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Yes — but narrowly, and not in the way most people mean when they say "home care". Two rules decide it, and almost every denied claim turns on one of them.
Leaving home must require considerable and taxing effort, and trips outside must be infrequent or for short duration — medical appointments, religious services, adult day care and similar do not break homebound status. Someone who drives themselves to the shops most days will not qualify, however much help they need at home.
There must be a need for skilled nursing on an intermittent basis, or physical therapy, speech-language pathology, or continued occupational therapy — ordered by a physician or allowed practitioner, under a plan of care they establish and review, following a documented face-to-face encounter.
Intermittent is the operative word. The benefit is built around visits, not shifts. Care needed daily and indefinitely, or for many hours a day, falls outside it.
This is the gap that surprises families: the help most older people actually need day to day is exactly the help this benefit excludes. Those needs are met through Medicaid home and community-based services in some states, veterans' programmes, long-term care insurance, or private payment.
Covered home health visits carry no coinsurance under Original Medicare. Durable medical equipment supplied alongside — a walker, a hospital bed — is covered under the usual Part B rules with the standard 20% coinsurance after the deductible. Medicare Advantage plans must cover at least the same benefit but may apply their own networks and prior-authorisation rules.
Deductibles and coinsurance percentages change annually. Verify current figures with Medicare.gov or your plan.
Only a Medicare-certified home health agency can bill the benefit. Certification also means the agency reports quality data — which is why public records exist for it. There are 12,460 certified agencies in the country; you can look up any of them by state and city, with CMS star ratings, patient survey results, and ownership.
Ownership is worth a look. The largest single group, Unitedhealth Group Incorporated, operates 449 agencies across 40 states — a scale that no single-agency view reveals. See all ownership groups.
Read the denial notice for which rule was cited — homebound status or skilled need. Both are documented judgements, and both can be appealed with better documentation from the ordering clinician. Agencies are also required to give advance written notice before stopping services they believe Medicare will not cover, which starts an expedited review clock.
No. The home health benefit covers intermittent skilled visits, not continuous care. Round-the-clock care at home is not covered by Medicare under any circumstances.
Only alongside a qualifying skilled need. Home health aide services can be covered when the patient also requires skilled nursing or therapy. Personal care alone, with no skilled need, is not covered.
That leaving home takes considerable and taxing effort, and that absences are infrequent or short. Medical appointments, religious attendance and adult day care do not disqualify someone.
Every certified agency has a CMS certification number and appears in the CMS provider files. Search this site by state and city to confirm, and to see the agency's published ratings and ownership.
Records for 14,690 nursing homes, 5,597 assisted living facilities and 28,152 hospice, home health, dialysis and rehabilitation providers: search by name or city · nursing homes · hospice · home health · dialysis · inpatient rehab · nursing home groups · other ownership groups.
This guide is general information from public sources, not medical, legal, or financial advice. Program rules and dollar figures change annually and vary by state — verify with Medicare.gov, your state Medicaid agency, or a certified elder law attorney before acting.