Understanding Medicare Coverage for Home Health Services
Medicare can cover skilled nursing, therapy, and home health aide visits at home, but the rules are specific. Here's what families in Washington need to know.
One of the most common questions families ask is whether home health care is covered by insurance. The answer depends on the type of care needed, the patient's eligibility, and the specific benefits of their plan. Understanding the basics can help you plan confidently and avoid surprise costs.
What Medicare Part A and Part B cover
Original Medicare (Parts A and B) can cover medically necessary, intermittent skilled care in the home when specific conditions are met. This is not round-the-clock care, and it is not long-term custodial care. It is short-term, skilled care ordered by a doctor.
- Skilled nursing care on a part-time or intermittent basis
- Physical therapy, occupational therapy, and speech-language pathology
- Medical social services
- A home health aide for personal care on a part-time basis, when paired with skilled care
- Certain medical supplies and durable medical equipment
Eligibility requirements
For Medicare to cover home health services, several conditions must be satisfied. Your loved one must be under the care of a doctor, must be homebound, and must need skilled care that a doctor certifies in a written plan.
- A doctor must establish and review a plan of care
- The patient must be certified as homebound, meaning leaving home requires considerable effort
- The care must be provided by a Medicare-certified home health agency
- Services must be intermittent, meaning part-time or occasional
Homebound does not mean bedridden. A patient can still leave home for medical appointments, religious services, or occasional outings and qualify for home health benefits.
What Medicare typically does not cover
It is just as important to understand the limits. Long-term custodial care, help with bathing and dressing when no skilled care is needed, and 24-hour in-home care are generally not covered by Medicare. These services may be covered by Medicaid, long-term care insurance, or paid privately.
How to verify your benefits
Every situation is different, and benefit rules change. The safest approach is to verify coverage before care begins. During a free consultation, our team reviews your loved one's insurance, explains what is covered and what may be out-of-pocket, and helps coordinate the physician orders required to start care.
Medically reviewed by a Blooming Beacon Registered Nurse (RN)
Last reviewed September 12, 2026. This article is for general education and is not a substitute for medical advice. For care specific to your loved one, call (253) 348-6004.
Blooming Beacon Care Team
The Blooming Beacon Care Team includes registered nurses, licensed practical nurses, and certified caregivers dedicated to helping families navigate home health care with confidence and compassion. Every article is written to be practical, honest, and grounded in the real needs of families across Pierce and South King County.