Original Medicare care guide
Medicare Home Health, Hospice and DME Coverage
Three commonly confused benefits use different eligibility rules: skilled home health care, comfort-focused hospice care and medically necessary durable medical equipment.
Coverage at a glance
How Medicare Covers Home Health, Hospice and Equipment
Home Health
You generally must be homebound and need part-time or intermittent skilled nursing, physical therapy, speech-language pathology or continuing occupational therapy. A doctor or other permitted practitioner must complete the qualifying face-to-face encounter, certify the need and order the care under Medicare’s timing and documentation rules. Currently permitted telehealth rules may apply. A Medicare-certified home health agency must deliver the services.
- Covered services can include skilled nursing, therapy, medical social services, supplies and a part-time home health aide while you also receive qualifying skilled care.
- Medicare does not cover 24-hour home care, home-delivered meals, unrelated homemaker services or personal care when that is the only need.
Compare Medicare home health with nonmedical home care →
For the PT, OT and speech-language pathology rules themselves—including outpatient Part B thresholds—see Medicare Therapy Coverage.
Hospice
Hospice is covered under Part A when the hospice medical director and the patient’s physician, if any, certify a life expectancy of six months or less if the illness follows its normal course. The beneficiary accepts comfort-focused care instead of Medicare coverage for treatment intended to cure the terminal illness and signs a hospice election.
Benefits can include symptom management, nursing, equipment, supplies, counseling, short-term inpatient care and limited respite arranged by the hospice. Hospice eligibility can continue beyond six months when the person remains eligible and is recertified.
If you keep Medicare Advantage during hospice: Original Medicare generally pays the Medicare hospice benefit and covered care related to the terminal illness. You can retain your plan by paying its premiums. Coordinate additional benefits, unrelated covered care and unrelated drug coverage with the plan and hospice. For unrelated covered services, you may have Original Medicare and plan options; ordinary MA network instructions are not the rule for the hospice benefit itself. See Medicare’s hospice booklet.
Arrange related care with the hospice team. Hospital outpatient or emergency-department care, inpatient care and ambulance transportation related to the terminal illness and related conditions must be arranged by the hospice team for coverage. Otherwise, you may have to pay the full cost. Unrelated care can remain covered under ordinary Medicare rules. Seek urgent medical help when needed; do not delay emergency treatment for a routine coverage check. Review Medicare’s hospice coverage rules.
Hospice Costs and Limits
There is no hospice deductible. You may pay up to $5 for each outpatient prescription for pain and symptom management and 5% of the Medicare-approved amount for inpatient respite care. Room and board is generally not covered when you live at home, in assisted living or in a nursing facility.
Respite is occasional and short term. The hospice arranges an approved inpatient stay so a caregiver can rest. It is not an ongoing residential benefit.
Durable Medical Equipment
Covered DME must be durable, used for a medical reason, useful to someone who is sick or injured, used in the home and expected to last at least three years. Examples can include walkers, wheelchairs, hospital beds, oxygen equipment and certain diabetes supplies. A treating practitioner must prescribe it, and the supplier must meet Medicare enrollment rules.
After the Part B deductible, you generally pay 20% of the Medicare-approved amount. Whether you rent or buy depends on the item and Medicare rules.
Coordination
Ask who is ordering, supplying and supervising the service
- Confirm that the home health agency, hospice or DME supplier participates in Medicare.
- Ask which part of Medicare will process the claim.
- Verify any Medicare Advantage network and prior-authorization rules.
- Request an explanation of items or hours that are not covered.
- Keep every election statement, plan of care, delivery ticket and noncoverage notice.
A Practical Equipment and Supplier Checklist
Before accepting delivery, ask the clinician and supplier to connect the order, the coverage requirements and your expected cost. A prescription alone does not settle every coverage question.
- Order and records: confirm who will supply the written order and supporting medical records, including any required visit or documentation for that item.
- Supplier: verify Medicare enrollment and whether the supplier accepts assignment for the item. With Medicare Advantage, also check the exact plan’s supplier network and authorization requirements.
- Equipment: ask which model and accessories are covered and whether an upgrade would leave you with an additional bill.
- Rental or purchase: ask which arrangement applies, how long payments may continue, who owns the equipment and what happens if your coverage or supplier changes.
- Ongoing service: identify who handles delivery, setup, repairs, replacement parts and recurring supplies. Keep the delivery record and supplier’s contact details.
- Cost or noncoverage: request an estimate and an explanation of any notice you are asked to sign. Understand the financial responsibility before choosing an optional item.
Medicare’s DME coverage overview explains general requirements and rental/purchase differences. For item-specific guidance, see CPAP and sleep-apnea coverage and Medicare diabetes coverage. If equipment is part of a planned recovery, use the surgery coverage checklist before the discharge arrangements are finalized.
Frequently asked questions
Home Health, Hospice and DME Questions
Does Medicare home health include a full-time caregiver?
No. The benefit is designed around part-time or intermittent skilled services. A home health aide can be covered only in defined circumstances while qualifying skilled care is also being received.
Can hospice last longer than six months?
Yes. Six months is the prognosis standard, not an automatic cutoff. Coverage can continue through additional benefit periods while eligibility is recertified.
Does hospice pay nursing-home room and board?
Generally no. Hospice covers care related to the terminal illness, but ordinary room and board is usually not covered.
Does Medicare pay for any medical equipment online?
Not automatically. The item must be covered, medically necessary and prescribed, and the supplier must meet Medicare requirements. Verify the supplier before ordering.
More Medicare guidance
Related Articles
Primary references
Official Sources
Reviewed against official sources on August 22, 2026. Medicare and state program rules can change; verify current requirements before acting.
Independent Medicare guidance
Questions About Coverage or Equipment?
Start with the treating team and supplier for care decisions and immediate needs. Benjamin can help explain your plan’s coverage process and the next administrative step.
Thompson Medicare Brokerage is not connected with or endorsed by the U.S. government or the federal Medicare program. This page provides general educational information. Coverage, costs, eligibility, networks, formularies and enrollment rights depend on individual facts, location, plan and coverage year. Thompson Medicare Brokerage does not offer every plan available in every area; Medicare.gov, 1-800-MEDICARE and SHIP can provide information about all available options.