You can get many Medicare services at home when a doctor says they are medically necessary. Medicare often pays for part-time skilled nursing, physical or speech therapy, and some home health aide care to help you recover after illness, surgery, or a hospital stay.
You will not get every type of personal care or long-term custodial help covered, so knowing what qualifies matters.
The Modern Medicare Agency helps you sort what Medicare will and will not cover. Our licensed agents talk with you one-on-one to find plans that match your needs without hidden fees.
Let us guide you through durable medical equipment, remote health options, hospice rules, and how to coordinate the services you need at home.
Overview of Medicare Coverage for Home Services
Medicare can pay for skilled medical care at home when you meet specific rules. It covers nursing, therapy, and certain aides for short-term needs after illness or surgery.
Your plan type, doctor’s orders, and ability to leave home affect what Medicare pays.
Eligibility Requirements
You must be under Original Medicare Part A and/or Part B and have a doctor certify that you need skilled care at home. The doctor must say you are homebound—meaning leaving home is difficult and requires help or medical transport.
You also must need intermittent or part-time skilled nursing, physical therapy, or speech therapy. Medicare does not cover long-term personal care like help with routine household tasks unless tied to a skilled service.
A certified home health agency must provide the care and accept Medicare. Expect documentation: the doctor’s orders, a plan of care, and periodic reviews.
If you have a Medicare Advantage plan, your plan must authorize the services under its rules. Always confirm coverage details before services start to avoid surprise bills.
Types of Medicare Plans Covering Home Services
Original Medicare (Part A and Part B) covers home health services when all conditions are met. Part A covers medically necessary skilled nursing and home health care after a hospital stay, while Part B covers skilled services and durable medical equipment ordered by your doctor.
Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, but they may have different prior-authorization rules, networks, and costs. If you have Medicare Advantage, check your plan’s member materials for which home health agencies are in-network and whether you need referrals.
Some plans bundle extra benefits like limited home aide visits, but coverage varies. Always verify whether therapy limits, visit frequency, or copays apply under your plan.
Enrollment Process
If you already have Original Medicare, you do not enroll separately for home health benefits; eligibility depends on clinical criteria and physician orders. To start services, your doctor refers you and creates a plan of care.
The home health agency conducts a certification and begins services once Medicare rules are met. Keep copies of the doctor’s orders and the agency’s plan.
If you have Medicare Advantage, enroll in a plan during the yearly election period or a special enrollment period. After enrollment, contact your plan and a Medicare-certified home health agency to confirm coverage steps.
For personalized help with plan selection, contact The Modern Medicare Agency. Our licensed agents speak with you one-on-one, match plans to your needs, and do not add extra fees that strain your budget.
Medically Necessary Home Health Services
Medicare can pay for specific skilled care at home when a doctor says you need it and you cannot leave home without help. Covered services include skilled nursing, therapy, and certain personal care when tied to medical treatment.
Skilled Nursing Care at Home
Skilled nursing covers care a registered nurse (RN) or licensed practical nurse (LPN) provides that only a medical professional can safely give. Examples include dressing changes for complex wounds, injections, monitoring of IV therapy, and managing medications that require clinical assessment.
Your doctor must order the care and certify that you need intermittent or part-time skilled nursing, not full-time custodial care. Medicare pays for skilled nursing when it’s medically necessary and provided by a certified home health agency.
You will not pay for covered skilled nursing visits, but you must still have Medicare Part A or Part B and meet eligibility rules. Keep documentation of doctor orders and nurse notes to avoid billing surprises.
The Modern Medicare Agency helps you find agencies that accept Medicare and coordinate doctor orders. Our licensed agents talk with you one-on-one, confirm eligibility, and explain exactly which skilled services Medicare will cover for your situation.
Physical, Occupational, and Speech Therapy
Medicare covers therapy services at home when a therapist’s skills are needed to treat or improve a medical condition. Physical therapy focuses on strength, balance, and mobility after surgery or illness.
Occupational therapy helps you regain daily living skills like bathing and dressing. Speech therapy treats communication or swallowing problems.
A doctor must certify therapy as medically necessary and set a plan of care. Medicare pays for part-time or intermittent therapy visits delivered by qualified therapists from a Medicare-certified home health agency.
You should expect regular progress notes, measured goals, and periodic reviews to show continued need for therapy. The Modern Medicare Agency connects you with therapists who work with Medicare rules and track measurable progress.
Our agents explain therapy coverage limits and help you choose a plan that minimizes out-of-pocket costs while getting the services you need.
Home Health Aide Services
Home health aides provide personal care tied to skilled services, such as help with bathing, toileting, and dressing, when those services are part of a Medicare-covered plan of care. Medicare pays for aide visits only if you are already receiving skilled nursing or therapy and a doctor certifies the need.
Aides do not provide complex medical treatments, but they help you maintain hygiene and safety so skilled staff can focus on clinical tasks. Visits are generally part-time and intermittent.
Medicare covers the aide’s services when delivered by a Medicare-certified agency; private-duty or full-time personal care is usually not covered. The Modern Medicare Agency guides you through finding certified agencies that bill Medicare correctly.
Our licensed agents speak with you one-on-one, explain when aide services qualify, and match you to coverage options that avoid unnecessary fees.
Durable Medical Equipment and Supplies
Durable medical equipment (DME) helps you stay safe and independent at home. You’ll learn what types of equipment Medicare covers, what paperwork you need, and how maintenance and replacement work.
Coverage for Medical Equipment
Medicare Part B covers medically necessary DME for use in your home. Covered items often include wheelchairs, hospital beds, oxygen equipment, walkers, and continuous positive airway pressure (CPAP) machines.
Coverage typically pays 80% of the Medicare-approved amount after you meet the Part B deductible; you are responsible for the remaining 20% unless you have supplemental insurance. To qualify, a doctor must certify that the equipment is medically necessary for your condition and suitable for use at home.
Medicare won’t pay for equipment that serves only convenience or home modifications, such as stair lifts. You must get DME from a supplier enrolled in Medicare.
If you want help comparing plans that cover DME, The Modern Medicare Agency can connect you with licensed agents who explain coverage details and costs in plain language. Our agents work with you one-on-one and aim to find options that fit your budget.
Required Documentation for Equipment
Your supplier must have a written order or prescription from your doctor before Medicare will pay. That order must state the item needed, medical reason, and expected duration of use.
Keep copies of the doctor’s order, any supplier statements, and Medicare’s Explanation of Benefits (EOB) for your records. You may also need supporting medical records, such as notes showing mobility limits, oxygen saturation tests, or sleep study results for CPAP coverage.
Medicare can require proof that you use the item as prescribed, so retain documentation of deliveries, fittings, and any supplier billing. When you work with The Modern Medicare Agency, our licensed agents help you understand which documents your doctor and supplier need.
They guide you through the paper trail so claims proceed smoothly and you avoid unexpected denials.
Maintenance and Replacement Policies
Medicare covers maintenance and repair of DME when the item was originally paid for under Medicare and repairs are medically necessary. Routine servicing by the supplier often falls under the DME benefit, but cosmetic damage or loss may not.
If repair costs are high, Medicare evaluates whether replacement is reasonable. Replacement rules depend on the item and useful life.
For example, power wheelchairs and hospital beds have specific reasonable useful life periods. Suppliers must follow Medicare rules before billing for replacement; they may need documentation showing the item is beyond repair or no longer effective.
Your supplier must inform you about repair policies and any out-of-pocket costs before performing work. The Modern Medicare Agency’s agents clarify maintenance and replacement rules for your specific equipment.
They help you find enrolled suppliers and explain how to handle claims, repairs, and appeals if Medicare denies coverage.
Personal Care and Custodial Services at Home
Personal care at home covers help with daily tasks like bathing, dressing, toileting, moving around, and meal prep. Medicare may pay for some of these services only when they happen alongside medically necessary skilled care.
Know what qualifies, what Medicare won’t cover, and where to get help that fits your budget and needs.
Non-Medical Assistance Limitations
Medicare generally does not pay for purely non-medical, or custodial, care when that care is the only thing you need. This includes help with eating, dressing, bathing, homemaking, and routine supervision.
If you only need these services, you will likely pay out of pocket or use other programs such as Medicaid, veterans’ benefits, or private long‑term care insurance. Medicare will cover a home health aide only when you also need skilled nursing or therapy and a doctor certifies that need.
Services must come from a Medicare‑certified home health agency. You should get an itemized plan of care from the agency so you can see exactly which personal tasks Medicare will pay for and which you will not.
Respite Care Options
Respite care gives temporary relief to family caregivers by providing short-term, supervised care in the home or in a facility. Medicare may cover respite only in limited cases, typically tied to home health or hospice programs when medical need exists.
That means Medicare will not usually pay simply to give caregivers a break. You can mix paid private aides with Medicare-covered skilled visits to create a practical respite plan.
Check local community programs, Area Agencies on Aging, and The Modern Medicare Agency for options that match your income and care needs. Our licensed agents talk with you one on one to find plans and programs without extra hidden fees.
Differences From Skilled Care
Skilled care involves medical tasks that must be done by licensed professionals, such as wound care, injections, IV therapy, and physical, occupational, or speech therapy. Medicare covers skilled services when they’re medically necessary and ordered by a doctor.
Coverage stops when you no longer need skilled care, even if you still need help with daily living. Custodial care is non-medical and does not meet Medicare’s skilled-care rules unless it is part of a plan that includes concurrent skilled services.
Always ask whether an agency is Medicare‑certified and get written orders from your physician. The Modern Medicare Agency helps you verify coverage details and find cost-effective packages that match your medical needs and budget.
Remote Health Services Covered by Medicare
Medicare lets you get many kinds of care at home. You can use video visits, devices that send health data to your doctor, and mental health counseling, all while avoiding frequent office trips.
Telehealth Visits
Medicare Part B covers many telehealth visits when an eligible provider bills Medicare. You can use live video to see doctors for routine checkups, urgent care, and follow-ups.
After you meet the Part B deductible, Medicare typically pays 80% of the approved amount and you pay the remaining 20% unless your plan says otherwise. You need a device with video—like a smartphone, tablet, or computer—and a secure connection.
Some telehealth visits can also happen by phone if video is not available for certain services. Check that your provider accepts Medicare and bills correctly before the visit.
The Modern Medicare Agency helps you find plans and providers that support telehealth. Our licensed agents talk with you one on one to match coverage to your needs without extra fees that break the bank.
Remote Patient Monitoring
Remote patient monitoring (RPM) uses devices at home to track vital signs and send data to your clinician. Common RPM items include blood pressure cuffs, glucose meters, pulse oximeters, and weight scales.
Medicare covers RPM when a clinician reviews the data and bills an RPM code, usually on a monthly basis. RPM works well for chronic conditions like heart failure, diabetes, and hypertension.
You keep devices at home, follow simple setup steps, and clinicians monitor trends and adjust treatment. RPM can reduce clinic visits and catch problems earlier.
Ask The Modern Medicare Agency about plans and providers that support RPM. Our licensed agents will explain device eligibility, billing rules, and how RPM fits your care plan.
Virtual Therapy Sessions
Medicare covers mental health visits through telehealth and certain virtual counseling sessions. Coverage includes psychotherapy, psychiatric medication management, and some behavioral health consultations from eligible providers.
You generally pay 20% after the Part B deductible unless your plan changes cost-sharing. Sessions can be live video or, in limited cases, by phone.
You must see an eligible provider who bills Medicare for those services. Frequency and types of covered therapy depend on your diagnosis and the provider’s billing practices.
The Modern Medicare Agency connects you to plans and clinicians who offer virtual therapy. Our licensed agents provide one-on-one help to align your mental health needs with affordable coverage options.
Home Hospice Care Coverage Details
Medicare can pay for hospice care at home when certain medical and paperwork rules are met. Coverage focuses on comfort, symptom control, and support for you and your family, typically through a Medicare-certified hospice provider.
Qualifying Conditions
To qualify, a doctor and the hospice medical director must certify that your life expectancy is six months or less if the illness runs its normal course. You must also sign a statement choosing palliative care focused on comfort instead of treatment meant to cure the terminal illness.
Medicare requires ongoing certification. The hospice team will re-evaluate your condition at set intervals.
If your condition improves, hospice can be suspended or ended, and you can return to regular Medicare-covered treatments. You can still get treatments for conditions unrelated to the terminal diagnosis if the hospice approves them.
Medicare covers hospice whether you live in a private home, assisted living, or certain nursing facilities, as long as the hospice provider is Medicare-certified.
Covered Hospice Services
Medicare’s hospice benefit covers a range of services tied to the terminal illness and related conditions. Core services include nursing care, medical social services, and physician oversight.
You also get medications for symptom control and pain relief, medical equipment like hospital beds, and supplies related to comfort care. Hospice provides counseling support—emotional and spiritual—for you and your family.
Short-term inpatient care for pain or symptom management is covered when home care is not enough. Bereavement support for family members is provided after a patient’s death.
Note that routine 24-hour in-home custodial care is generally not covered. Medicare will cover intermittent in-home care and short stays in inpatient hospice facilities when needed for symptom control.
Home-Based End-of-Life Support
A Medicare-certified hospice team coordinates care at home. That team usually includes a hospice doctor, nurses, social workers, counselors, and trained aides.
They make home visits, set up equipment, and teach family caregivers how to manage symptoms and medications. If you need 24-hour skilled nursing for severe symptoms, Medicare may cover short periods of intensified care in the home or an inpatient hospice unit.
Hospice also arranges emergency visits and gives you direct lines to staff for urgent needs. Our licensed agents are real people you can speak with one-on-one.
They review your situation, explain hospice rules, and match Medicare-certified hospice providers to your needs without charging extra fees.
Coverage Limitations and Exclusions
Medicare home health helps with skilled nursing, therapy, and medical equipment, but it does not cover long-term personal care, unlimited visits, or all supplies. You’ll need a doctor’s plan and proof that skilled care is medically necessary.
Commonly Excluded Services
Medicare does not pay for most non-skilled personal care. This includes help with bathing, dressing, eating, and routine household chores when those tasks are the only services you need.
Homemaker services and long-term custodial care are excluded unless they are part of a plan that also includes covered skilled care. Medicare also won’t cover 24-hour-a-day care at home, meal delivery without medical justification, or most transportation costs.
Durable medical equipment that is not medically necessary or that duplicates other covered items may be excluded. If you need personal care only, you should expect to pay out of pocket or seek supplemental coverage.
Length and Frequency Restrictions
Medicare covers part-time or intermittent skilled care, not continuous care. “Part-time” usually means care several hours a day, and “intermittent” means care that isn’t needed every day.
Your doctor must certify that the skilled care is needed and set the length of the home health episode. Medicare also reviews progress.
If your need for skilled care ends or you can safely leave home without assistance, coverage can stop. Therapy services may be limited if you reach clinical goals.
Ask your provider and The Modern Medicare Agency about expected visit counts and how often reviews occur so you can plan.
Out-of-Pocket Costs
Original Medicare pays for covered home health services, but you may still owe costs for some items. Medicare Part B covers doctor-ordered home health visits and durable medical equipment, but certain supplies and non-covered services require payment by you or a supplemental plan.
You may face copayments or coinsurance for outpatient therapy or for equipment not fully covered. Medicare Advantage plans vary, so check your plan’s rules and cost-sharing.
Contact The Modern Medicare Agency — our licensed agents speak with you one-on-one to compare plans, explain costs, and find options that match your budget without hidden fees.
How to Access and Coordinate Medicare Services at Home
You will need to confirm eligibility, choose Medicare-certified providers, and set up a written care plan. Expect a face-to-face visit from a doctor, clear paperwork from the agency, and one-on-one help from licensed agents at The Modern Medicare Agency.
Working With Approved Providers
Medicare pays only Medicare-certified home health agencies for covered home services. Ask the agency for its Medicare ID and verify certification on Medicare.gov.
Choose providers that offer skilled nursing, physical or occupational therapy, speech therapy, or home health aides when those services match your needs. You must have a face-to-face visit with a doctor or qualified practitioner before services start.
The provider sends a plan of care and a certification to Medicare stating the medical need, how often services will occur, and the expected length of care. Keep copies of all documents.
The Modern Medicare Agency connects you with certified agencies and explains what each agency will bill. Our licensed agents talk with you one-on-one, review agency credentials, and help you avoid surprise charges.
Care Planning and Case Management
The agency develops a written plan of care based on the physician’s orders. The plan lists services, frequency, goals, and who is responsible for each task.
Read the plan carefully and ask for changes if it doesn’t match your needs. A case manager or nurse usually coordinates visits, schedules therapists, and monitors progress.
Track visits and outcomes in a simple notebook or app so you can report issues quickly. If durable medical equipment or drugs are needed, the agency should document who provides and bills for them.
The Modern Medicare Agency assigns a licensed agent to review your plan with you. We explain what Medicare covers, what you owe, and how services tie to your health goals.
Our agents help coordinate care and follow up to reduce gaps or miscommunication.
Navigating Appeals and Denials
If Medicare denies a service, you have the right to appeal. First, request a written notice explaining the denial and the exact reason.
This notice will include deadlines and steps for filing an appeal. Gather supporting documents: the plan of care, doctor’s notes, therapy progress notes, and any bills related to the denied service.
File the appeal on time; your agent can help with forms and evidence. Keep copies of everything and send records by certified mail or the method specified in the denial notice.
The Modern Medicare Agency offers one-on-one support during appeals. Our licensed agents help you collect the right documents, fill out forms, and contact the agency or Medicare as needed.
We do not charge extra for this assistance and work to protect your rights under Medicare.
Recent Changes and Updates to Medicare Home Coverage
Medicare updated home health payment rules for 2025 and 2026. Payments were adjusted to avoid deep cuts and to better match actual care costs.
CMS revised how payments are calculated for home health agencies. These changes include updates to case-mix weights, functional impairment levels, and comorbidity groups.
These updates can affect what services get covered and how agencies are reimbursed. Quality measurement and reporting rules also changed.
CMS aims to improve accuracy and equity in reporting. This may shift which providers you choose based on quality scores.
You may see changes to therapy and skilled nursing coverage rules. Medicare clarified that certain therapies count only when medically necessary and tied to an eligible home health plan of care.
- Check coverage details before care starts to avoid surprise bills.
- Ask about how updates affect visits, therapy limits, and durable medical equipment.
- Keep records of visits and the clinician’s notes for appeals or reviews.
The Modern Medicare Agency helps you navigate these updates. Our licensed agents are real people you can speak with 1 on 1.
They match Medicare packages to your needs without hidden fees. They explain how rule changes affect your coverage.
