Getting home health care starts with a doctor’s order. A physician, nurse practitioner, or physician assistant must certify that you need skilled medical services at home before any coverage kicks in. From there, the process involves choosing an agency, understanding what your insurance will pay for, and knowing what services are actually available. Here’s how to move through each step.
Start With Your Doctor
Home health care isn’t something you can sign up for on your own. A licensed provider needs to evaluate your condition, determine that you need skilled care, and create a formal plan of care that spells out what services you’ll receive and how often. This plan is what authorizes a home health agency to begin sending nurses, therapists, or aides to your home.
If you or a family member thinks home health care is needed, bring it up at your next appointment or call your doctor’s office directly. Common triggers include a hospital discharge, a new diagnosis that requires ongoing wound care or injections, difficulty recovering from surgery, or a decline in mobility that makes outpatient visits impractical. Your doctor will assess whether the care you need qualifies as “skilled” rather than purely personal assistance, because that distinction determines what insurance will cover.
What Counts as Skilled Care
Skilled care is medical care delivered by trained professionals: registered nurses, physical therapists, occupational therapists, or speech therapists. It includes things like wound care, IV therapy, monitoring unstable medications, rehabilitation exercises after a stroke or joint replacement, and teaching you or a caregiver how to manage a new condition. The key requirement is that the care must be complex enough to require a licensed professional’s judgment.
Custodial care is different. This covers help with daily activities like bathing, dressing, eating, and getting around the house. Home health aides can provide this type of support, but most insurance programs only cover it when it’s bundled with skilled care. If all you need is help with daily tasks and no medical services, you’ll likely need to explore other payment options (more on that below).
How Medicare Covers Home Health
Medicare is the most common payer for home health care, and it covers these services with no copay or deductible as long as you meet the requirements. You need a doctor’s certification, you must need part-time or intermittent skilled nursing or therapy, and you must be considered “homebound.”
Homebound doesn’t mean you can never leave the house. It means leaving home is a major effort because of illness or injury, you need help from another person or assistive devices like a walker or wheelchair to get out, or your condition makes it inadvisable. You can still attend medical appointments, religious services, or adult day care and maintain homebound status.
Medicare pays for home health in 30-day episodes. At the end of each episode, your doctor reviews whether you still need services and can recertify you for another 30-day period. There’s no hard cap on how many episodes you can receive, but you must continue to meet the eligibility criteria each time. Nurse practitioners, clinical nurse specialists, and physician assistants can all handle this recertification, not just physicians.
Medicaid and State Waiver Programs
If you don’t qualify for Medicare or need long-term personal care that Medicare won’t cover, Medicaid may be an option. Every state runs its own Medicaid program, and the services available vary significantly depending on where you live.
The most flexible option is a Home and Community-Based Services (HCBS) waiver. These state-run programs are specifically designed for people who would otherwise need care in a nursing facility but prefer to stay at home. Services can include case management, personal care aides, homemaker assistance, adult day health programs, respite care for family caregivers, and home health aide visits. Some states target these waivers to specific populations, such as elderly residents, people with intellectual disabilities, or technology-dependent children.
To qualify, you generally need to meet your state’s income requirements and demonstrate that your care needs are serious enough that you’d be eligible for institutional placement. States can adjust income rules under these waivers, so even if your income is slightly above the usual Medicaid threshold, you may still qualify. Contact your state Medicaid office or a local Area Agency on Aging to find out which waivers are available and whether there’s a waiting list, as some states do have them.
Home Health Care for Veterans
All enrolled veterans are eligible for homemaker and home health aide services through the VA, provided they meet the clinical criteria and qualify for community care. This program is designed for veterans who need help with daily activities, are socially isolated, or whose family caregiver is experiencing burnout.
The process starts by talking with a VA social worker, who will assess your needs and help arrange services. The VA also offers a Veteran Decision Aid, an online tool that helps you figure out which home care or long-term care services best match your current situation. There’s a companion Caregiver Self-Assessment that helps family members evaluate how much support they can realistically provide and identify their own needs.
Choosing a Home Health Agency
Once you have a doctor’s order and know how you’re paying, you’ll need to pick an agency. Your doctor or hospital discharge planner will often recommend one, but you’re not locked into their suggestion. You have the right to choose any Medicare-certified agency in your area.
Medicare’s Care Compare tool at medicare.gov lets you search and compare agencies by location. Each agency has a quality of patient care star rating based on eight measures that track whether patients actually improve and whether care is delivered safely. There’s also a separate patient survey rating that reflects what past patients thought of the care they received. Looking at both ratings gives you a more complete picture than either one alone.
Beyond the ratings, practical considerations matter. Ask how quickly the agency can start services, whether they have staff with experience in your specific condition, how they handle after-hours emergencies, and who your main point of contact will be. A good agency should be responsive before you even sign on. If they’re hard to reach during the intake process, that’s a signal worth paying attention to.
Paying Out of Pocket or With Private Insurance
If you don’t qualify for Medicare, Medicaid, or VA benefits, you can still hire home health care privately. Many agencies offer both skilled and custodial care on a private-pay basis, and some long-term care insurance policies cover home health services.
Private-pay rates vary widely by region, but expect to pay between $25 and $75 per hour for home health aide services and more for skilled nursing visits. Some agencies offer package rates or reduced pricing for regular weekly schedules. If you have long-term care insurance, check your policy for any waiting period (often 30 to 90 days) before benefits begin, and confirm whether the agency you’re considering meets the policy’s requirements for provider certification.
For families who need custodial care but can’t afford agency rates, hiring an independent caregiver is another option. This can be significantly cheaper, but you take on responsibilities as an employer, including payroll taxes and liability. Some states allow Medicaid recipients to hire their own caregivers, including family members, through self-directed care programs.
What to Expect When Care Begins
After you select an agency, a nurse or therapist will visit your home for an initial assessment. They’ll review your doctor’s plan of care, evaluate your living environment for safety issues, and set specific goals, like improving your ability to walk independently or managing a wound until it heals. This first visit typically takes longer than regular visits, often an hour or more.
From there, your care schedule depends on what’s in the plan. Some people receive daily nursing visits for a week or two after surgery, then taper down. Others get physical therapy two or three times a week for several months. A home health aide might come a few times a week to help with bathing and light housekeeping while skilled care is also being provided. Your care team communicates regularly with your doctor, and the plan gets updated as your condition changes.
If at any point you’re unhappy with the care you’re receiving, you can request a different aide or nurse, file a complaint with the agency, or switch to a different agency entirely. Medicare protects your right to change providers, and your doctor can transfer your plan of care to a new agency without starting the process over from scratch.