A parent is discharged from the hospital. The social worker hands you a list of home health agencies and tells you to “follow up with home care.” You have 24 hours, maybe 48. You do not know which agencies are good, which accept your parent's insurance, or what Medicare will actually pay for.
This guide covers exactly those questions, without the jargon.
The Medicare home health benefit: what it is
Medicare Part A and Part B both include a home health benefit. When all qualifying criteria are met, Medicare pays 100% of the cost of covered home health services — there is no deductible or copay for the services themselves. This is one of the most generous benefits in Medicare, and one of the most underused because families do not know it exists or do not know how to access it.
The benefit is not unlimited. It is structured around 60-day episodes of care, and it covers skilled services — not the custodial care that most families assume is included.
The four qualifying criteria
To qualify for Medicare home health coverage, all four of the following must be true:
- The patient must be homebound.Medicare's definition of homebound is specific: leaving home requires considerable effort, and absences are infrequent, short in duration, or for medical appointments. A patient who can drive to the grocery store regularly does not meet this standard — even if they recently had surgery.
- Skilled care must be medically necessary. A physician must certify that the patient needs at least one skilled service: skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy (when combined with one of the others). The need must be documented in the medical record.
- A physician must authorize the plan of care. A doctor, nurse practitioner, clinical nurse specialist, or physician assistant must establish a plan of care and re-certify it at the start of each 60-day episode.
- The agency must be Medicare-certified. Only agencies that have been certified by CMS can bill Medicare for home health services. WeCarely lists only Medicare-certified agencies.
What Medicare does cover
Within a qualifying episode, Medicare covers the following:
| Service | What it includes | Typical frequency |
|---|---|---|
| Skilled nursing | Wound care, medication management, injection training, IV therapy, monitoring of acute conditions | 1–5 visits/week |
| Physical therapy | Strength and mobility restoration, fall prevention, gait training, post-surgical rehabilitation | 2–5 visits/week |
| Occupational therapy | Relearning daily tasks (dressing, bathing, cooking), adaptive equipment training | 1–3 visits/week |
| Speech-language pathology | Swallowing assessment, speech rehabilitation, cognitive-communication therapy | 1–3 visits/week |
| Home health aide visits | Personal care (bathing, grooming) — only when skilled care is also ongoing | Up to daily, limited hours |
| Medical social work | Care planning, connecting to community resources, family counseling | As needed |
One important nuance: Medicare covers home health aide visits only as long as skilled nursing or therapy is also ongoing. Once the skilled service ends — when the nurse signs off the wound care, when therapy goals are met — the aide coverage ends with it.
What Medicare does not cover
This is where most families are blindsided. Medicare home health does not cover:
- 24-hour or live-in care. Home health aide visits are intermittent — typically a few hours per visit, not around-the-clock coverage.
- Custodial or companion care by itself. Help with cooking, cleaning, laundry, medication reminders, and companionship is not covered unless it accompanies a skilled service visit.
- Homemaker services. Grocery shopping, errands, and household management are not covered.
- Personal care when skilled care has ended.Once the physician's plan of care is complete, aide visits stop — even if the patient still needs help bathing and dressing.
The gap this creates is significant and commonly misunderstood: a patient may need help with personal care 7 days a week, but Medicare will only pay for it during the weeks when a nurse or therapist is also visiting. Families typically need to arrange private-pay or Medicaid-funded personal care to fill this gap.
The 60-day episode structure
Medicare home health care is structured in 60-day episodes. At the start of each episode, the agency conducts an OASIS assessment — a standardized evaluation of the patient's functional status — and the physician certifies the plan of care. At day 60, the episode ends. If the patient still meets the qualifying criteria, a new episode can begin with a new physician certification.
There is no fixed limit on the number of episodes. A patient who continues to need skilled care and meets the homebound criterion can remain on the benefit indefinitely — though in practice, Medicare auditors scrutinize long-running episodes, and agencies must document that ongoing care remains clinically justified.
What to do before hospital discharge
The discharge process is chaotic. Social workers are managing multiple cases simultaneously; the patient may not be thinking clearly; the family may be exhausted and overwhelmed. Here is a checklist of what to do before leaving the hospital:
- Ask the social worker whether your family member qualifies for Medicare home health. Do not assume. Ask explicitly. If the answer is yes, ask which agencies the hospital works with — and understand that you are not required to use one of those agencies. Medicare gives you the right to choose any Medicare-certified agency.
- Get the physician's signed order for home health before discharge. This is the document the home health agency needs to start services. Without it, there may be a gap of several days before care begins.
- Ask what skilled services are ordered. Nursing? Physical therapy? Occupational therapy? This tells you what to expect from the agency in terms of visit frequency and duration.
- Ask about discharge medications. New prescriptions after a hospital stay are common, and medication errors in the first two weeks at home are a major driver of readmission. Confirm that the home health agency will include medication reconciliation in the nursing assessment.
- Identify the custodial care gap before you need to fill it. If your family member will need more help than Medicare covers — likely — start planning now. The time to evaluate private-pay or Medicaid-funded personal care is before discharge, not two weeks later when the crisis is acute.
How to choose an agency during a discharge crunch
When you have 24 hours and a list of agency names, you cannot do a thorough evaluation. Focus on three things:
- CMS star rating. Agencies with 4 or 5 CMS quality stars have meaningfully better clinical outcomes on average. In a time- constrained choice, this is your best single signal. WeCarely displays CMS stars for every agency.
- Availability. An excellent agency that cannot start services for five days is not the right choice right now. Call and ask when they can begin.
- Language capability.If your family member is not a fluent English speaker, confirm immediately that the agency has aides and nurses who speak their language. Do not accept “we have some bilingual staff.” Ask who specifically would be assigned.
After the Medicare benefit ends: what comes next
When the physician determines that the patient no longer needs skilled care — or when the patient no longer meets the homebound definition — Medicare home health ends. Families are then responsible for arranging any ongoing personal care privately.
Options at this stage include:
- Private-pay home care through the same or a different agency, billed at standard rates ($30–$50/hour depending on location)
- Medicaid-funded personal care for those who qualify — income and asset limits apply, and wait times vary by state and program
- Adult day health programs, which provide structured daytime programming and are significantly less expensive than in-home aides
- Family caregiving, potentially compensated through Medicaid waiver programs in some states
Find a Medicare-certified agency near you
The following links take you directly to ranked listings of Medicare- certified agencies in major cities. Every agency on WeCarely has been filtered to include only CMS-certified providers.