What can Medicare cover—and what could you owe?
For eligible patients, Original Medicare generally covers ordered home health without a home health copayment. Start with five facts.
1. The patient needs skilled, intermittent care.
Covered home health may include nursing, physical therapy, occupational therapy, medical social work, or aide care within a skilled plan. It is not round-the-clock companion care.
2. “Homebound” does not mean trapped at home.
It generally means leaving requires help, equipment, or a major effort—or is not advised because of the patient's condition. Short or infrequent trips do not automatically disqualify someone.
3. A qualified provider must order the care.
The provider documents the need, establishes the plan, and completes the required related face-to-face encounter.
4. The patient can choose the agency.
Medicare does not require the patient to use the first agency on a discharge list. Coverage rules stay the same across Medicare-certified agencies. Compare who serves the address, can provide the ordered care, can accept the referral, and fits the recovery.
5. Original Medicare generally has no home health copayment.
Eligible home health services are generally covered without a home health copayment. Equipment and other services can follow different rules. Medicare Advantage and private plans may require a network agency or prior authorization, so confirm the details before care begins.
Answers to the cost questions families ask first
Does Medicare cover home health?
Medicare can cover eligible, medically necessary home health services when the skilled need, homebound status, order, and other requirements are met.
Does Medicare cover home health at 100%?
Eligible home health services under Original Medicare are generally covered without a home health copayment. Durable medical equipment and other services may have different costs. Confirm what applies to your coverage before care begins.
Does choosing OHH change my Medicare coverage?
Your Medicare coverage rules are the same across Medicare-certified home health agencies. You have the right to choose which qualified agency provides the care.
Does Medicare pay for 24-hour care at home?
No. Medicare home health covers intermittent skilled care, not round-the-clock custodial or companion care.
What if I have Medicare Advantage or private insurance?
These plans may have network or prior-authorization rules. OHH accepts Medicare, Medicaid, private insurance, and private pay and will explain the available coverage information before care begins.
Questions about Medicare or insurance?
Call with the patient's home address and coverage information. We can explain what OHH accepts and what to confirm before care begins.
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