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How Many Hours of Home Health Care Does Medicare Cover?
Date Updated: December 20, 2024
Written by:
Sarah has produced thousands of articles in diverse niches over her decade-long career as a full-time freelance writer. This includes substantial content in the fields of senior care and health care. She has experience writing about wide-ranging topics, such as types of care, care costs, funding options, state Medicaid programs and senior resources.
Reviewed by:
Gene Altaffer has a Masters in Gerontology from the University of Southern California and has worked in many avenues along the continuum of long-term care, assisting thousands of clients and their families since 1995. He also sold long-term care insurance from numerous carriers while also assisting families with retirement planning. Gene helps seniors navigate their Medicare plans, ensuring they understand their benefits and options.
Medicare covers 35 hours of home health care each week, maximum. However, most individuals only qualify for 28 hours or less of weekly care. The amount of funded home health care depends on an individual’s circumstances and whether a physician considers such care essential.
Eligibility Criteria for Home Health Care
Medicare funds medically necessary home health care under Parts A and B.
Eligibility criteria include:
- U.S. citizenship or lawful permanent resident status
- A qualifying disability, such as:
- ALS (Amyotrophic Lateral Sclerosis)
- End-stage kidney disease
- Age 65 or older
- A qualifying work record with sufficient Social Security taxes paid by the individual or their spouse
Alternatively, those without enough Social Security credits can pay Medicare premiums.
Those covered by Medicare A or B must fulfill extra criteria to receive home health care funding.
- Be homebound, meaning they:
- Have difficulties leaving the house due to their condition
- Require excessive effort to go out
- Have a doctor who recommends not going out
- Have a physician prescribe home health care support based on medical need
Home Health Care Hours
Most people qualify for home health care services for a maximum of eight hours per day up to 28 hours weekly. Typically, visits don’t occur every day. This limit includes skilled nursing care and home health aide assistance. In narrow circumstances where a doctor deems it essential, individuals may receive fewer than eight hours of daily care but with more frequent visits, with an absolute cap of 35 hours per week.
Medicare won’t pay for more than 35 hours of weekly home health care, and it never funds around-the-clock assistance in someone’s private residence. Additionally, services only continue for as long as a doctor prescribes them; they must review a patient’s condition and recertify that care remains medically necessary every 60 days. Only Medicare-certified agencies can provide home health care services.
Ways to Pay for More Care
If seniors want more care hours than Medicare allows, they must find alternative ways to pay for additional services. This includes using private funds, such as savings and income. As of 2024, the median monthly cost of home health care runs $33 per hour nationwide. However, those with limited resources may qualify for financial aid through state Medicaid plans or waiver programs.
Seniors may also consider staying in a residential setting. Nursing homes provide around-the-clock care and supervision for those with clinical conditions or difficulties performing day-to-day tasks. While some older adults move to nursing homes for the foreseeable future, others stay temporarily while recovering enough to safely return home. Alternatively, assisted living facilities provide hands-on assistance for those with limited medical needs. Communities may offer regular wellness checks and nursing oversight, partner with rehabilitation agencies for on-site therapies and have on-site diagnostic facilities and pharmacies.