Medicare & eligibility
Does Medicare cover in-home care? How Medicare pays for home health
Original Medicare covers home health care — skilled nursing, therapy and related services at home — when four conditions are met. Here is who qualifies, what is covered, what you pay and how long coverage lasts, based on Medicare’s own rules.
Eligibility
Who qualifies for home health care services?
Original Medicare covers home health care when all four of these are true.
- You are homeboundLeaving home is medically inadvisable or needs help — a person, a device or special transportation — and takes a considerable and taxing effort.
- You need intermittent skilled careSkilled nursing, physical therapy or speech-language pathology, or a continuing need for occupational therapy.
- A doctor or allowed practitioner orders itThey see you in person within 90 days before or 30 days after care starts, and establish and review your plan of care.
- A Medicare-certified agency provides itRinaldi Home Health Care is Medicare-certified (and Medi-Cal certified).
An allowed practitioner — a nurse practitioner, clinical nurse specialist or physician assistant — can certify eligibility, order home health services, and establish and review the plan of care, just like a physician.
CMS Medicare Benefit Policy Manual, Chapter 7With Original Medicare
$0
Your cost for covered home health services
Eligible patients pay nothing for covered home health visits. For medical equipment Medicare covers, you pay 20% of the Medicare-approved amount after the Part B deductible.
Coverage
What Medicare covers — and what it doesn’t
Medicare’s home health benefit is for skilled, part-time care that helps you recover or manage an illness at home.
Covered when you qualify
- Part-time or intermittent skilled nursing
- Physical therapy, occupational therapy and speech-language pathology
- Medical social services
- Part-time or intermittent home health aide care (with skilled care)
- Injectable osteoporosis drugs for women who qualify
- Durable medical equipment and medical supplies for use at home
Not covered
- 24-hour-a-day care at home
- Home meal delivery
- Homemaker services, like shopping and cleaning, unrelated to your care plan
- Custodial or personal care when it is the only care you need
Cost
How much does Medicare pay for home health care?
Medicare does not pay for home health by the hour. It pays the home health agency for each 30-day period of care, and with Original Medicare you pay $0 for covered home health services.
The one common cost is equipment: for durable medical equipment Medicare covers — a walker or hospital bed, for example — you pay 20% of the Medicare-approved amount after you meet the Part B deductible.
Sources: Medicare.gov — Home health services; CMS Medicare Benefit Policy Manual, Chapter 7 — Home Health Services
How long will Medicare pay for home health care?
There is no set limit. Medicare does not limit the number of continuous 60-day recertifications for people who remain eligible. If you still need care, your doctor or allowed practitioner recertifies your plan of care at least every 60 days.
Source: CMS Medicare Benefit Policy Manual, Chapter 7 — Home Health Services
Will Medicare pay for home health care for dementia patients?
Yes, when the same rules are met: the person is homebound, needs intermittent skilled care, and has a doctor’s order. Medicare does not cover custodial care or 24-hour supervision when that is the only care needed.
Other coverage
Medicare Advantage, Medi-Cal and private insurance
Rinaldi Home Health Care accepts Original Medicare and private and commercial insurance, and is Medi-Cal certified. If you have a Medicare Advantage plan, Medicare advises checking with your plan about its home health benefits.
Not sure what your plan covers? Call (818) 898-1100 to check whether your plan covers home health care with us.
Getting started
How to get home health care with Medicare
Four steps take you from a doctor’s visit to your first day of care at home.
Talk to your doctor
Ask whether you qualify for home health, and name the agency you would like to use.
In-person visit and order
Your doctor or an allowed practitioner sees you in person and orders home health under a plan of care.
The referral is sent
Your doctor’s office or hospital faxes the referral to Rinaldi at (818) 898-1145.
Care begins at home
A nurse or therapist makes your first visit — typically within 24–48 hours of the referral.
FAQ
Medicare home health: questions, answered
Does Medicare cover in-home care?
Medicare covers in-home health care — part-time skilled nursing, therapy and related services — when you are homebound, need intermittent skilled care, and a doctor or allowed practitioner orders it after seeing you in person. It does not cover 24-hour care or non-medical home care when that is the only care you need.
Who qualifies for home health care services?
Under Original Medicare you qualify when you are homebound; you need intermittent skilled nursing, physical therapy or speech-language pathology, or a continuing need for occupational therapy; a doctor or allowed practitioner sees you in person and orders home health under a plan of care; and a Medicare-certified agency provides the care.
How long will Medicare pay for home health care?
There is no set limit. Medicare does not limit the number of continuous 60-day recertifications for people who continue to be eligible; your doctor or allowed practitioner recertifies your plan of care at least every 60 days.
How much does Medicare pay for home health care per hour?
Medicare does not pay home health by the hour. It pays the home health agency for each 30-day period of care, and with Original Medicare you pay $0 for covered home health services. For Medicare-covered medical equipment you pay 20% of the Medicare-approved amount after the Part B deductible.
Does Medicare cover a home health aide?
Yes, part-time or intermittent home health aide care is covered when you are also receiving skilled nursing or therapy. Medicare does not cover personal care from an aide when it is the only care you need.
Will Medicare pay for home health care for dementia patients?
Yes, if the person meets the same rules as everyone else: homebound, in need of intermittent skilled care, and under a doctor’s order. Medicare does not cover custodial care or 24-hour supervision when that is the only care needed.
How many hours a day will Medicare pay for home health care?
Medicare covers part-time or intermittent care, not round-the-clock care. For skilled nursing, Medicare defines intermittent as care needed fewer than 7 days a week or less than 8 hours a day, for periods of 21 days or less, with limited extensions.
Do I need a referral for home health care?
Yes. A doctor or allowed practitioner — such as a nurse practitioner — must see you in person and order home health care. You can call a Medicare-certified agency like Rinaldi to ask about next steps, and the agency works from your doctor’s order.
Find out if you qualify for home health
Call (818) 898-1100 and we'll explain the next steps, including what your doctor needs to send. Physicians can fax referrals to (818) 898-1145.