Key Takeaways

• Medicare covers a broad range of home health services in 2025, but the rules and limitations can affect your eligibility and how much care you receive.

• You must meet specific criteria to qualify, including being under a doctor’s care and homebound; understanding these conditions is essential to avoid unexpected out-of-pocket costs.

What Counts as Home Health Care Under Medicare?

Medicare defines home health care as a limited set of medical services provided in your home to treat an illness or injury. In 2025, this includes:

• Skilled nursing care

• Physical, occupational, and speech therapy

• Medical social services

• Part-time or intermittent home health aide services

• Certain medical supplies and durable medical equipment (DME)

This care must be deemed medically necessary by a healthcare provider and must be provided by a Medicare-approved home health agency.

Who Is Eligible for Medicare Home Health Services?

To receive Medicare-covered home health benefits, you must meet these key requirements:

• Be enrolled in Medicare Part A and/or Part B.

• Be under the care of a doctor who has created and regularly reviews your care plan.

• Have certification from your doctor that you are homebound. This means leaving home requires considerable effort and assistance.

• Require skilled care (such as nursing or therapy services) on an intermittent basis.

• Use a home health agency certified by Medicare.

You do not need to be hospitalized to qualify, but your doctor must certify that home health care is appropriate.

How Long Can You Receive Home Health Care?

Medicare does not set a hard limit on the number of days you can receive home health care, but there are restrictions:

• Services are covered in 60-day episodes of care. If you still qualify after 60 days, your doctor must recertify your eligibility.

• You must continue to meet Medicare’s criteria at each recertification interval.

• The care must continue to be medically necessary and ordered by your doctor.

If you stop meeting the criteria, your coverage ends, even if you haven’t improved yet.

What Medicare Covers—and What It Doesn’t

In 2025, Medicare pays for many—but not all—types of home health care. It is important to understand what’s included and what’s not.

Covered by Medicare:

• Up to 28 hours per week of skilled nursing and therapy (can extend to 35 hours in some cases)

• Physical, occupational, and speech-language therapy

• Medical social services (such as help finding community support)

• Part-time home health aide services (limited to personal care if skilled care is also being provided)

• Certain medical supplies like catheters and wound dressings

• Durable medical equipment, like wheelchairs or oxygen (usually 80% of the cost after the Part B deductible)

Not Covered by Medicare:

• Full-time or round-the-clock care

• Meal delivery

• Homemaker services like cleaning or laundry

• Custodial care (if that’s the only care needed)

This means Medicare helps with medical needs, but not with day-to-day living assistance unless it is tied to a covered service.

New Developments in 2025

Medicare has made some adjustments in recent years to support home-based care:

• Expanded Telehealth Access: Medicare now allows some home health visits to be conducted virtually if clinically appropriate.

• Better Integration with Chronic Care Programs: If you have multiple chronic conditions, you may benefit from coordinated home care management covered under Medicare.

• Focus on Post-Hospital Recovery: If you’ve been discharged from a hospital or skilled nursing facility, you may qualify for short-term intensive home health care to avoid rehospitalization.

However, these changes still require you to meet basic Medicare home health criteria.

Does Medicare Advantage Offer More Home Health Flexibility?

Medicare Advantage (Part C) plans are required to offer the same level of home health coverage as Original Medicare. However, many plans may include additional benefits, such as:

• Expanded caregiver support

• Transportation for medical appointments

• Help with home modifications for safety

Even though these extras can be helpful, they vary by plan, and not all enrollees qualify for them. You should carefully check your plan’s Evidence of Coverage document or speak to a licensed agent listed on this website for plan-specific details.

How to Start Home Health Services

If you think you need home health care:

1. Talk to your doctor. Your doctor must confirm that you need skilled home care and refer you to a Medicare-approved agency.

2. Choose a Medicare-certified home health agency. You can search online or ask your doctor for a recommendation.

3. Undergo an in-person or virtual assessment. The agency will assess your condition and needs, then create a care plan approved by your doctor.

Care begins only after this process is complete. The agency must provide you with a written notice explaining what services will be provided and your rights.

What You’ll Likely Pay

While Medicare generally covers most home health services at no cost to you, there are a few things to watch for:

• Home Health Services: Covered in full if you meet all eligibility requirements.

• Durable Medical Equipment (DME): You typically pay 20% of the Medicare-approved amount after meeting your Part B deductible.

• Additional Services: Any service not deemed medically necessary or not ordered by your doctor will not be covered.

Keeping your doctor involved and maintaining documentation are crucial to avoid billing surprises.

What Happens If You’re Denied?

If Medicare or your plan denies home health services, you have appeal rights. Here’s what you can do:

• Request an Immediate Review. If care is ending, you can request a fast-track appeal to continue receiving services while your case is reviewed.

• File a Standard Appeal. This involves submitting documentation to challenge the denial.

• Get Help. Consider contacting a Medicare advocate or licensed agent for guidance through the appeals process.

The appeals process must follow strict timelines, so act quickly if you receive a notice of denial.

The Home Health Certification Rule

One rule to note in 2025 is the requirement for your doctor to certify the need for home health care and recertify every 60 days. The documentation must include:

• Evidence that you’re homebound

• Specific skilled care needs

• A detailed care plan

Without this certification, Medicare won’t pay the agency—even if you qualify otherwise.

Avoid These Common Pitfalls

Understanding Medicare’s home health rules can help you avoid these common mistakes:

• Skipping the doctor referral. You can’t start Medicare-covered services without it.

• Assuming all home services are covered. Non-medical help like cooking or cleaning isn’t included.

• Failing to use a Medicare-certified agency. Coverage only applies if the provider is approved by Medicare.

• Not monitoring recertification. Services won’t continue unless your doctor recertifies you every 60 days.

Ask questions and stay involved in your care plan to avoid disruptions.

Understanding Medicare’s Rules Helps You Get the Right Care

Home health care can be a valuable benefit under Medicare in 2025, but only if you understand the rules and stay eligible. From knowing what services are covered to managing doctor certifications, staying informed puts you in control.

If you’re unsure whether you qualify or want to review your current plan’s home care options, get in touch with a licensed agent listed on this website. They can help you understand what’s available and how to make the most of your benefits.