In most cases, Medicare covers up to 8 hours a day and a combined maximum of 28 hours a week of skilled nursing and home health aide care — and up to 35 hours a week for a short stretch if your provider decides it is necessary (Medicare.gov).
There is no cap on the number of visits. If you keep qualifying, the visits keep coming. The cap is on how much care fits into a week, and 28 hours is four hours a day — which is a very different thing from the round-the-clock help most families are picturing when they ask this question.
The limits, side by side
| What | Medicare’s rule |
|---|---|
| Hours per day | Up to 8, skilled nursing and aide care combined |
| Hours per week | Up to 28 in most cases |
| Short-term exception | Less than 8 hours a day, up to 35 hours a week, if your provider says it’s necessary |
| Total visits | Unlimited, as long as you keep qualifying |
| Recheck | Recertification by a physician or allowed practitioner at least every 60 days |
| Your cost | $0 for covered home health services |
The 28-hour figure and the 35-hour exception both come straight from Medicare’s own coverage page. The 60-day recertification is in the regulation itself — 42 CFR 424.22, which also makes clear there is no limit on how many times you can be recertified if you still need the care.
Who qualifies — the two gates
Home health is not something you can simply arrange. Two conditions have to be true at the same time.
You need part-time or intermittent skilled services. Skilled nursing, physical therapy, occupational therapy, or speech-language pathology. If you need more than part-time or intermittent skilled care, you do not qualify for the home health benefit at all.
You are homebound. Medicare defines that as both of the following: leaving home isn’t recommended because of your condition, or you have trouble leaving without help — a cane, wheelchair, walker, crutches, special transportation, another person — and you are normally unable to leave, and leaving takes a lot of effort.
Homebound does not mean housebound. You can leave for medical treatment. You can go to religious services. You can attend adult day care and still qualify.
On top of that, a health care provider must assess you face-to-face before certifying that you need home health, must order the care, and a Medicare-certified home health agency has to deliver it. If your provider refers you, they should hand you a list of agencies serving your area, and they must disclose whether their organization has a financial interest in any agency on it.
What the aide can and cannot do
This is where the expectation gap usually opens.
Medicare will cover a part-time or intermittent home health aide — help with walking, bathing, grooming, changing bed linens, feeding — but only if you are also getting skilled nursing, physical therapy, speech-language pathology or occupational therapy at the same time. The aide rides along with the skilled care. When the skilled need ends, the aide ends with it.
And Medicare explicitly does not pay for:
- 24-hour-a-day care at home
- Home meal delivery
- Homemaker services like shopping and cleaning that are unrelated to your care plan
- Custodial or personal care — bathing, dressing, using the bathroom — when that is the only care you need
That last line is the whole long-term care problem in a single sentence. The help most people eventually need is exactly the help the home health benefit is designed not to be.
What it costs
You pay nothing for covered home health services. The exception is equipment: after you meet the Part B deductible — $283 in 2026 — you pay 20% of the Medicare-approved amount for covered durable medical equipment, the hospital bed or the walker or the oxygen setup. Our annual Medicare cost breakdown walks through how that deductible fits with everything else you pay in a year.
Before care starts, the agency should tell you how much Medicare will pay, and should tell you both verbally and in writing if Medicare will not cover something — a notice called an Advance Beneficiary Notice. If you are on a Medicare Advantage plan, check your plan’s rules: coverage of home health can run through a plan network and carry its own authorization requirements and cost-sharing, which is a real difference from Original Medicare rather than a footnote. If you have a Medigap policy, tell the agency so the bills route correctly.
If the agency says your care is ending, you can appeal — fast
Home health does not usually stop with a denial letter. It stops with an agency telling you the care is finishing, often with a couple of days’ notice.
You have a formal right to challenge that, and the clock is short.
Before covered care ends, the agency must give you a Notice of Medicare Non-Coverage, generally at least two days before the last covered day. That notice is not a formality — it is the document that starts your appeal rights, and it tells you how to use them.
If you disagree, you can request an expedited review by the Beneficiary and Family Centered Care Quality Improvement Organization for Florida. The essentials:
- Call by noon of the day after you receive the notice. This is the part people miss. It is a next-day deadline, not a next-week one.
- Care generally continues while the review runs, and you are not charged for that period if the decision goes your way.
- The reviewer looks at whether you still meet the coverage criteria — the skilled need and the homebound status — not at whether the agency wants to keep serving you.
- The decision typically arrives within about two days.
If the expedited review upholds the agency, there are further levels of appeal, but they run on ordinary timelines rather than emergency ones.
Two things make an appeal succeed or fail, and neither is the phone call itself. The first is whether the skilled need is documented: “she is not getting any better” is a reason coverage ends, not a reason it should continue, whereas an unstable wound, a medication regimen needing adjustment or therapy still producing measurable change is the opposite. The second is whether your doctor is engaged — the reviewer is reading clinical documentation, so a physician willing to write down why skilled care is still required matters more than anything you say.
Ask for the notice in writing the moment anyone mentions discharge, and read the date on it.
The Florida wrinkle
Florida is one of six states — with Illinois, Ohio, Texas, North Carolina and Oklahoma — in Medicare’s Review Choice Demonstration for home health services, which CMS extended for five years effective June 1, 2024 (CMS.gov).
It is a billing-integrity program aimed at agencies, not at you, and it does not change what you are entitled to. But it does mean Florida agencies are submitting documentation for review either before the claim or after payment, and paperwork that thorough is paperwork that can stall. If a Tampa or Sarasota agency asks for a signature or a physician’s note quickly, that is why. Return it quickly.
What to ask the agency in the first week
The difference between families who get the full benefit and families who get less is usually just knowing which questions to ask early.
- “How many hours a week am I certified for, and by whom?” Get the number rather than a description of it. It is on the plan of care.
- “When is my next recertification date?” Recertification is at least every 60 days. Knowing the date means the discharge conversation never arrives as a surprise.
- “Which services am I getting — and is the aide tied to any of them?” If the aide is riding along with physical therapy, the aide ends when therapy does. That date is the one worth writing down.
- “Are you giving me an Advance Beneficiary Notice for anything?” That notice means the agency expects Medicare not to pay for a specific item. Ask what and why before you sign.
- “What happens if I need more than you can provide?” The answer tells you whether the agency has a private-pay arm, and what it charges — which is the number that matters once the benefit ends.
Write the recertification date on the calendar. It is the single most useful piece of paper in the whole arrangement.
The part this benefit was never built for
The Administration for Community Living reports that about 70% of people turning 65 will need some type of long-term care services in their lifetimes (ACL.gov). Very little of that need looks like skilled nursing under a 60-day certification. Most of it looks like someone coming three afternoons a week, indefinitely, to help with the ordinary business of a day.
Medicare’s home health benefit is a rehabilitation benefit with a stopwatch on it. It is genuinely useful after a fall, a stroke, a joint replacement or a hospital discharge — and it is not a plan for what comes after. We wrote about the other half of that gap in Does Medicare Pay for Assisted Living in Florida?
If you want to see the size of the gap in dollars rather than in hours, our long-term care cost estimator takes the current cost of care where you actually live — Tampa, Clearwater and Naples are not the same market — and projects it forward at an inflation rate you choose. Run it twice, at 3% and at 5%, and the difference is the conversation.
Virginia Barausky is CLTC-certified, and comparing traditional, hybrid and asset-based ways to fund that gap is the core of her practice rather than a sideline. If you’d like the options put side by side against your own numbers, schedule a call. There’s no cost, and nothing to decide on the first conversation.