Does Medicare Cover Home Health Care? A Complete Guide for Boca Raton, Delray Beach & Boynton Beach Families
What counts as Medicare home health care?
Medicare home health care is short-term, medically necessary care delivered in your home. It’s meant to help you recover from an illness, injury, or surgery, or to manage a chronic condition, while staying out of a hospital or skilled nursing facility.
It includes services like:
- Skilled nursing care
- Physical, occupational, and speech-language therapy
- Home health aide support (only when paired with skilled care)
- Medical social services
- Certain medical supplies and durable medical equipment (DME)
This is different from non-medical home care, sometimes called custodial care or companion care, which covers help with bathing, dressing, meal prep, and daily supervision. Medicare doesn’t pay for that kind of support on its own.
Why doesn’t Medicare cover non-medical home care? Medicare’s home health benefit was built as medical insurance for a skilled, time-limited recovery need, not as an ongoing personal care program. It exists to help you get back to a stable baseline after an illness, injury, or surgery, through nursing and therapy tied to a doctor’s plan of care. Custodial, long-term support falls outside that design by definition. That’s also why a home health aide is only covered when paired with skilled nursing or therapy: Medicare treats personal care as a supplement to medical treatment, never as the standalone reason for coverage. Ongoing custodial care is instead the role Medicaid plays, through programs like Florida’s Medicaid Waiver, which is why families often need private pay or long-term care insurance to bridge the gap Medicare leaves open.
If you’re weighing the difference between the two, our guide on private pay home care breaks down how families typically cover that gap.
Do I qualify for Medicare home health coverage?
Medicare uses a four-part test. You need to meet all four, not just some of them, for coverage to apply.
- You’re under a doctor’s care with a plan of care. A physician or authorized provider must see you, certify your need for home health care, and set up a plan of care that’s reviewed and recertified regularly, typically every 60 days.
- You need skilled, intermittent care. This means part-time skilled nursing care, or physical, occupational, or speech-language therapy. “Intermittent” generally means care isn’t needed around the clock. Occupational therapy can continue an existing episode of care, but it can’t be the sole reason home health starts.
- You’re homebound. More on exactly what this means below, since it’s the part that trips up most families.
- Your care comes from a Medicare-certified home health agency. This is where certification matters. Using an agency that isn’t Medicare-certified means Medicare won’t pay, regardless of how qualified the caregivers are. City Choice is Medicare-certified, so this requirement is already handled when you work with us.
What does “homebound” actually mean?
This is the single biggest point of confusion we hear from families, so it’s worth stating clearly: homebound does not mean bedridden, and it does not mean you can never leave your house.
Medicare considers you homebound if leaving your home takes a considerable and taxing effort, and you typically need help from another person or a mobility device like a walker or wheelchair to do it, or your doctor believes your condition could get worse if you leave. Your doctor makes this determination as part of certifying your plan of care.
Here’s what doesn’t break your homebound status:
- Going to medical appointments
- Attending religious services
- Going to a licensed adult day care center
- Short, infrequent outings for non-medical events, like a family gathering, funeral, or graduation
In other words, an occasional outing with help doesn’t disqualify you. The rule is about your general condition and how difficult regular movement is for you, not about being confined to a bed or a single room.
Does Medicare Part A or Part B pay for home health care?
Home health care can be covered under either Part A or Part B, depending on your situation, and the difference comes down to what happened right before care started.
Part B is the default entry point for most people. Under Part B, you can qualify for home health care simply by being homebound and needing skilled care. There’s no requirement that you were hospitalized first.
Part A applies in a more specific case: after a hospital stay of at least three consecutive days, or a covered stay in a skilled nursing facility. In that situation, Part A covers your first 100 days of home health care, as long as you also meet the other three eligibility requirements and start home health services within 14 days of your discharge.
For most ongoing home health needs that aren’t tied to a recent hospitalization, Part B is what applies.
A quick primer: What are Medicare Parts A, B, C, and D?
If you’re newer to Medicare, here’s the short version of how the whole program breaks down, since it helps to see where home health fits into the bigger picture.
- Part A covers hospital care, and some home health and hospice care.
- Part B covers doctor visits, outpatient care, and most home health services.
- Part C, also called Medicare Advantage, is an alternative to Original Medicare offered by private insurers. It bundles Part A and Part B, and usually Part D, into one plan.
- Part D covers prescription drugs.
Together, Part A and Part B make up what’s called Original Medicare. If you have a Medicare Advantage plan instead, your home health coverage rules can differ. Some Medicare Advantage plans require you to use an in-network agency and may involve copayments where Original Medicare wouldn’t. It’s worth checking your specific plan’s rules, or asking your agency to verify on your behalf, before care begins. For the full picture of how Medicare works, Medicare.gov is the official government resource.
What does Medicare home health cover — and what doesn't it cover?
Once you meet the eligibility requirements, here’s what’s actually included.
Covered:
- Part-time or intermittent skilled nursing care
- Physical therapy
- Occupational therapy
- Speech-language pathology services
- Home health aide services, but only when you’re also receiving skilled nursing or therapy
- Medical social services
- Certain medical supplies and durable medical equipment
Not covered:
- 24-hour care at home
- Meal delivery
- Homemaker services like general housekeeping
- Custodial or personal care, when that’s the only type of care you need
That last point is worth repeating, because it’s where a lot of families get caught off guard. If your loved one just needs help with bathing, dressing, or supervision, and there’s no skilled nursing or therapy need alongside it, Medicare’s home health benefit doesn’t apply. That’s a private-pay or long-term care insurance situation instead.
What will Medicare home health care cost me?
For most people, covered home health services under Original Medicare cost $0. There’s typically no deductible or coinsurance for the skilled care itself.
The one exception is durable medical equipment. If your plan of care includes DME, like a walker, wheelchair, or hospital bed, you’ll generally pay 20% of the Medicare-approved amount after your Part B deductible.
If you have a Medicare Advantage plan instead of Original Medicare, your costs may look different. Some plans include copayments for home health services or require prior authorization, so it’s worth confirming your specific plan’s terms.
How many hours of home health care can I get through Medicare?
Medicare home health isn’t designed to replace full-time or live-in care. In most cases, combined nursing and home health aide services are limited to up to 8 hours a day, capped at 28 hours per week. In some situations where your doctor determines it’s medically necessary, that can be extended to up to 35 hours per week for a limited time. Therapy visits are calculated separately and aren’t included in that hour cap.
There’s no lifetime limit on how long you can receive Medicare home health benefits, as long as you continue to meet the eligibility requirements and your doctor recertifies your plan of care.
Medicare vs. private-pay home care in Boca Raton, Delray Beach & Boynton Beach
This is where a lot of local families land, and it’s worth spelling out clearly: the homebound requirement only applies to Medicare-covered home health. It has nothing to do with private-pay in-home care.
Many families in Boca Raton, Delray Beach, and Boynton Beach start looking into home support well before a loved one would ever meet Medicare’s homebound standard. An aging parent who needs help a few days a week with meals, medication reminders, or getting to appointments doesn’t need to qualify as homebound to receive that support. That kind of care is simply private-pay, and it’s flexible in a way Medicare’s benefit isn’t, since there’s no doctor certification, no skilled-care requirement, and no hour cap tied to it.
It’s common for a family’s situation to shift between the two. Someone might start with a few hours of private-pay support after a fall, then later qualify for Medicare-covered skilled nursing following surgery or a hospital stay. Understanding both options ahead of time means you’re not scrambling to figure out coverage during a stressful moment. If you want more detail on how private pay works day to day, our Ways to Pay overview covers all the payment paths we support, including insurance, long-term care insurance, veteran benefits, and workers’ compensation.
How do I find out if I qualify for Medicare home health coverage?
The fastest way to get a clear answer is to talk to someone who can walk through your specific situation. We built a free Medicare Insurance Coverage Checker to help families in Boca Raton, Delray Beach, and Boynton Beach get a preliminary read on where they stand before making any decisions.
From there, our intake team can help confirm eligibility, coordinate with your physician on the plan of care, and get services started quickly if you qualify. Because City Choice is Medicare-certified, that piece of the eligibility puzzle is already taken care of on our end.
Common questions about Medicare and home health care
Straight answers to what families ask us most. Don’t see yours? Call 305-363-7755 and ask.
No. Under Part B, you can qualify for home health care without ever being hospitalized, as long as you’re homebound and need skilled care. A prior hospital stay only matters if you’re seeking coverage under Part A specifically, which applies for the first 100 days following a qualifying 3-day inpatient stay or a covered skilled nursing facility stay.
Not on its own. Medicare only covers a home health aide when you’re also receiving skilled nursing care or therapy. If daily living support, like bathing or dressing, is the only help you need, that falls under private-pay or long-term care insurance instead.
There’s no set lifetime limit. Coverage continues as long as you keep meeting all four eligibility requirements and your doctor recertifies your plan of care roughly every 60 days. If your condition improves to the point where skilled care is no longer medically necessary, coverage typically ends at that point.
Medicare Advantage plans are required to cover the same home health benefits as Original Medicare, but the process can look different. You may need to use an in-network agency, get prior authorization, or pay a copayment depending on your specific plan. It’s worth confirming these details with your plan provider or asking your home health agency to verify on your behalf.
This comes up often, especially for families managing a chronic condition or a slow recovery. If your needs exceed what Medicare covers, whether that’s more hours per week or ongoing custodial support, private pay, long-term care insurance, or a combination of both typically fills that gap. Our team can help you understand what a blended coverage plan might look like for your specific situation.
We're here to help you navigate Medicare home health coverage
Medicare’s home health rules exist for a reason, but they’re not always intuitive, especially when you’re trying to figure them out while also caring for a parent or spouse. City Choice has been guiding Boca Raton, Delray Beach, and Boynton Beach families through exactly this process, and we’re glad to do the same for you.
If you’re not sure whether your situation qualifies, don’t guess. Call our intake team at 305-363-7755 or reach out through our free consultation page, and we’ll help you figure out your next step.