Medicare’s home health benefit contains two very different cost rules. Covered home health services themselves carry no patient charge, while Medicare-covered equipment used at home generally leaves the beneficiary responsible for 20% of the approved amount after the Part B deductible. Confusing those categories can turn a promised zero-dollar visit into an unexpected equipment bill.
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What Medicare home health covers at no cost
Home health coverage is available only when the beneficiary meets Medicare’s conditions. The person must need part-time or intermittent skilled services and be homebound under the program’s definition. A qualified provider must conduct the required assessment, order the care, and arrange services through a Medicare-certified home health agency. Medicare’s home-health rules draw the line between visits and equipment. Medicare’s current home health page states that covered home health services cost $0. On the same page, the agency says a beneficiary pays 20% of the Medicare-approved amount for covered medical equipment after meeting the Part B deductible, including items such as wheelchairs, walkers, and hospital beds.
The separate treatment reflects what Medicare is paying for. Skilled nursing, qualifying therapy, medical social services, and certain part-time aide services can fall within the home health benefit. Durable medical equipment is billed under its own Part B rules even when the equipment is delivered as part of care at home.
Why durable equipment still carries 20% coinsurance
Covered skilled services can include wound care, injections, monitoring an unstable condition, physical therapy, occupational therapy, and speech-language pathology. Home health aide care is covered only when the patient is also receiving qualifying skilled services; personal care by itself does not create eligibility. The durable-equipment coverage page explains what the 20% applies to. Medicare does not cover round-the-clock care at home, home-delivered meals, unrelated homemaker services, or custodial help when that is the only care needed. A household that assumes the benefit pays for general caregiving may face private-pay charges despite an approved skilled-care plan.
For equipment, both the prescriber and supplier generally must meet Medicare requirements. Assignment matters because a participating supplier that accepts assignment agrees to the Medicare-approved amount. Equipment may be rented or purchased depending on the item, and repair or replacement rules can affect later costs.
Supplier status determines the equipment starting price
The 20% share is calculated from Medicare’s approved amount, not automatically from the supplier’s sticker price. The agency’s equipment supplier directory identifies Medicare-enrolled suppliers and allows price comparisons for specific ZIP codes and items. A supplier that accepts assignment agrees to the approved amount as full payment for the covered item, while a nonparticipating supplier can expose the patient to different billing risk. The order, supplier enrollment, and assignment answer should be confirmed before delivery.
An Advance Beneficiary Notice is not a denial; it is a warning that the supplier expects Medicare may not pay and gives the patient choices about receiving the item and seeking an official decision. Medicare’s beneficiary-protection guidance explains that an ABN should identify the service and expected financial liability. Blank or vague notices should not substitute for an itemized estimate. The signed notice, prescription, delivery ticket, and claim decision form the record if coverage is challenged.
Who qualifies for home health coverage
The split cost rule applies to Original Medicare beneficiaries receiving covered home health and covered equipment. A Medicare Advantage plan must cover Medicare-required services but may use plan networks, prior authorization, and plan-specific cost sharing. Medigap or other insurance may pay part of the 20% equipment coinsurance.
Confirming coverage before equipment arrives
Before care starts, the home health agency should explain what Medicare is expected to pay and identify any service or supply it believes will not be covered. When noncoverage is expected, the agency should issue an Advance Beneficiary Notice describing the item and estimated financial responsibility. An equipment order should be checked against Medicare’s supplier directory, and the supplier should be asked whether it accepts assignment. The beneficiary or representative can request the Medicare-approved amount and the expected 20% share before delivery instead of relying on a retail price.
Care plans, physician orders, delivery receipts, and notices should be kept together. If a claim is denied, those records support an appeal and help show whether the service met home health criteria or the equipment was medically necessary and properly ordered. The zero-dollar rule is limited to covered home health services. It does not make every form of care in the home free, and it does not erase Part B cost sharing for equipment. The verified distinction is service-specific: $0 for covered home health visits, then 20% of the approved equipment amount after the deductible.
The label on a bill can reveal why cost sharing appears. Nursing and therapy visits should be processed as home health services when all requirements are met, while a wheelchair or hospital bed appears as durable medical equipment. Supplies consumed as part of care may follow still another rule. An itemized explanation lets the beneficiary test the correct category instead of assuming the agency broke a zero-cost promise.
Equipment ownership terms matter over time. Some items are rented for a period before ownership transfers, while others are purchased. Supplier changes, repairs, replacement after loss or damage, and use of a nonparticipating supplier can alter later bills. Before accepting delivery, the household can ask whether the item is rented or purchased, the expected number of rental months, and who handles maintenance. Those questions protect against recurring charges that were not obvious at the first visit.
“Homebound” does not mean a person can never leave home. Medicare focuses on whether leaving requires considerable effort or assistance and whether absences are limited. The certifying clinician’s records should describe that condition and the skilled service required; a vague request for help at home is not enough to establish the benefit.
This article was researched and drafted with AI assistance and reviewed against the linked primary sources.
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Warren Cohen is a finance writer based in Phoenix, Arizona, covering personal finance topics including credit, banking, and beginner investing. He earned his degree in business administration from Arizona State University and began his career working in consumer finance, where he gained direct experience with lending and credit systems. He now writes for personal finance websites and fintech platforms, focusing on clear, practical content that helps readers make informed financial decisions.
