What Medicare actually covers at home

Medicare's home health benefit pays in full for nursing and therapy visits at home, with no deductible and no copay. Families are often surprised by how much it covers, and then surprised again by what it does not.

Who qualifies

Two conditions have to be met. First, the patient must be homebound, which does not mean bedbound: it means leaving home takes a considerable and taxing effort, such as needing a walker and another person's help. Going to the doctor, to church or to the barber occasionally does not disqualify anyone. Second, the patient must need skilled care, such as nursing or therapy, and a physician or nurse practitioner must certify that after a face-to-face visit.

What it covers

Covered services include skilled nursing, physical, occupational and speech therapy, medical social work, and part-time home health aide visits while skilled care is ongoing. Durable medical equipment like walkers and hospital beds is covered separately under Part B, usually at 80 percent.

What it does not

Medicare does not pay for 24-hour care at home, for meals, or for help with bathing and housekeeping when that is the only help needed. That is where private duty and personal care come in. Our intake team can tell you within one call whether a patient is likely to qualify and what the rest of the plan might cost; see our insurance page for the plans we accept.