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Home health

Understand skilled care at home, Medicare coverage, and what home health does not provide.

Reviewed August 22, 2026

Home health is intermittent skilled care ordered by a clinician. It may include nursing, physical or occupational therapy, speech-language pathology, medical social services, and limited aide care. It is not round-the-clock caregiving.

Your next 3 actions

  1. Ask the treating clinician what skilled problem needs home treatment. Request an order and a clear goal, such as wound care, medication teaching, or safer walking after a hospitalization.
  2. Compare Medicare-certified agencies. Check quality information in Medicare Care Compare and confirm the agency serves the address and accepts the insurance.
  3. At the first visit, get the plan and contact route. Know the visit frequency, goals, after-hours number, supply responsibility, and what changes require a call to 911.

Options and tradeoffs

  • Medicare-certified home health: Clinical care at home when eligibility rules are met. Visits are intermittent and may not cover daily personal care needs.
  • Outpatient therapy or clinic care: May offer equipment and specialist access, but requires safe transportation.
  • Private-duty nursing: Longer nursing shifts for complex needs; coverage is separate and often limited.
  • Nonmedical home care: Helps with daily activities and supervision, but does not replace skilled assessment or treatment.

Questions to ask

  • Which discipline will visit, how often, and for how long?
  • What measurable goal should improve? When will progress be reviewed?
  • Who coordinates with the primary clinician and pharmacy?
  • What symptoms should prompt the agency, the clinician, urgent care, or 911?
  • Are supplies, equipment, and medications covered separately?
  • If an aide is included, which tasks and how many visits are authorized?
  • What happens if a visit is missed or staffing is unavailable?
  • What appeal or complaint path applies if care is reduced or denied?

Warning signs

Home health is not an emergency service. Call 911 for severe trouble breathing, signs of stroke, uncontrolled bleeding, or another immediate threat. Call the clinician promptly for a sudden decline, new confusion, repeated falls, medication errors, worsening wound, fever, or inability to eat or drink. Be wary of unsolicited callers offering “free” home health or asking for a Medicare number before a clinician has discussed a need.

Common failures

  • Expecting continuous supervision. Arrange separate help between visits.
  • Not practicing between therapy visits. Ask for written exercises and safe caregiver instructions.
  • No single medication list. Keep one current list available to the agency, prescriber, and pharmacy.
  • Assuming discharge means the person is fully recovered. Ask what goal was met, what remains, and who takes over.

Costs and payment basics

Original Medicare covers eligible home health when a Medicare-enrolled clinician certifies the need, the person is homebound under Medicare’s definition, and a Medicare-certified agency provides the care. Medicare states covered home health services have no cost, while durable medical equipment generally has cost sharing after the Part B deductible. Medicare Advantage rules and networks can differ. Nonmedical caregiving, meals, and 24-hour home care are generally not covered as home health.

King County help

Sources

Reviewed 2026-08-23.