Hospital Care

Medical Home Care

This content is for informational purposes only. For medical advice or diagnosis, consult a healthcare professional. In case of an emergency, immediately call 911.

Medical home care brings professional medical services directly to patients in the comfort of their own home without the need for a hospital stay or nursing facility. It allows people recovering from illness or injury to maintain their independence and daily routines while still receiving skilled care from nurses and therapists.

Medical home care is provided through Medicare and/or Medicaid-certified Home Health Agencies (HHAs), under a physician’s orders. Services may include hospital-based home care programs, visiting nurse services, physical, occupational, and speech therapy, and medical social services.

For day-to-day assistance such as bathing, meal preparation, or light housekeeping, please visit our Home Care page.

Coverage and Benefits

Original Medicare (Part A & B)

Eligibility: Original Medicare covers home health care for patients who are homebound. A doctor or nurse practitioner must conduct a face-to-face evaluation to certify the need for home care. This evaluation must occur within 90 days before or 30 days after care begins. Brief, infrequent absences, such as attending a religious service or a medical appointment, are permitted.
Coverage: Costs may be covered under Medicare Part A (Hospital Insurance) or Part B (Physician Insurance).
Prior Hospitalization: Both Part A and Part B can cover home health care. A prior hospital stay is not required if the homebound requirement and physician’s order are met, Part B can provide coverage. Part A may apply following a hospitalization or a Skilled Nursing Facility (SNF) stay.
Coverage Scope and Limitations:
- Skilled Nursing & Rehab Services: Covered for as long as care is medically necessary and the patient remain homebound (physician re-certification required every 60 days; no visit limit).

- Home Health Care: Covered without a time limit, as long as it is medically necessary (physician re-certification required every 60 days). Typically limited to up to 8 hours per day and 28 hours per week; may be temporarily expanded to up to 35 hours per week (under 8 hours/day) when medically needed.
- Not Covered: 24-hour around-the-clock care, meal delivery, housekeeping (cleaning, laundry), shopping, and other non-medical custodial services.
Patient Costs: There is no copay for approved home health services. If durable medical equipment (DME, wheelchair or walker) is included, a 20% coinsurance applies under Part B.

Medicare Advantage (Part C)

Coverage: Includes all standard Original Medicare benefits, and some plans may offer additional support beyond what Original Medicare covers.
Extra Benefits: Some plans provide additional services not covered by Original Medicare, such as transportation to medical appointments or limited in-home assistance.
In-Network vs. Out-of-Network: Benefits apply when using home care providers that are in-network with your plan. Using out-of-network providers may result in significantly higher out-of-pocket costs, or no coverage at all, depending on the plan.

* In-Network refers to hospitals, physicians, and providers (including doctors, nurse practitioners, and physical therapists) who have a contracted agreement with your insurance plan.
* Out-of-Network providers do not have a contract with your insurer, which can result in significantly higher out-of-pocket costs.
*Most Medicare Advantage plans require prior authorization before home care services begin. Contact your plan ahead.

Long-Term Care Medicaid (MLTSS)

Eligibility: MLTSS is available to Medicaid recipients who require nursing home-level care (assistance with 3 or more Activities of Daily Living) and meet income and asset requirements. For those who have both Medicare and Medicaid (dual eligibles), Medicare generally covers skilled home health care, while MLTSS covers long-term personal care services.
Patient Costs: For those who qualify, services are typically provided at no cost to the patient.

*For details visit our MLTSS Page.

Private Insurance

Coverage: Coverage scope and duration vary by plan. Review your policy or contact your insurer before receiving services.
Prior Authorization: Most private insurers require prior authorization before services begin.

Cost Sharing by Insurance Type (2026)

Insurance Type	Deductible	Coinsurance / Copayment
Original Medicare (Part A & B)	$0 for approved services)	$0; 20% coinsurance for DME after Part B deductible of $283 is met
Long Term Care Medicaid (MLTSS)	$0	$0
Private Insurance	Varies by Plan	Varies by plan; Prior authorization may be required