If you need to know how much Medicare pays for home health care per hour or there is no single hourly rate. Medicare typically pays a Medicare-certified home health agency for 30 days of care, not for every hour. The amount Medicare pays can depend on the patient’s health condition, care needs, and other factors. “How much Medicare pays” can mean how much Medicare pays the agency or how much the patient pays.
If you qualify for Medicare-covered home health care, you typically pay $0 for covered services under Original Medicare. This guide clarifies who qualifies, what services Medicare covers, how many hours may be allowed, how payments work or what Medicare does not cover with 24-hour home care.
Quick answer: Medicare doesn’t pay a set amount per hour for home health care. Instead, it typically pays a Medicare-certified home-health agency for 30 days of care. If you qualify, you pay $0 for covered home-health services under Original Medicare. You typically pay 20% for covered medical equipment after meeting the Part B deductible. Medicare doesn’t pay for 24-hour care or long-term individual care.
Does Medicare Pay an Hourly Rate for Home Health Care?
No, Medicare does not usually pay a set hourly rate for home health care. Instead, Original Medicare usually pays a Medicare-approved home health agency for 30 days of care. The amount depends on the patient’s health needs and the care they need.
Medicare uses a system called the Patient-Driven Groupings Model (PDGM) to determine how much the agency is paid. So, don’t divide the 30-day payment by the number of visits and call that amount an hourly Medicare rate.
The payment may depend on:
- The patient’s health condition
- How much support the patient needs
- Other health conditions
- When and how the patient started home health care
- The number and kind of visits
- The location where the patient lives
If you are also trying to understand which services Medicare will pay for, read our guide on Medicare coverage for home health care in Seattle.
There are three changed numbers that families sometimes confuse:
Medicare reimbursement: What Medicare pays the eligible home-health agency.
Caregiver wage: What the agency may pay its employee.
Private-pay rate: What a family pays for services that Medicare does not cover.
These amounts are not interchangeable. A private caregiver’s hourly rate is not the same as Medicare’s home-health reimbursement.
How Much Does a Medicare Beneficiary Pay?
Under Original Medicare, an eligible person typically pays $0 for covered home-health services if they meet Medicare’s requirements. But, this does not mean that all care at home is free. For covered durable medical equipment (DME), the person typically pays 20% of the Medicare-approved amount after meeting the Part B deductible, if the supplier accepts Medicare assignment. The person may also have to pay the full price of services that Medicare does not cover.
Before care starts, the home-health agency should clarify that the expected costs or what Medicare will cover. If the person has Medicare Advantage, prices, provider networks or coverage rules may change. Check out the plan each time to know what you may want to pay.
Who Qualifies for Medicare-Covered Home Health Care?
Medicare covers home health care only when a person meets certain requirements. A doctor’s order alone does not mean Medicare will pay. The person usually must:
- Be under the care of a doctor or approved healthcare provider
- Have a care plan that is created and reviewed often
- Need part-time or occasional skilled care
- Be homebound under Medicare’s rules
- Get care from a Medicare-certified home health agency
- Have the essential face-to-face visit and doctor’s order
Being homebound does not mean the person must stay at home all the time. It typically means leaving home is difficult and requires help or a lot of effort. Short trips and trips for medical care typically do not disturb eligibility.
Which Home-Health Services Does Medicare Cover?
Medicare may cover some home-health services if the person meets Medicare’s requirements and the services are medically required.
| Service | Covered? | Simple condition |
| Expert nursing | Yes | Must be medically required and part of the care plan |
| Physical therapy | Yes | Medicare’s necessities must be met |
| Occupational therapy | Yes | Must meet Medicare’s coverage instructions |
| Speech therapy | Yes | Must meet Medicare’s coverage directions |
| Medical social services | Yes | Must be part of the treatment plan |
| Home-health aide | Sometimes | Usually covered only when the person also gets skilled care |
| Medical supplies | Yes | Must be needed for covered home-health care |
| Medical equipment | Yes, if suitable | The patient typically pays 20% later the Part B deductible |
Home-health aide services may include benefits with bathing, getting dressed, eating, walking and changing bed sheets. But Medicare does not typically pay for an aide just because someone wants help with day-to-day activities. The person must be receiving covered skilled care, such as nursing or therapy.
How Many Hours of Home Health Care Will Medicare Cover?
Medicare typically covers part-time or occasional home health care, not full-time care. Expert nursing and home health aide services may be covered for up to 8 hours a day and 28 hours a week combined. In some special cases, Medicare may cover up to 35 hours a week for a short time if the care is medically required. These hours are not guaranteed. The number of hours depends on the person’s health needs and care plan. Medicare may cover home health visits as long as the person meets its requirements.
Medicare does not cover 24-hour home health care.
What Home-Care Services Will Medicare Not Pay For?
Medicare does not pay for many non-medical or long-term care services. You may want to pay for these services yourself if they are just for everyday help.
- 24-hour care at home
- Meal delivery
- Shopping, cleaning or laundry that’s not part of your care plan
- Long-term everyday care
- Help with bathing, dressing, or using the bathroom when this is your only necessity
- Private caregivers who are not providing Medicare-covered services
- Services that Medicare doesn’t consider medically necessary
In general, Medicare doesn’t cover most long-term, non-medical care at home, in the community or in a care facility.
Home Health Care vs. Non-Medical Home Care
The terms home care and home health care may sound the same, but they refer to different kinds of care.
| Home Health Care | Non-Medical Home Care |
| Offers medical or therapy services | Benefits with everyday actions |
| Frequently provided by nurses or therapists | Typically provided by caregivers or aides |
| Must meet Medicare directions | Often paid for privately |
| May be covered by Medicare | Typically not covered by Original Medicare |
| Usually provided part-time or as needed | Can be provided for longer hours |
Example: A nurse who treats a wound at home may offer home health care that Medicare covers. A caregiver who stays with somebody for 8 hours, prepares meals, offers company or helps with household tasks may provide non-medical home care, which Medicare typically doesn’t cover.
Before starting care, just ask the provider if they are Medicare-certified or whether the service is part of a Medicare-covered home health care plan.
What Happens If Medicare Will Not Cover a Service?
If Medicare may not pay for a service, the healthcare agency should tell you before providing it. In some cases, you may obtain an Advance Beneficiary Notice of Noncoverage (ABN). This notice informs you that Medicare may not pay and that you may have to pay.
- The agency should give you an ABN before the service if it thinks Medicare may not cover it.
- The notice should tell you which service may not be covered and why.
- It should also tell you about how much you may have to pay.
- You can ask the provider to submit a claim to Medicare for an official decision.
- If Medicare does not pay, you may have the right to appeal.
For assistance with your situation, contact Medicare, your Medicare plan or a State Health Insurance Assistance Program (SHIP) counselor. This is general info or not legal guidance.
Does Medicare Advantage Pay Differently?
Yes, Medicare Advantage plans may have different rules for home health care. They must cover the home health services Medicare covers, but the directions for getting these services can change. Each time check your plan first.
- Your plan must cover Medicare-covered home health care.
- The plan may have changed provider networks and approval rules.
- Some plans may propose extra help at home.
Extra benefits vary for each plan. Don’t assume they cover caregivers, meals, or housework. Check your Evidence of Coverage or call your plan to learn what’s covered, which providers you can use, and what you may have to pay.
How Can Someone Pay for Care Medicare Does Not Cover?
If Medicare doesn’t pay for some care, other options can help cover the cost. The right option depends on your desires, money, and available programs.
Medicaid: Medicaid may pay for some services that Medicare doesn’t cover. Rules and benefits can differ by state.
Long-term-care insurance: This insurance may help pay for long-term personal or everyday care.
Veterans’ programs: Eligible veterans may get assistance with certain care services through veterans’ programs.
PACE: PACE may help eligible older adults access medical and long-term care. It is only available in some areas.
State and community programs: Some local programs may provide financial assistance, care services or other support.
Private payment: You can pay for care yourself using your savings or income.
Family caregiving: Family members may help with everyday tasks and private care without being paid.
Before choosing an option, find out what the program covers and what you may need to pay out of pocket.
Questions to Ask a Home-Health Agency
Before starting home-health care ask these simple questions:
- Are you a Medicare-certified home-health agency?
- Did my doctor or healthcare provider order these services?
- What services are included in my care plan?
- How frequently will someone visit my home?
- What will Medicare pay for?
- Will I have to pay anything out of pocket?
- Do I want any medical equipment?
- Could I get an ABN if Medicare may not pay?
- Do I have to pay for any suggested services myself?
- What happens if my care changes?
- Who should I contact if my services are reduced or stopped?
By asking to these questions that can help you know what Medicare covers and what you may want to pay for yourself.
Frequently Asked Questions
Does Medicare pay for home health care by the hour?
No. Medicare does not pay a set hourly rate. It typically pays the approved agency for covered care.
How much does Medicare pay for a home-health aide?
There is no set hourly amount. Aide care may be covered when you want expert home health care.
Does Medicare pay 100% of home health care?
Typically, yes for covered home health services. You generally pay $0. But some equipment may require a 20% payment.
Will Medicare pay for a caregiver all day?
Usually, no. Medicare doesn’t pay for full-day or 24-hour home care.
Does Medicare cover 24-hour home care?
No. Medicare typically covers only part-time or occasional home health care.
How many hours per week will Medicare cover?
There is no fixed number for everyone. In various cases, care can be up to 8 hours a day and 28 hours a week.
Does Medicare cover help with bathing and dressing?
Sometimes. This support may be covered when you too receive expert home health care.
Can Medicare pay a family member to be a caregiver?
Usually, no. Original Medicare does not usually pay family members for consistent caregiving.
How long can someone receive Medicare home health services?
There is no set time limit. Coverage can remain as long as you meet Medicare’s requirements.
Does Medicare Advantage cover more home care?
Some plans may. Benefits and rules change, so check your plan.
What is the difference between Medicare and Medicaid home care?
Medicare mainly covers medical home health care. Medicaid may also cover personal care and long-term care, depending on state directions.
How do I find out a Medicare-certified home-health agency?
Ask your healthcare provider for local agencies. Then make sure the agency is Medicare-certified.
Final Takeaway
Medicare doesn’t pay a fixed hourly rate for home health care. Instead, it typically pays approved home-health agencies through a 30-day payment system. If you qualify, you typically pay $0 for covered services. Key things to check include whether you qualify, what care Medicare covers, how often you can receive care or whether you must pay for any services or equipment Medicare doesn’t cover.