Paying for care
How home health care gets paid for.
Medicare pays the full cost of covered home health services. Here is how the three payment routes work, and what Medicare requires.
Insurance Coverage
We will verify your coverage upon receipt of any assignment of benefits, and we will bill your insurance carrier directly.
Medicare
If you are eligible for home health coverage through Medicare, our office will bill Medicare directly.
Direct Payment
When billed directly to you, the Wholesome Home Health statement clearly identifies the visits and hours spent by our care professionals. You pay only the per-visit or per-hour rate — we cover all taxes and insurance for our employees.
Does Medicare cover it?
Medicare covers home health care when all of the following are true.
A provider orders it
A doctor or other health care provider must order your care, and must certify that you need it.
You are seen face-to-face
A health care provider must assess you in person before certifying that you need home health services.
You need part-time or intermittent skilled care
Skilled nursing, physical therapy, speech-language pathology, or continued occupational therapy. If you need more than part-time or intermittent skilled care, you will not qualify.
You are homebound
Medicare has a specific definition of this, and it is less restrictive than most people assume. See below.
The agency is Medicare-certified
A Medicare-certified home health agency must provide the care. Wholesome Home Health has been Medicare-certified since October 2024.
What “homebound” actually means
People often assume homebound means never leaving the house. It does not. Under Medicare’s definition, both of these must be true:
- Leaving home isn’t recommended because of your condition, or you have trouble leaving without help — a cane, wheelchair, walker, crutches, special transportation, or another person.
- You are normally unable to leave home, and leaving takes a lot of effort.
And you can still do all of this while qualifying:
- Leave home for medical treatment.
- Take short, infrequent absences for non-medical reasons, such as attending religious services.
- Attend adult day care.
What you pay
Medicare pays the full cost of covered home health services. You pay nothing for them.
These are Medicare's rules, not a guarantee of coverage in any individual case. Your eligibility is determined by your provider and by Medicare.
After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for Medicare-covered durable medical equipment. If you have a Medicare Advantage plan, check with your plan — its home health benefit may differ. Before care starts, we will tell you what Medicare will pay, and tell you in writing if there is anything Medicare will not cover.
What home health does not cover
Being straight about this saves everyone a difficult conversation later. Medicare’s home health benefit does not pay for:
- 24-hour-a-day care at home
- Home meal delivery
- Homemaker services, such as shopping and cleaning, unrelated to your care plan
- Custodial or personal care — help with bathing, dressing or using the bathroom — when that is the only care you need
What to ask your doctor
Home health starts with a physician’s order. If you think it is needed, these are the questions that move it forward.
- Do you think home health is appropriate for me — and would I meet Medicare’s homebound criteria?
- Which services do you want ordered — nursing, physical therapy, occupational therapy, speech therapy?
- How often should the nurse or therapist visit?
- Can you send the order and my records to Wholesome Home Health?
Medicare rules on this page are from medicare.gov — Home health services, checked 27 August 2026. They describe Medicare’s requirements, not a guarantee of coverage in any individual case. Your eligibility is determined by your provider and by Medicare.
We will check your coverage before care starts.
Call and tell us what insurance you have. We verify coverage on receipt of an assignment of benefits and bill your carrier or Medicare directly.