The discharge planner hands over a sheet of paper with a dozen agency names on it, says “just pick one,” and heads to the next room. Dad is ready to go home, everyone is tired, and the list might as well be written in another language. So, the family picks the name at the top. Sometimes that works out fine. Sometimes it doesn’t, and nobody realizes until a week of missed visits later that they had a real choice.
Home health care can make recovering at home safer and easier, but getting it set up involves a few steps families rarely see coming. This guide walks through how home health care gets started, what the plan of care is, how long care lasts, and how to compare agencies so you can choose with confidence instead of by alphabetical order.
First, Is It Home Health Care You Need?
Home health care is skilled medical care at home, like nursing or physical therapy, ordered by a doctor. It’s different from non-medical home care, such as help with bathing, meals, or companionship. Our guide to home health vs. home care explains the difference, and our overview of home health care for seniors covers the full picture.
For people with Original Medicare, Medicare.gov lists these basic requirements:
- The patient needs part-time or intermittent skilled care, such as skilled nursing or therapy.
- The patient is homebound, meaning leaving home takes considerable effort. Our guide to what “homebound” means explains this in plain language.
- A doctor or other qualified provider has seen the patient in person and ordered the care.
- The care comes from a Medicare-certified home health agency.
When those requirements are met, Original Medicare pays for covered home health services in full. Medical equipment, like a walker or hospital bed, is typically covered at 20% coinsurance after the Part B deductible.
Step by Step: How Home Health Care Gets Started
1. A Provider Decides Home Health Is Needed
Home health usually starts in one of two places: a hospital or rehab facility as part of discharge planning, or a doctor’s office when someone at home is struggling after an illness, a fall, or a new diagnosis. Families can ask about it directly. A simple “Would home health help here?” at a doctor’s appointment is often how it begins.
2. The Face-to-Face Visit
Medicare requires a face-to-face encounter with a doctor or another qualified practitioner, such as a nurse practitioner or physician assistant, related to the main reason for home health care. Under the federal rule at 42 CFR 424.22, that visit generally needs to happen within 90 days before care starts or within 30 days after, and it can take place by telehealth. A recent hospital stay often counts.
3. The Referral to an Agency
The doctor certifies that the patient qualifies and sends a referral to a home health agency. This is the step where the family’s choice matters most, and it’s covered in detail below.
4. The Agency’s First Visit
A nurse or therapist from the agency visits the home for an initial assessment. They review health history and medications, look at the home for safety concerns, and talk about goals. Before care begins, the agency is expected to give the patient a written notice of their rights and explain, orally and in writing, what Medicare or other insurance will pay and what, if anything, the patient might owe.
5. The Plan of Care
The agency and the patient’s doctor create a written plan of care. It typically spells out:
- Which services are needed, such as skilled nursing, physical therapy, occupational therapy, or a home health aide.
- How often each type of visit will happen.
- The goals of care and how progress will be measured.
- Medications, equipment, and any special instructions.
Under the home health patient rights rule at 42 CFR 484.50, patients have the right to take part in planning their care and to be told about changes. It’s fine to ask for a copy of the plan and to speak up if the schedule doesn’t match what’s needed.
6. Visits Begin
Nurses, therapists, and aides then visit on the schedule in the plan. Our guide to home health nurse visits explains what happens during nursing visits, and our guide on what a home health aide does covers the aide’s role.
How Long Home Health Care Lasts
Medicare home health is certified in periods of up to 60 days. If skilled care is still needed after that, the doctor can recertify it, and there’s no set limit on the number of recertifications as long as the patient continues to qualify. Care typically ends when goals are met, such as a wound healing or the family learning to manage a new routine.
If an agency plans to reduce or end Medicare-covered services, patients generally receive a written notice in advance and can request a fast appeal if they disagree. Our nurse visits guide explains what happens when visits end and how that appeal works.
You Have the Right to Choose Your Agency
This is the part many families don’t realize. When a hospital refers a Medicare patient to home health, federal discharge planning rules at 42 CFR 482.43 say the hospital generally needs to:
- Give the patient a list of Medicare-participating home health agencies that serve their area.
- Tell the patient they’re free to choose among those agencies.
- Respect the patient’s preferences when possible.
- Disclose any agency on the list in which the hospital has a financial interest.
- Share quality information to help the patient choose.
Medicare.gov notes the same applies when a doctor’s office arranges care: the provider should give you a list of agencies that serve your area and tell you about any financial interest. A recommendation from a doctor or discharge planner can be a helpful starting point, but the final choice belongs to the patient and family.
If You Have Medicare Advantage
Medicare Advantage plans also cover home health care, but they often limit coverage to agencies in their network and may require prior authorization. Before choosing, it’s worth calling the plan to confirm which agencies are in network. Our guide to Medicare Advantage home health coverage explains what to ask.
How to Compare Home Health Agencies
Start With Medicare Care Compare
Medicare Care Compare lets you search Medicare-certified home health agencies by ZIP code and see the services each one offers. It also shows two kinds of star ratings from CMS, updated quarterly:
- Quality of Patient Care: based on measures like how quickly care starts, whether patients improve in walking, bathing, and breathing, and how often patients end up back in the hospital.
- Patient Survey: based on what patients say about their care, communication with staff, and the agency overall.
CMS describes the ratings as one tool among several, so it’s worth looking at the details behind the stars, too. Some smaller agencies don’t have enough data for a rating, which isn’t necessarily a bad sign.
Questions to Ask Each Agency
- Are you Medicare-certified, and are you in network for my loved one’s plan?
- Can you start care within the timeframe the doctor ordered?
- Do you serve our address, including rural areas, consistently?
- Do you offer every service in the plan of care, such as physical, occupational, or speech therapy?
- Will we have the same nurse and therapists most of the time?
- Who do we call after hours or on weekends, and how quickly does someone respond?
- How do you coordinate with our doctor, and how will we hear about changes?
- Is there anything Medicare or our plan won’t cover, and what would it cost?
Signs an Agency May Be a Good Fit
- They answer the phone, return calls promptly, and explain things clearly.
- They’re specific about when the first visit will happen.
- They ask about your loved one’s goals, not only their diagnosis.
- They’re comfortable talking about their ratings and how they’ve worked to improve.
Can You Switch Agencies?
Generally, yes. Medicare rules allow a patient to transfer to a different home health agency, and families often do when care isn’t working out, such as missed visits, poor communication, or concerns about quality. The simplest route is to talk with the doctor, choose a new agency, and let both agencies coordinate the transfer so there’s no gap in care.
Every state also has a toll-free hotline for questions or complaints about home health agencies, and agencies are expected to share that number with patients at the start of care. Our guide to post-hospital in-home care has more on planning the first weeks at home.
When You Need More Help Than Home Health Provides
Home health care is part-time by design, and Medicare doesn’t cover 24-hour care or help with everyday tasks when that’s the only care needed. Many families pair home health visits with non-medical in-home care to cover the hours in between. A State Health Insurance Assistance Program (SHIP) counselor can answer Medicare coverage questions for free.
When you’re ready to compare options, you can find home health providers near you in the Senioridy directory, and in-home care providers for the help in between.
This article is for informational purposes only and does not constitute legal, financial, or medical advice. Medicare coverage rules, timeframes, and requirements are subject to change, so always confirm current details with Medicare, your plan, or your home health agency. Medicare Advantage plans may have network, prior authorization, and cost-sharing rules that differ from Original Medicare. For free, personalized Medicare guidance, contact your State Health Insurance Assistance Program (SHIP) counselor. Questions about a specific medical condition or care plan are best directed to your loved one’s physician.