By Marc Gilman
📞 Call (800) 927-9326 or (603) 493-1394 | ✉️
One of the most common misunderstandings I encounter with Medicare clients in Bedford and throughout Hillsborough County is about home health coverage. Most people assume Medicare will cover a home health aide when they need ongoing help at home — bathing, dressing, meals, household tasks. In many cases, it won’t. And by the time they realize that, they’re already in a situation where the gap is expensive and the options are limited.
This post explains exactly what Medicare’s home health benefit covers, what it doesn’t, and what the coverage gap means for families navigating care at home.
Key Takeaways
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Medicare covers skilled home health services — nursing care, physical therapy, speech therapy, and occupational therapy — when specific eligibility criteria are met.
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Coverage is available under Medicare Part A or Part B, depending on the circumstances.
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You pay $0 for covered home health services. You pay 20% of the Medicare-approved amount for durable medical equipment received through a home health agency.
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Medicare does not cover 24-hour home care, housekeeping, meal delivery, or help with daily activities like bathing and dressing if that is the only care you need.
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The critical distinction is skilled care (Medicare covers) vs. custodial care (Medicare generally does not cover).
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When Medicare home health ends, the gap is real — and long-term care coverage, Hospital Indemnity Plans, and Medicaid waiver programs are the primary options that fill it.
What Is Medicare’s Home Health Benefit?
Medicare’s home health benefit is designed to deliver short-term, medically necessary care to people who are recovering at home after an illness, injury, or hospitalization. It is not a long-term care program, and it is not a personal care program. Understanding that distinction upfront prevents a lot of painful surprises.
The benefit is covered under both Medicare Part A and Part B:
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Part A covers home health services typically following a hospital stay or skilled nursing facility admission.
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Part B covers home health services for people who need skilled care but haven’t necessarily been hospitalized — as long as the other eligibility requirements are met.
Who Qualifies for Medicare Home Health Services?
Four criteria must all be met. Miss any one of them and Medicare won’t cover the services.
1. You must be homebound.
“Homebound” has a specific Medicare definition that is narrower than most people expect but broader than most people fear. It does not mean you can never leave your home. It means leaving home requires a considerable effort — because of illness, injury, or a condition that makes getting around difficult — and leaving home is infrequent, for short durations, or requires the help of another person or assistive device like a wheelchair or walker.
Leaving home for a medical appointment, adult day program, or occasional personal errand doesn’t disqualify you. But if you’re getting out regularly and independently, you likely won’t meet the homebound standard.
2. You must need skilled care on a part-time or intermittent basis.
Skilled care means care that can only be safely and effectively provided by — or under the supervision of — a licensed professional. Skilled nursing care, physical therapy, speech-language pathology, and occupational therapy all qualify. The need for skilled care must be medically necessary to improve, maintain, prevent decline of, or slow a health condition.
“Part-time or intermittent” is key. Medicare’s home health benefit is not designed for people who need full-time nursing care every day for an extended period. If you require around-the-clock skilled nursing, a skilled nursing facility or inpatient care setting is the appropriate level of care — not home health.
3. A physician or other qualified provider must order and certify the care.
A physician, nurse practitioner, clinical nurse specialist, or physician’s assistant must document an in-person visit with you — either in the three months before the home health care begins, or within one month after care starts — and must certify that you meet the eligibility criteria and establish a plan of care.
4. You must receive care from a Medicare-certified home health agency.
Not every home care agency is Medicare-certified. Using a Medicare-certified agency matters because it determines whether services are covered and ensures the agency meets federal quality and safety standards. You can search for Medicare-certified agencies at medicare.gov/care-compare.
What Does Medicare Actually Cover?
When all four criteria are met, Medicare covers the following services with no cost-sharing to you:
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Skilled nursing care — wound care, medication management, monitoring of serious illness, injections, and other care that requires a licensed nurse
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Physical therapy — to restore strength, mobility, and function after illness or injury
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Speech-language pathology — for speech, swallowing, or cognitive communication issues
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Occupational therapy — to help you adapt daily activities and environments after illness or injury
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Home health aide services — personal care like bathing, grooming, and feeding, but only when provided alongside skilled nursing or therapy care. This is one of the most important points in this entire post: home health aide services for personal care are covered only as a companion to skilled care, not on their own.
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Medical social services — counseling and help connecting with community resources
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Injectable osteoporosis drugs — for eligible women
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Medical supplies for use at home
For durable medical equipment — wheelchairs, walkers, hospital beds, oxygen equipment — Medicare covers 80% of the Medicare-approved amount. You pay the remaining 20%, which is where Medicare Supplement (Medigap) plans become relevant.
Coverage continues for as long as you meet the eligibility criteria — you remain homebound, you continue to need skilled care, and your doctor continues to certify the care as medically necessary. There is no set number of days or visits. When the need for skilled care ends, coverage ends.
What Does Medicare NOT Cover?
This is where most families run into problems.
Medicare does not cover any of the following when they are the only care you need:
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24-hour home care — continuous care around the clock is not covered under the home health benefit
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Custodial care — help with activities of daily living such as bathing, dressing, grooming, toileting, and eating, when this is the primary or only need
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Meal delivery — Medicare does not pay for delivered meals at home
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Homemaker services — shopping, cleaning, laundry, meal preparation, and other household tasks are not covered
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Long-term personal care — if a family member needs ongoing help at home that isn’t tied to a specific illness requiring skilled care, Medicare is not the answer
This is the gap that catches families off guard. The scenario plays out regularly: a parent is discharged from the hospital, receives Medicare-covered home health services for several weeks while recovering, and then the condition stabilizes — the skilled care need resolves, and Medicare coverage ends. The parent still needs help with daily activities, but that help is now entirely out-of-pocket unless other coverage is in place.
Understanding the Critical Distinction: Skilled Care vs. Custodial Care
This is the single most important concept in understanding Medicare’s home health benefit.
Skilled care requires the training and judgment of a licensed professional — a registered nurse, physical therapist, or speech-language pathologist. Examples: wound care that requires sterile technique, medication teaching for a new insulin regimen, balance training after a stroke, swallowing therapy after a hospitalization.
Custodial care is help with the tasks of daily living — bathing, dressing, feeding, using the bathroom, getting in and out of bed. These tasks don’t require clinical training. They require time, patience, and physical presence — and they are extremely expensive when provided professionally.
Medicare covers skilled care. Medicare generally does not cover custodial care standing alone.
The confusion arises because the line between the two isn’t always obvious. A home health aide providing personal care during a Medicare-covered home health episode is covered — but only because skilled nursing or therapy is also part of the plan of care. The moment the skilled care component ends, the aide coverage ends too.
Medicare Advantage and Home Health
If you’re enrolled in a Medicare Advantage plan rather than Original Medicare, home health coverage must be at least equivalent to Original Medicare — but the rules on agency certification, network requirements, and prior authorization can vary. Some Medicare Advantage plans require prior authorization for home health services, and your agency must be in-network.
If you’re receiving Medicare home health services and are considering a plan change, confirm your current agency is in-network under the new plan before switching.
The Gap — and What Fills It
For most Medicare beneficiaries in Hillsborough County, the home health gap eventually becomes a real issue. The coverage runs out because the skilled care need resolved, or because the person never had a skilled care need in the first place — they simply need help at home.
The options that fill this gap:
Long-Term Care (LTC) insurance covers custodial care in a variety of settings — at home, in assisted living, or in a skilled nursing facility. It’s one of the most effective tools for protecting against the cost of home care that Medicare won’t cover. LTC coverage is significantly easier and less expensive to obtain before age 65, which is why we raise it with every client at 64.
Life insurance with an LTC rider provides access to a portion of the death benefit while you’re alive if you need long-term care. It combines two coverage needs into one product and is a popular option for people who haven’t purchased a standalone LTC policy.
Hospital Indemnity Plans (HIP) pay a cash benefit for hospital stays. That cash can be used for anything — including home care not covered by Medicare.
Medicaid waiver programs are available in New Hampshire through programs like the Choices for Independence (CFI) Waiver, which covers home and community-based services for people who would otherwise require nursing home-level care. Income and asset rules apply, and these programs often have waitlists.
Out-of-pocket — the default for many families who haven’t planned ahead. Home health aide services in New Hampshire currently run between $25 and $35 per hour for non-Medicare-covered personal care, depending on the agency and level of care required.
Frequently Asked Questions
Does Medicare cover a home health aide in Bedford, NH? Medicare covers home health aide services — help with bathing, grooming, and feeding — but only as part of a Medicare-covered home health episode that also includes skilled nursing care or therapy. If a home health aide is the only care needed, Medicare does not cover it.
How long will Medicare pay for home health services? There is no predetermined limit on Medicare home health coverage. Coverage continues as long as you remain homebound, continue to need skilled care on a part-time or intermittent basis, and your physician or other qualified provider continues to certify the care as medically necessary. Coverage ends when the skilled care need is no longer present.
Does Medicare cover 24-hour home care in New Hampshire? No. Medicare’s home health benefit is designed for part-time or intermittent skilled care. Around-the-clock home care is not covered.
What’s the difference between a home health agency and a home care agency? A home health agency provides Medicare-certified skilled care — nursing, therapy, and aide services as part of a medical plan of care. A home care agency provides non-medical personal care and homemaker services — help with bathing, meals, housekeeping — that are not covered by Medicare. Both types of agencies operate in the greater Bedford–Manchester area.
What happens when Medicare home health coverage ends? Coverage ends when you no longer meet the eligibility criteria — typically when the skilled care need resolves. At that point, ongoing personal care is an out-of-pocket expense unless you have long-term care insurance, Medicaid, or another supplemental benefit in place. This is the coverage gap that LTC planning at 64 is specifically designed to address.
Is there anything that covers the gap Medicare home health leaves? Yes. Long-term care insurance, life insurance with LTC riders, Medicaid waiver programs (like New Hampshire’s Choices for Independence Waiver), and Hospital Indemnity Plans all provide some level of coverage for care Medicare won’t pay for. Which is the right option depends on your health, age, and financial situation. This is a conversation worth having before a care need arises, not after.
Serving Bedford and All of Hillsborough County
Gilman Agency helps Medicare beneficiaries throughout Hillsborough County understand their coverage — including the home health benefit, Medigap, Medicare Advantage, and long-term care planning options. We serve Bedford, Manchester, Nashua, Merrimack, Goffstown, Amherst, Milford, Hudson, Hollis, Litchfield, Pelham, Brookline, New Boston, Weare, Antrim, Bennington, Deering, Francestown, Greenfield, Greenville, Hancock, Hillsborough, Lyndeborough, Mason, Mont Vernon, New Ipswich, Peterborough, Sharon, Temple, Wilton, and Windsor.
If you or a family member is navigating a home care situation and want to understand what Medicare covers — and what you may need in addition to it — give us a call. It’s always free.
📞 (800) 927-9326 or (603) 493-1394 | ✉️
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