Understood Care
If you are asking how home care works or whether Medicare pays for it, you are not alone. In our video, Amanda at Understood Care explains the practical steps. If you need dressing changes, help organizing and understanding medicines, or therapy at home, your clinician can write an order to start home health. A Medicare certified home health agency then provides your care and bills Medicare. There are a few important rules, including having a qualifying skilled need and meeting homebound criteria. This article translates the rules into clear steps, shows what is covered, and points you to resources that make care at home safer and easier.
You will also find direct help from Understood Care when you need mobility equipment, safer home setups, transportation to appointments, or a dedicated advocate to coordinate the details
Home care is a broad term. It can include non medical help with bathing, dressing, meals, and light housekeeping. Home health care is medical care delivered at home by licensed clinicians and therapists under a care plan. Medicare covers home health care when you qualify. Medicare does not pay for ongoing non medical companion services when that is the only help you need.
Amanda’s message reflects what many of you experience. If you need wound dressing changes, teaching and setup for medications, or therapy such as physical therapy or occupational therapy, your primary care clinician can order home health. A nurse practitioner or physician assistant can be involved too. The agency comes to you and bills Medicare when the requirements are met. Most agencies also ask that you meet homebound criteria. Brief trips out of the house for medical care are expected, and short infrequent nonmedical absences like attending religious services are compatible with homebound status. Check details with your clinician and agency.
To qualify you need all of the following
Medicare defines homebound to mean that you have trouble leaving home without help because of illness or injury, that leaving is not recommended, or that leaving takes major effort. You may leave home for medical treatment or for short infrequent nonmedical reasons such as attending religious services.
Before certifying home health, a clinician must see you face to face. By rule, the encounter must occur within the 90 days before or the 30 days after home health starts and must document why you are homebound and need skilled services.
Medicare covers these home health services when you qualify
In most cases part time or intermittent means up to eight hours per day combined nursing and aide services for a maximum of 28 hours per week, with limited situations up to 35 hours per week when your clinician decides it is necessary.
The Medicare Home Health booklet describes how agencies work with you and your clinician to create and review the plan of care, what skilled therapy requires, and how aide and social work services are added when you are already receiving skilled care.
Medicare does not cover
These limits are important when planning. If you only need help with daily activities, you can look for community and family supports, local programs, and long term care options.
You pay zero for covered home health services. After you meet the Part B deductible, you pay twenty percent of the Medicare approved amount for covered durable medical equipment such as a walker or wheelchair. Agencies must tell you in writing if Medicare is unlikely to pay for an item or service and should give you an Advance Beneficiary Notice before providing it.
For mobility equipment support and safe setup at home, our team can help you understand options and coverage
https://understoodcare.com/care-types/mobility-equipment
If transportation to medical visits is a barrier, see
https://understoodcare.com/transportation-help
Home health agencies follow core infection prevention practices and teach patients and caregivers how to protect themselves. Wash hands before and after care, clean and store supplies as taught, and follow instructions for wound care and catheters.
During Medicare home health, clinicians often train family caregivers to support safe care between visits. Research shows caregiver instruction helps with discharge timing and reduces risks when combined with clear communication and written plans.
Therapy at home builds strength and balance so you can move more safely. Ask about simple home exercises and environmental adjustments. For practical home safety ideas, visit
https://understoodcare.com/healthcare-info/home-safety-and-accessibility
Our advocates can
Start here to meet with an advocate
https://app.understoodcare.com/
Learn about advocate support
https://understoodcare.com/healthcare-info/what-are-healthcare-advocates
Home health is medical care delivered at home by licensed clinicians and therapists under a care plan when you meet Medicare rules. Non medical home care is help with daily activities and companionship. Medicare covers home health when you qualify. Medicare does not pay for ongoing companion or housekeeping services when those are the only services you need.
No. Medicare allows you to leave home for medical treatment and for short infrequent nonmedical absences such as attending religious services. You must still meet the overall standard that leaving home requires considerable effort or is not recommended.
Home health services are part time or intermittent. In most cases that means up to eight hours a day with a weekly total of twenty eight hours for nursing and aide services combined, with short term increases up to thirty five hours when your clinician decides it is necessary.
A clinician must order your care and complete a face to face encounter around the start of care. The visit must occur within the ninety days before or thirty days after home health starts and must document why you are homebound and need skilled services.
You pay zero for covered home health services. After the Part B deductible, you pay twenty percent of the Medicare approved amount for covered durable medical equipment such as walkers and wheelchairs.
Medicare covers home health aide services only when you are also receiving skilled nursing or therapy from the agency at the same time. If you only need help with daily activities, look into community programs and long term care options in your area.
Yes. When you qualify, the plan of care can include skilled nursing and one or more therapy disciplines based on your needs. The agency coordinates services with your clinician.
Medicare Advantage must cover at least what Original Medicare covers but plans can have network and authorization rules. Check your plan details and ask the agency to verify coverage before care starts.
Durable medical equipment is paid separately from the home health visit cost structure. You usually owe twenty percent of the Medicare approved amount after the Part B deductible. Your clinician must order the equipment, and the agency can help coordinate delivery.
You have rights during home health, including the ability to choose an agency and to speak up about quality concerns. Ask your clinician for help if you need to change.
This content is educational and is not a substitute for medical advice. Always consult your healthcare provider for personalized care.
We know navigating Medicare and care needs can feel lonely, but you don’t have to do it alone.
Our caring team takes care of the paperwork, claims, and home care so you’re always supported.
