Medicare 2026

Medicare and Home Health Care: Who Qualifies and What's Covered

If you or someone you love is recovering from an illness, surgery, or managing a condition that makes leaving the house difficult, home health care can be a lifeline. Medicare does cover home health services in many situations — but the rules are specific, and it helps to understand them before care begins. Here's a plain-English look at who qualifies, what's included, and what isn't.

Who qualifies for Medicare home health care

To receive home health benefits through Medicare, you need to meet several conditions at the same time:

1. You are homebound. This means leaving home takes considerable and taxing effort. You can still leave for medical appointments, religious services, family events, or short, infrequent outings — being homebound doesn't mean never stepping outside. 2. You are under a doctor's care with a plan of care. A doctor (or certain other allowed providers) must certify that you need home health services and must regularly review a written plan of care created for you. 3. You need intermittent skilled care. That means skilled nursing care, physical therapy, speech-language pathology, or continued occupational therapy — on a part-time or intermittent basis, not around the clock. 4. The care comes from a Medicare-certified home health agency. Not every agency qualifies. Before services start, ask whether the agency is Medicare-certified; if it is not, Medicare will not pay.

If you meet all of these conditions, Medicare's home health benefit can be available to you.

What home health care covers

Covered services under the home health benefit can include:

• Skilled nursing care on a part-time or intermittent basis — things like wound care, injections, IV therapy, patient and caregiver education, and monitoring of a serious illness.
• Physical therapy, speech-language pathology, and occupational therapy when ordered as part of your plan of care.
• Home health aide services on a part-time or intermittent basis — but only when you are also receiving skilled care. Aide services can include help with bathing or dressing in that context.
• Medical social services to help with social and emotional concerns tied to your illness, such as counseling or help finding community resources.
• Certain medical supplies for use at home, like wound dressings, when ordered by your provider as part of your care.

Here's the good news on cost: there is no charge to you for covered home health services. You don't pay a copay or coinsurance for the nursing visit, the therapy session, or the aide's covered time with you.

Durable medical equipment (DME) — such as a walker, wheelchair, or hospital bed — ordered along with your home health care is handled a bit differently. DME is covered under Medicare Part B, and you generally pay 20 percent of the Medicare-approved amount after you've met the Part B deductible.

What home health care does not cover

Medicare's home health benefit is designed for intermittent skilled care, not for continuous custodial support. That means the following are not covered:

• 24-hour-a-day care at home. If you need around-the-clock help, that falls outside the home health benefit.
• Meal delivery to your home.
• Homemaker services — such as shopping, cleaning, and laundry — when that is the only kind of help you need.
• Custodial or personal care (like help with bathing, dressing, or using the bathroom) when it is the only care you need. These services are only covered when you also need skilled care.

For people who need long-term personal or custodial care, families often turn to other options such as long-term care insurance, Medicaid (which has its own eligibility rules), or out-of-pocket arrangements. Medicare.gov has information on these alternatives.

A note on how you receive your Medicare

People get Medicare in different ways. Some stay with Original Medicare (Parts A and B) and may add a stand-alone Part D drug plan and/or a Medigap policy to help with cost-sharing. Others choose a Medicare Advantage plan, which bundles Part A, Part B, and usually Part D through a private insurer and often uses provider networks.

Both paths cover the home health benefit, but the way you access care — including whether a specific agency is in network, and how authorizations work — can differ. Neither approach is universally better; each has trade-offs around choice of providers, out-of-pocket costs, and extra benefits. It's worth reviewing your situation each year.

Enrollment windows worth knowing

If you want to review or change your Medicare coverage, the main annual window — Open Enrollment — runs October 15 through December 7, 2026, with any changes taking effect January 1, 2027.

If you have Medicaid or Extra Help (the Part D Low-Income Subsidy), you have a monthly Special Enrollment Period that lets you move to Original Medicare with a stand-alone Part D plan, or switch stand-alone Part D plans. If you are a full-benefit dual-eligible (Medicare and full Medicaid), you can also join an integrated Dual Eligible Special Needs Plan (D-SNP) in any month.

A few program figures to keep in mind

• The Part D out-of-pocket cap for 2027 is $2,400 (it is $2,100 in 2026).
• The maximum Part D deductible any plan may charge in 2027 is $700.
• The Part D base beneficiary premium for 2027 is $41.33 — a national figure used in the late-enrollment penalty calculation; actual plan premiums are set plan by plan.
• The Social Security Administration announced on October 14, 2026 a 3.6 percent cost-of-living adjustment (COLA) for benefits beginning January 2027.
• The 2027 Part B standard premium and deductible, and the 2027 IRMAA income brackets, had not been announced at the time of writing. CMS typically announces them in the fall. Check Medicare.gov for the latest.

Where to go next

For official, up-to-date details on home health coverage, eligibility rules, and finding a Medicare-certified home health agency, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Getting clear on the rules now can save stress later — and help make sure the care you or your family member needs is covered the way you expect.