Medicare pays the full cost of home health care, with no copay, when four things are true: you are homebound, you need part-time or intermittent skilled care, a doctor or other provider has ordered it after seeing you, and a Medicare-certified agency delivers it. It can continue for as long as you keep qualifying, but it never pays for 24-hour care or for an aide on their own.
Our page on whether Medicare covers home care answers the yes-or-no question. This one explains how the benefit works: hours, renewals, who gets paid and what to do if it stops.
Who qualifies for the Medicare home health benefit?
Medicare.gov and the CMS Medicare Benefit Policy Manual, chapter 7 set the same tests. Use this table as a checklist before you call anyone.
| Requirement | What Medicare looks for |
|---|---|
| Under a provider’s care and plan of care | A doctor or other allowed provider, such as a nurse practitioner, orders the care. The plan of care is reviewed and signed at least every 60 days. |
| Face-to-face visit | The provider sees you in person and confirms you need home health. The manual says this visit must happen within the 90 days before care starts or the 30 days after. |
| Skilled need | You need part-time or intermittent skilled nursing, physical therapy or speech-language pathology, or you have a continuing need for occupational therapy. |
| Homebound | You meet both parts of the two-part test explained below. |
| Medicare-certified agency | Only an agency certified by Medicare can provide the care and bill Medicare for it. |
Diagnosis is not on the list. The tests are about the care you need and your ability to leave home.
What does “homebound” mean?
The manual splits it into two criteria, and you need both. First, you either need help to leave home (a cane, walker, wheelchair, special transportation or another person’s help), or leaving home is medically contraindicated. Second, you normally cannot leave home, and leaving takes considerable and taxing effort.
Homebound does not mean housebound. Medicare allows trips for health care, including adult day care, and infrequent or short absences such as a religious service or a walk around the block.
What does Medicare home health cover, and what does it not?
The covered list is shorter than most families expect. Here is the split, from Medicare.gov.
| Covered | Not covered |
|---|---|
| Part-time or intermittent skilled nursing: wound care, injections, IV or nutrition therapy, teaching you and your caregiver, monitoring unstable health | 24-hour-a-day care at home |
| Physical therapy, occupational therapy and speech-language pathology | Home meal delivery |
| Medical social services | Homemaker services such as shopping and cleaning that are unrelated to your care plan |
| Part-time or intermittent home health aide care (walking, bathing, grooming, bed linens, feeding), only while you also get skilled nursing or therapy | Custodial or personal care alone, such as bathing, dressing or toileting when that is the only care you need |
| Durable medical equipment and medical supplies for home use |
How many hours a week will Medicare pay for?
Visits are unlimited if you qualify, but the hours are not. “Part-time or intermittent” means skilled nursing and aide time combined must stay under 8 hours a day and at most 28 hours a week. If your provider decides it is needed, Medicare can allow up to 35 hours a week, still under 8 hours a day, for a short time.
The manual adds something families rarely hear. Care beyond those limits can be provided or paid for by another payer without costing you the Medicare-covered part. Its example is a patient who has monthly nursing visits plus aide care around the clock: the agency bills Medicare for the covered hours and bills the patient or another payer for the rest. Our guide to private home care covers the paid-by-you side.
How long does Medicare home health last, and what is a 60-day period?
Care is certified in 60-day periods. According to the manual, Medicare does not limit the number of continuous 60-day recertifications for people who keep qualifying. Each 60-day certification can include two 30-day payment periods.
- Day 1: the agency starts care under the provider’s signed plan of care.
- Days 56 to 60: a recertification assessment is generally done during the last 5 days of the period.
- Day 61: if you still qualify, the provider recertifies you and a new 60-day period begins.
- The end: care stops when you no longer meet the requirements, for example when you can leave home easily or no longer need skilled care.
Medicare.gov describes the goal as helping you get better, maintain your level of function or slow your decline, so improvement is not required.
What does it cost?
You pay nothing for covered home health services. Medicare-covered medical equipment is different: after you meet the Part B deductible, you pay 20% of the Medicare-approved amount. Before care begins, the agency should give you a written Advance Beneficiary Notice (ABN) for anything Medicare will not cover.
Does Medicare pay home health aides by the hour?
No. This is behind the question “how much does Medicare pay for home health care per hour,” and the answer surprises people. CMS pays agencies a national standardized rate for each 30-day period, adjusted for the patient’s condition and the local wage index. When a period has too few visits, Medicare pays per visit instead.
That payment goes to the agency. It is not the aide’s wage, and you do not pay it. No per-hour figure applies to you.
Original Medicare or Medicare Advantage: what changes?
Federal rules require Medicare Advantage plans to cover all services covered by Part A and Part B, and the rule names home health. You get the same benefit, but the plan runs it. Medicare.gov tells plan members to check with their plan about their home health benefits, so ask which agencies are in the network and what you would pay. Appeals also work differently, as covered below.
Will Medicare pay for home health care for dementia?
Only when the usual tests are met. Someone with dementia can qualify if they are homebound and need skilled nursing or therapy, for example after a fall or surgery, or for wound care. Needing someone to supervise, remind or help with bathing and dressing is custodial care, and Medicare does not cover it by itself.
Most families need ongoing help beyond what Medicare covers. Our guides on dementia care at home and Alzheimer’s care in New York explain what that help looks like.
How do I find a Medicare-certified agency in New York City?
A licensed home care agency is not automatically a Medicare-certified one, so check before you commit.
- Ask the provider for a list. Medicare.gov says your provider should give you agencies serving your area and must disclose any financial interest in them.
- Compare them on Care Compare. Care Compare is Medicare’s official tool for choosing a home health provider, with a quality star rating and a patient survey rating.
- Call two or three. Confirm they are Medicare-certified, take your plan if you have Medicare Advantage and serve your neighborhood.
- Get the cost in writing. Ask about the ABN for anything not covered.
More on vetting agencies: how to choose a home care agency in New York.
What if home health is denied or Medicare says it is ending?
If an agency is ending care you are getting, you should receive a Notice of Medicare Non-Coverage at least 2 days before it ends. Follow the instructions on the notice. Per Medicare.gov’s fast appeals page, you have until noon the day before the end date to ask your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) for a fast appeal. Medicare says the QIO decides by close of business the day after it has the information it needs. Services before the end date are not your responsibility.
For a denied claim under Original Medicare, the first level is a redetermination by your Medicare contractor. Use the date on your Medicare Summary Notice. The second level is reconsideration, requested within 180 days. The page is Appeals in Original Medicare.
In a Medicare Advantage plan, Level 1 is a plan reconsideration, filed within 65 days of the denial notice. A fast decision comes within 72 hours when waiting could seriously harm your health. See Appeals in Medicare health plans.
For free one-on-one help in New York, call the state’s SHIP, HIICAP, at 1-800-701-0501 (listed by SHIP).
When to combine Medicare with private or Medicaid help
Medicare is built for a time-limited medical need. After surgery or a hospital stay it can send a nurse and a therapist for a few weeks, which is the path in our post-surgery home care guide. If someone also needs daily help with bathing, meals or supervision, that goes beyond the benefit. Families then pay privately, use Medicaid home care if eligible, or combine them.
When Medicare is not enough: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
If you don’t know what you qualify for, start with what is on the table: insurance, income, benefits already received and the person’s care needs. First find out which programs fit.
Don’t wait for a hospital stay or a fall to start looking at Medicaid and home care programs. It is far easier to arrange safe care before things reach a crisis. NYC Aging, NY Connects and Medicaid specialists are good places to ask.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We can talk through which of your needs Medicare may cover and which need another solution. Call (718) 232-2777 or use our contact page.
Medicare rules and amounts change each year. Everything above was checked against medicare.gov, cms.gov, ecfr.gov and shiphelp.org on 9 October 2026. Confirm your own situation with your provider, your plan or 1-800-MEDICARE.
Frequently asked questions
Does Medicare cover home health care?
Yes, if you are homebound, need part-time or intermittent skilled care, and use a Medicare-certified agency under a provider’s plan of care. Covered services cost you nothing.
How long will Medicare pay for home health care?
For as long as you keep qualifying. Care is certified in 60-day periods, and the manual says Medicare does not limit the number of continuous recertifications.
How much does Medicare pay for home health care per hour?
It does not pay per hour. CMS pays the agency a standardized rate per 30-day period, or per visit when there are few visits.
Can Medicare pay for a caregiver?
Medicare pays a certified agency for skilled care, plus an aide only while you also get nursing or therapy. It does not cover custodial care alone or 24-hour care at home.
Will Medicare pay for home health care for dementia patients?
Yes, if the person is homebound and needs skilled nursing or therapy. Supervision and help with daily activities by themselves are not covered.
Do I need a doctor’s referral for Medicare home health?
Yes. A doctor or other provider such as a nurse practitioner must see you in person, confirm you need home health and order the care.
Is Medicare Advantage different from Original Medicare for home health?
Plans must cover the same Part A and Part B services, including home health, but the plan runs approvals and networks. Appeals start with the plan.
