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Medicare Qualifications


A question we hear regularly is “what are the Medicare qualifications, and do I qualify”.

Home health care includes a wide range of health and social services brought into  your home to treat illness or injury. The complete services covered by Medicare’s home health benefit include skilled nursing care, therapy, and care provided by a home health aide. Depending on the circumstances, home health care will be covered by either Part A or Part B.

medicareAccording to the Centers for Medicare & Medicaid Services (CMS), the average monthly premium for a Medicare Advantage (MA) plan has dropped to $21 in 2021 and is projected to drop to $19 in 2022. However, the average monthly premium for a Part D prescription drug plan will increase slightly to $33, compared with $31.47 this year.


Though Medicare Qualifications can be strict, they will cover your care if these requirements are met:

  • You are completely home bound and unable to leave your home on your own.
  • You need skilled nursing services and/or skilled therapy care on an intermittent basis or you have a  meeting with a doctor within the 90 days before you start home health care, or the 30 days after the first day you receive care.
  • Your doctor signs a home health certification confirming that you are home bound and need skilled care. The certification must also state that your doctor has approved a plan for you and that the meeting requirement was met. Your doctor should review your situation every 60 days. You must receive care from a certified Medicare agency.

Note: You cannot qualify for Medicare home health coverage if you only need occupational therapy. However, if you qualify for home health care on another basis, you can also get occupational therapy. When your other home health needs end, you can continue receiving Medicare-covered occupational therapy under the home health benefit if you need it.

If you meet all the requirements, Medicare should pay for skilled care in your home and/or home health aide services. If you have questions or experience billing issues, call 1-800-MEDICARE.

For more on this topic, read Medicare Rules on Home Health Care.

You can learn more about Medicare and supplemental plans by following the links below:

Related: How to Pay for In-Home Health Care in Arizona.