Eligibility Requirements
To qualify for Medicare-covered home health care, the patient must be considered "homebound" — meaning leaving home requires considerable effort and assistance. A physician must also certify that the patient needs intermittent skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy.
Services Medicare Will Pay For
- Skilled nursing care (wound dressing, catheter care, injections)
- Physical, occupational, and speech therapy
- Medical social services and counseling
- Part-time or intermittent home health aide services (personal care)
- Durable medical equipment (wheelchairs, walkers, hospital beds) — patient pays 20%
Services Medicare Does Not Cover
- 24-hour-a-day care at home
- Meal delivery or homemaker services (when that is the only care needed)
- Personal care services like bathing and dressing if no skilled care is required
- Custodial or non-medical companion care on its own
"The key is documentation. Every visit must be tied to a physician's order and a clear plan of care that Medicare can audit if needed."
How to Avoid Common Denials
Denied claims usually stem from one of three issues: the patient was not properly certified as homebound, the care plan was not updated regularly, or the services provided did not require a skilled professional. Working with an experienced home health agency that understands Medicare documentation standards dramatically reduces these risks.