More Home Care Is Covered by Medicare—But Only If You Meet These Rules

Key Takeaways

• Medicare covers more types of home health services in 2025, but strict eligibility rules still apply, especially regarding your health status and provider certification.

• You must be under the care of a doctor and considered “homebound” to qualify, and coverage generally does not extend to 24-hour or long-term custodial care.

What Counts as Medicare-Covered Home Care in 2025

Medicare does offer coverage for certain types of home care, but it’s important to understand that this doesn’t mean full-time, long-term care at home. Instead, Medicare home health benefits focus on short-term, medically necessary services that support recovery and improve health outcomes.

Covered Services May Include:

• Skilled nursing care (such as wound care or injections)

• Physical therapy

• Occupational therapy

• Speech-language pathology services

• Home health aide services (on a part-time or intermittent basis)

• Medical social services

• Durable medical equipment (such as walkers, wheelchairs)

To qualify, these services must be prescribed by a doctor and provided through a Medicare-certified home health agency.

The 2025 Eligibility Criteria You Must Meet

Medicare does not automatically provide home care to every beneficiary. The eligibility rules are detailed and enforced consistently across all states. Here’s what you must meet to qualify:

You must be under a doctor’s care

Your physician must create and regularly review a plan of care. This includes documentation of your medical condition, treatment goals, and the type of care you need.

You must be certified as homebound

This means that leaving your home is extremely difficult due to illness or injury. You can leave your home only occasionally and for short durations—for example, for a doctor’s appointment or religious service.

You must need skilled care

Medicare only covers home health services if you need skilled nursing care or therapy (physical, occupational, or speech-language) on a part-time or intermittent basis.

You must use a certified agency

The care must be provided through a Medicare-approved home health agency. Without this certification, your services won’t be covered.

What Medicare Doesn’t Cover for Home Care

Despite expanded definitions in 2025, there are still clear boundaries. Medicare does not function like long-term care insurance. Coverage is specific and time-limited.

Not Covered:

• 24-hour-a-day home care

• Meal delivery or homemaker services (unless incidental to personal care)

• Personal care services (like bathing, dressing, or toileting) if they’re the only care you need

• Custodial care, even if it’s in your home and ongoing

These limitations mean that many families still need to consider other options, like Medicaid, long-term care insurance, or paying out of pocket, for extensive in-home assistance.

Recertification and How Long Coverage Lasts

Medicare typically covers home health care in 60-day episodes. At the end of each episode, your doctor must recertify your need for continued services. There is no hard limit on the number of episodes you can receive, but each one must be medically necessary and meet all criteria.

In 2025, the following rules apply:

• Each home health certification lasts 60 days.

• A face-to-face meeting with your doctor must occur within 90 days before or 30 days after the start of services.

• You must continue to meet the eligibility requirements throughout the service period.

How to Start Home Health Services

If you believe you qualify, the first step is to talk to your doctor. The doctor will assess your needs and, if appropriate, refer you to a Medicare-certified home health agency.

Once the agency accepts the referral, they will:

• Confirm your eligibility

• Coordinate with your doctor to develop a care plan

• Provide care based on that plan and update it as needed

You do not need to be hospitalized before starting home health care. Many people transition into home care directly from a doctor’s office or outpatient clinic.

What You May Pay Out-of-Pocket

While Medicare Part A or Part B covers most home health services at no cost to you, there are some instances where you may have expenses:

• Durable medical equipment: You typically pay 20% of the Medicare-approved amount.

• Non-covered services: If your care includes services Medicare doesn’t cover, you’ll be responsible for the full cost unless you have other coverage.

• Late enrollment or coverage gaps: If you enrolled late in Part B or had a gap in coverage, penalties or delays may apply.

It’s always best to ask your provider which services are covered before care begins.

Expanded Access in Rural and Underserved Areas

In 2025, the Centers for Medicare & Medicaid Services (CMS) continues expanding programs that target underserved regions. This includes initiatives to:

• Increase the number of certified home health agencies in rural counties

• Support telehealth services for remote therapy sessions

• Reduce paperwork and reporting burdens to improve efficiency

However, access still varies by ZIP code, and the availability of services depends on local resources. If you live in a remote area, ask your doctor or agent about special programs that may apply to you.

Using Telehealth as Part of Home Health in 2025

Telehealth plays a growing role in home care. While Medicare does not count telehealth visits toward the “in-person” requirements for initial certification, it does cover them as part of your care plan once services begin.

Telehealth may include:

• Virtual check-ins with a nurse or therapist

• Remote patient monitoring (for blood pressure, glucose, etc.)

• Follow-up therapy sessions

These tools can enhance care, especially in between visits or in areas with limited in-person access. But they do not replace the requirement for hands-on care where clinically necessary.

Appeals and What to Do If You’re Denied

If Medicare denies your home health coverage, you have the right to appeal. This includes denials based on:

• Ineligibility determinations

• Coverage limits

• Disputes over what constitutes skilled care

You should receive a Medicare Summary Notice explaining the denial. Follow these steps:

1. Request a written explanation from your provider.

2. File an appeal within 120 days of the denial.

3. Include all supporting documentation from your doctor.

If you’re unsure how to start, a licensed agent listed on this website can help guide you through the appeals process.

Staying Informed About Changes to Home Care

CMS updates coverage guidelines annually. In 2025, some of the most notable changes involve:

• More flexibility for therapists to determine ongoing need

• Simplified forms for recertification

• Expanded definition of “homebound” to include more chronic conditions

However, these updates often vary in implementation. It’s wise to regularly review your Medicare & You handbook, speak with your doctor, and check for any official notices.

Understanding the Limits Before You Rely on Medicare Home Care

Medicare’s home health benefit provides important services, but it is not a substitute for long-term home care or personal care aides. Your plan must be medically necessary, coordinated with a doctor, and delivered by a certified agency.

If you’re considering home health care, contact a licensed agent listed on this website to review your eligibility, clarify coverage options, and get help finding an approved provider.