Home Health Care
Medicare-covered intermittent skilled nursing or therapy services delivered in a patient's home when the patient is homebound and a physician certifies medical necessity.
Medicare home health care is one of the most misunderstood benefits. Many beneficiaries believe Medicare covers ongoing in-home help with activities of daily living (bathing, cooking, cleaning) — it does not. Medicare covers only skilled services: part-time or intermittent nursing care, physical therapy, speech-language pathology, occupational therapy, and medically-necessary aide services when provided in conjunction with skilled care. The patient must be certified as homebound (leaving home requires considerable effort or assistance) and under a physician's plan of care.
Medicare pays 100% for approved home health services — there is no deductible or coinsurance for home health under Part A or Part B. A Medicare-certified home health agency is paid directly by Medicare. Visits are typically 30–60 minutes, 3–5 times per week. The average Medicare home health episode covers 30–60 days.
The gap between what Medicare covers (skilled, intermittent care) and what most aging adults actually need (daily custodial assistance) is substantial. Non-Medicare home care — hiring a home health aide for custodial support — costs $25–$40/hour nationally (median $30/hour in 2023 per Genworth), adding up to $54,000–$87,600/year for 8 hours/day of aide care. This custodial cost is the primary driver of long-term care planning.
Real-World Example
After hospital discharge for hip surgery, a homebound patient received Medicare-covered home health: a nurse visit twice weekly for wound care and a physical therapist three times weekly for 6 weeks — all at no cost to the patient. The 2-hour/week personal care aide her family hired separately cost $31/hour out-of-pocket.