Navigating Medicare and Home Health Coverage
Understanding Medicare coverage can feel confusing, especially when home health care becomes part of the conversation. Families often have questions like “Is this covered?”, “What qualifies?”, or “What do we do next?”
At Wyo Home Health, we help patients and families navigate these questions every day. Knowing how Medicare works with home health can make the process less stressful and help you plan with confidence.
What Is Home Health Care?
Home health care provides skilled medical services in a patient’s home when ordered by a healthcare provider. The goal is to support recovery, manage medical conditions, and help patients remain safe and independent at home.
Services may include:
Skilled nursing
Occupational therapy
Certified nursing assistant (CNA) support
Medication education
Chronic condition management
Post-surgical care
Does Medicare Cover Home Health?
Yes. Medicare may cover home health services when certain criteria are met. Coverage is based on medical need, not age or income.
Medicare typically covers:
Skilled nursing care
Physical therapy
Occupational therapy
Medical social services when needed
Part-time or intermittent care
Coverage is determined by provider orders and medical eligibility.
What Qualifies Someone for Medicare-Covered Home Health?
To qualify for Medicare home health coverage, a patient generally must:
Be under the care of a doctor or qualified provider
Have a medical need for skilled services
Receive services from a Medicare-certified home health agency
Have a plan of care established and reviewed by a provider
Common situations that may qualify include:
Recent hospital discharge
Recovery after surgery
New or changing medical conditions
Difficulty managing medications
Wound care needs
Declining mobility, balance, or strength
Your provider makes the determination and submits the order for home health.
What Medicare Does Not Cover
It’s also helpful to understand what Medicare does not cover underhome health:
24-hour care
Full-time personal care only
Homemaker services when medical care is not needed
Home health focuses on skilled medical support, not long-term custodial care.
How Long Does Medicare Cover Home Health?
Home health coverage is not time-based. It is needs-based.
Services continue as long as:
The patient continues to meet medical criteria
Skilled care is needed
Progress is being made or monitored
Care plans are reviewed regularly to ensure services remain appropriate.
How to Get Started With Medicare Home Health
The first step is talking with your healthcare provider. You can ask:
“Would home health help support recovery at home?”
“Can we request a home health evaluation?”
“Can you send a referral to Wyo Home Health?”
Once ordered, the home health agency coordinates care, visits, and communication with your provider.
You Have a Choice in Your Home Health Provider
Many people don’t realize this. You have the right to choose your home health agency.
Even if a hospital or clinic suggests a provider, you can request Wyo Home Health by name.
Your Health. Your Home. Your Choice.
We’re Here to Help
Navigating Medicare and home health coverage doesn’t have to be overwhelming. Whether you’re planning ahead or responding to a recent change in health, asking questions early can help you make informed decisions.
If you think home health may be helpful, talk with your provider and explore your options. Support, education, and skilled care can make a meaningful difference, right at home.