Medicare home health after a hospital stay — overview
Original Medicare (Part A and Part B) covers home health care under specific conditions. Most patients access this benefit after a hospital stay or skilled-nursing-facility stay, when they are recovering at home and need short-term skilled clinical care.
Despite the popular name "Medicare home care," the program is highly specific. Medicare home health is short-term, skilled, and intermittent — it is not designed to provide ongoing personal-care help with bathing, dressing, or housekeeping over months or years. Understanding what it covers (and what it does not) prevents the most common Medicare disappointment families face.
Who qualifies for Medicare home health
To qualify, all of the following must be true:
- You are under the care of a doctor who establishes and reviews your plan of care.
- You are certified as homebound. Leaving home requires considerable effort, and you do so only infrequently — for medical appointments, religious services, family events, or short outings of limited duration.
- You need skilled nursing care on an intermittent basis, or skilled physical therapy, speech-language pathology, or continued occupational therapy services.
- You receive services from a Medicare-certified home health agency.
- The services are reasonable and necessary for the treatment of your illness or injury.
What Medicare home health covers
If you qualify, Medicare pays 100% of the cost (no copay, no deductible) for these services:
- Part-time or intermittent skilled nursing care.
- Physical, occupational, and speech-language therapy.
- Medical social services.
- Part-time or intermittent home health aide services (only if you are also receiving skilled care like nursing or therapy).
- Medical supplies for home health care.
- Durable medical equipment (DME) like wheelchairs and walkers — paid at 80%, with you or your supplemental insurance covering the remaining 20%.
- Injectable osteoporosis drugs.
What Medicare home health does NOT cover
- 24-hour-a-day care at home. Medicare home health is intermittent (less than 8 hours/day, less than 28 hours/week, with possible short-term increases).
- Meal delivery.
- Homemaker services like cleaning, laundry, or grocery shopping.
- Custodial or personal care when this is the only care needed (i.e., bathing, dressing, toileting, eating).
- Care from an agency that is not Medicare-certified.
How long Medicare home health lasts
Coverage is structured in 60-day episodes. At the end of each 60-day episode, the home health agency reassesses you and, if you still meet the criteria, can recertify you for another 60 days. There is no maximum number of episodes — coverage continues as long as you remain eligible.
In practice, most post-hospital home health courses last 4 to 8 weeks. Patients with chronic conditions like CHF, COPD, or diabetes can sometimes remain on home health for longer when episodic decompensation requires ongoing skilled monitoring.
How home health is set up after hospital discharge
- Hospital discharge planner involves you. Before you leave the hospital, the discharge planner identifies that you will need home health and asks if you have a preferred agency.
- You choose the agency. Medicare law gives you the right to choose any Medicare-certified home health agency that serves your area, regardless of what the hospital's preferred provider is.
- The hospital faxes orders to your chosen agency.
- Agency calls you within 48 hours to schedule the first visit.
- First visit happens within 48 hours of discharge, ideally the same day.
- Plan of care is established. The home health nurse develops a plan with you, your doctor signs off, and services begin.
How to choose a Medicare home health agency
Quality varies dramatically. CMS publishes star ratings on Care Compare; choose only agencies rated 3.5 stars or higher unless local options are very limited.
- Quality of patient care star rating (1–5 stars).
- Patient survey star rating (1–5 stars).
- Improvement and stability outcomes — how patients did after care ended.
- Use of acute-care hospitalization measure — lower is better; readmissions are bad outcomes.
- Years in business and ownership stability.
- Therapy services available in your area — not all agencies offer all therapy types in all locations.
Common Medicare home health appeals
If your home health is being terminated and you disagree, you have appeal rights. Common scenarios:
- You receive a Notice of Medicare Non-Coverage (NOMNC). File an expedited Quality Improvement Organization (QIO) appeal within 24 hours by calling the QIO listed on the notice. The agency must continue services until the QIO decides.
- The agency tells you you are no longer homebound. Document any difficulty leaving home — falls, exhaustion, dyspnea, dizziness, anxiety, or assistance required. Provide this documentation to the agency and your physician.
- The agency says you no longer need skilled care. If you have ongoing wound care, IV medications, complex diabetes management, ostomy care, or unstable chronic illness, document the need with your doctor.