6 min read ยท Last updated August 5, 2026
- Medicare home health covers part-time skilled nursing, physical therapy, occupational therapy, and speech therapy, plus a home health aide only when a skilled service is also happening.
- To qualify, your parent must be “homebound,” a specific two-part legal test, and need one of those skilled services, not just help with daily tasks.
- Medicare does not cover 24-hour care, homemaker services, or custodial help with bathing and dressing when that is the only care needed.
- Private custodial home care runs a national median of $35 an hour, about $80,080 a year at 44 hours a week, a cost Medicare’s home health benefit was never designed to cover.
In this article
- The gap between the care plan and what your family can staff
- What to check in the first days after discharge
- What the benefit actually covers, and what it does not
- The two tests that gate every visit
- The mistakes that end the benefit early
- What to line up at 30, 60, and 90 days
- FAQ
David’s 79-year-old mother was discharged home on a Friday with a care plan built around three nursing visits a week, while the actual gap in her day was the other 165 hours nobody in the family could cover.
The gap between the care plan and what your family can staff
A hospital discharge planner’s job is to confirm the medical plan is safe, not to solve who sits with your mother while you are at work. Medicare’s home health benefit pays for part-time or intermittent skilled visits, meaning a nurse or therapist comes for a scheduled visit and leaves. It was never designed to replace a person in the house.
That distinction matters because the benefit is real and worth using correctly, but it will not close the staffing gap by itself. Knowing exactly what it covers, so you are not blindsided when it stops, is the first step to planning around it.
What to check in the first days after discharge
Get the plan of care in writing. It lists which services were ordered, how often, and for how long. Ask the home health agency for a copy the same week care starts.
Confirm the homebound determination was documented. This is the legal test that qualifies your parent for the benefit at all (see below). If it was never clearly documented, the claim can be denied later.
Ask what happens when the skilled visits stop. Aide hours only continue alongside a skilled nursing or therapy visit. The moment those stop, so does the aide time, even if your parent still needs help.
What the benefit actually covers, and what it does not
| Medicare home health covers | Medicare home health does not cover |
|---|---|
| Part-time or intermittent skilled nursing care | 24-hour-a-day care in the home |
| Physical, occupational, and speech-language therapy | Homemaker services like shopping and cleaning, unrelated to the care plan |
| Home health aide help, only alongside a skilled visit | Custodial or personal care (bathing, dressing) as the only service needed |
| Medical social services and durable medical equipment | Home meal delivery |
The aide-hours cap, even when a skilled visit is happening, tops out under 8 hours a day and 28 hours a week in most cases (Medicare.gov; 42 CFR 409.44). That ceiling is the reason a family that needs someone present most of the day cannot solve it through this benefit alone.
The two tests that gate every visit
Homebound. Medicare’s rule requires two things to be true at once: your parent needs help, a device, or special transportation to leave home, or leaving is medically inadvisable, and leaving home takes considerable and taxing effort, so it happens rarely. Trips to a doctor, dialysis, or adult day care do not disqualify someone; those absences are treated as expected.
Skilled need. A service only counts as “skilled” if it genuinely requires a licensed nurse or therapist. If a task, like reminding someone to take a pill, could safely be done by an average person with no training, Medicare does not count it as a skilled service, no matter who performs it.
There is also a face-to-face encounter requirement, added by the Affordable Care Act in 2010: a physician or other approved practitioner must have seen the patient in person or by telehealth within 90 days before home health starts, or within 30 days after, and must document that the visit supports both tests above (42 CFR 424.22).
Certification runs in 60-day periods, and a doctor has to recertify that your parent still qualifies at least every 60 days for care to continue (42 CFR 424.22(b)). If your parent goes a full 60-day period without at least one skilled visit, the plan of care ends on its own, whether or not anyone intended that.
The mistakes that end the benefit early
Assuming family help disqualifies the case. It does not. Medicare presumes there is no one able and willing to provide the care unless your family says otherwise. Having relatives nearby does not, by itself, cut off the benefit.
Letting skilled visits lapse without asking why. If nursing or therapy visits stop before your parent has actually recovered, ask the agency directly whether the case is being closed and why. A 60-day gap with no skilled visit ends the plan of care automatically.
Waiting until the benefit ends to look at custodial care options. Medicaid’s Home and Community Based Services (HCBS) programs, which help pay for non-medical, custodial care so seniors can stay home, vary by state and often have waiting lists. Start that research the same week home health begins, not the week it ends.
What to line up at 30, 60, and 90 days
By day 30: Plan of care confirmed in writing, homebound status documented, and a clear answer on how many aide hours, if any, are included.
By day 60: Recertification decision made by the physician. If skilled visits are tapering off, start the conversation about what replaces them.
By day 90: If ongoing custodial help is needed and Medicare will not cover it, an application started with your state’s Medicaid HCBS waiver program, or a private-pay plan budgeted at the going market rate, a national median of $35 an hour for non-medical caregiver services (CareScout 2025 Cost of Care Survey).
If your parent was just hospitalized, start with the first 72 hours after a parent is hospitalized. If a nursing home placement is also on the table, see Medicare’s 3-day inpatient rule before a nursing home stay. And if the hospital sets a discharge date before home health is actually ready to start, a free, fast Medicare appeal can pause that date while an independent reviewer decides.
Frequently asked questions
What does homebound actually mean for Medicare? It means leaving home requires considerable effort, often with a device, special transportation, or help from another person, and that it happens rarely. Trips for medical care, like dialysis or a doctor visit, do not count against this and will not disqualify your parent.
Will Medicare pay for a home health aide to help my parent bathe and dress? Only if a skilled nursing or therapy visit is also happening in that same period. Medicare does not cover custodial help like bathing or dressing as the only service, and aide hours end the moment skilled visits stop.
How long does the home health benefit last before we need to requalify? A doctor must recertify eligibility at least every 60 days. If your parent goes a full 60-day period without at least one skilled nursing or therapy visit, the plan of care ends automatically.
What is the face-to-face encounter requirement? A physician or approved practitioner must have examined your parent, in person or by telehealth, within 90 days before home health starts or 30 days after, and must document that the visit supports the need for skilled care.
What if we need more hours than Medicare will cover? Look into your state’s Medicaid Home and Community Based Services (HCBS) waiver program, which helps cover non-medical custodial care, or budget for private-pay help. Non-medical caregiver care runs a national median of $35 an hour.
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