not generally cover continuous caregiving, meal delivery, routine housekeeping or personal care when bathing, dressing, toileting or similar assistance is the only help needed.
That distinction is important. Home health provides medically necessary skilled services. Home care generally provides non-medical assistance with daily activities, supervision, meals, transportation and companionship.
Some Central Texas families need both services at the same time.
Senior Industry Services provides educational resources to help families understand care terminology and locate local providers. SIS does not determine Medicare eligibility or guarantee that Medicare will approve a particular service.
Families can also read Home Care vs. Home Health vs. Palliative Care vs. Hospice for a clearer comparison.
Medicare Home Health Eligibility Requirements
To qualify for the Medicare home health benefit, a person generally must:
- Be enrolled in Medicare Part A or Part B
- Be under the care of a doctor or another Medicare-authorized healthcare provider
- Receive care under an established and regularly reviewed plan of care
- Need intermittent skilled nursing, physical therapy or speech-language pathology—or have a continuing need for occupational therapy after initially qualifying
- Be considered homebound
- Receive services from a Medicare-certified home health agency
Before home health begins, a doctor or other authorized provider must complete the required face-to-face encounter, confirm the need for home health and order the care. The home health agency then evaluates the person and coordinates the care plan with the ordering provider.
What does “homebound” mean?
Being homebound does not mean someone can never leave home.
Medicare generally considers a person homebound when:
- Leaving home is not medically recommended; or
- The person needs help from another person, special transportation or equipment such as a walker, wheelchair or crutches; and
- The person normally cannot leave home easily, and leaving requires a considerable and taxing effort
A person may still leave home for medical appointments, religious services, adult day care or short and infrequent non-medical trips.
Simply preferring to stay home is not enough. The medical record must support the person’s condition, limitations and difficulty leaving.
Is a hospital stay required?
No. Unlike Medicare coverage for a skilled nursing facility, Medicare home health does not generally require a qualifying three-day hospital stay.
A person may be referred after hospitalization, rehabilitation or surgery, but someone already living at home may also qualify when Medicare’s requirements are met.
Must the agency be Medicare-certified?
Yes. Original Medicare requires covered services to be provided through a Medicare-certified home health agency.
When comparing agencies serving Austin, San Marcos, New Braunfels, Temple, Killeen, Waco and surrounding Central Texas communities, families should ask:
- Is the agency Medicare-certified?
- Does it provide the ordered nursing or therapy service?
- How soon can care begin?
- Does it serve the person’s ZIP code?
- Who should the family call after hours?
- What services will Medicare cover?
- Will any service require private payment?
Families can review How to Choose a Home Health Care Provider in Central Texas for additional questions to ask.
Medicare Home Health Services Covered and Hours Per Week
Medicare may cover the following medically necessary services when all eligibility requirements are satisfied.
Skilled nursing
Covered skilled nursing may include:
- Wound care
- Injections
- Intravenous or nutrition therapy
- Catheter care
- Patient and caregiver education
- Monitoring a serious illness or unstable medical condition
Medicare does not cover ongoing medication reminders when that is the only service needed. Skilled nursing related to medication teaching, assessment or management may be covered when medically necessary and included in the care plan.
Therapy services
Covered therapy may include:
- Physical therapy to improve or maintain movement, strength and balance
- Occupational therapy to improve or maintain the ability to perform daily tasks
- Speech-language pathology for communication or swallowing difficulties
Medicare coverage is not limited only to people expected to make a full recovery. Skilled therapy may also be covered when it is necessary to maintain the person’s condition or prevent or slow deterioration.
Home health aide services
A home health aide may provide limited personal care such as help with bathing, grooming, walking or changing bed linens—but only when the person is also receiving qualifying skilled nursing or therapy services.
Medicare does not cover ongoing personal-care assistance when that is the only service needed.
How many hours does Medicare cover?
Medicare home health is part-time or intermittent—not around-the-clock care.
According to Medicare, skilled nursing and home health aide services are generally limited to:
- Up to eight hours per day combined
- Up to 28 hours per week combined
In some cases, Medicare may cover up to 35 hours per week for a short period when the healthcare provider determines that the additional care is medically necessary.
The 28- and 35-hour limits specifically apply to combined skilled nursing and home health aide services. Therapy frequency is determined separately under the medically necessary plan of care.
Medicare does not impose a general 100-day limit on qualifying home health services. Coverage may continue as long as the person remains eligible and the services remain reasonable and medically necessary.
What Medicare does not cover
Medicare home health generally does not pay for:
- 24-hour care at home
- Live-in caregivers
- Meal delivery
- Shopping or routine housekeeping unrelated to the care plan
- Transportation
- Companionship
- Personal or custodial care when it is the only care needed
What does the beneficiary pay?
Under Original Medicare:
- The beneficiary generally pays $0 for covered home health services
- After the Part B deductible, the beneficiary generally pays 20% of the Medicare-approved amount for covered durable medical equipment
The agency should explain what Medicare is expected to cover and provide an Advance Beneficiary Notice when it believes Medicare may not pay for a proposed item or service.
People enrolled in Medicare Advantage should check their plan’s network, authorization and coverage requirements.
Frequently Asked Questions
Who qualifies for the Medicare home health benefit?
A person generally must be enrolled in Medicare Part A or Part B, be homebound, need qualifying part-time or intermittent skilled care, receive care under an authorized plan and use a Medicare-certified home health agency. Eligibility depends on the person’s documented medical circumstances.
Does Medicare cover 24-hour home care?
No. Medicare home health does not pay for continuous or live-in caregiving. Families needing overnight supervision or around-the-clock help may need private-pay home care, long-term-care insurance benefits, Medicaid services if eligible or another care setting.
What is the difference between home health and home care?
Home health provides skilled medical or therapy services ordered by a healthcare provider. Home care usually provides non-medical help with bathing, dressing, meals, transportation, supervision and other daily needs. Medicare does not generally cover personal care when it is the only service required.
Can someone receive home health without being hospitalized first?
Yes. A hospital or skilled nursing stay is not always required. A person living at home may qualify when an authorized provider documents that the person is homebound and needs qualifying skilled services.
How long will Medicare pay for home health?
There is no general 100-day limit for Medicare home health. Coverage may continue as long as the person meets the eligibility requirements and the services remain medically reasonable and necessary. The provider and home health agency must continue reviewing and documenting the care plan.
Where can Central Texas families find home health resources?
Families can ask the ordering provider or hospital discharge planner for Medicare-certified agencies serving their ZIP code, compare agencies through Medicare and explore the Senior Industry Services Senior Care Directory.
Educational disclaimer: This article provides general educational information and is not medical, insurance or Medicare eligibility advice. Coverage depends on the beneficiary’s condition, documentation, plan of care, provider orders and Medicare rules. Senior Industry Services and Senior-AI do not determine coverage, provide medical care or guarantee any provider. Confirm individual benefits with Medicare, the health plan, the ordering provider and the selected Medicare-certified home health agency.