Yes. If the rules are met, eligible patients pay $0 out of pocket for covered home health services. Medicare.gov states it plainly: you pay nothing for covered home health services. The benefit is paid under Part A, Part B, or both.

The words “for eligible patients” carry real weight. Four things all have to be true:

1. The patient is homebound as Medicare defines it.
2. The patient needs skilled care — nursing or therapy — on a part-time or intermittent basis.
3. A doctor or allowed practitioner orders the care and certifies eligibility after a face-to-face visit.
4. A Medicare-certified home health agency provides it. Bright Horizon is Medicare-certified (CA license 550007849).

All of the following, per Medicare.gov and 42 CFR 409.42:

• Under the care of a doctor or allowed practitioner — which since the CARES Act also means a nurse practitioner, physician assistant or clinical nurse specialist — who sets up and reviews a plan of care.
• Needs at least one skilled service: intermittent skilled nursing care (other than only drawing blood), physical therapy, speech-language pathology, or continued occupational therapy.
• Is certified as homebound. See the next question — it does not mean bedridden.
• Gets the care from a Medicare-certified home health agency.

Coverage is reviewed on a rolling basis: the certifying practitioner must recertify the plan of care at least every 60 days as long as care is still needed.

Important, and widely misunderstood: your parent does not have to be getting better to keep coverage. Under the Jimmo v. Sebelius settlement, coverage turns on the need for skilled care, not on the potential for improvement. Skilled nursing or therapy needed to maintain function or slow a decline is covered, and there is no cap on how long that can last if the criteria stay met.

Homebound does not mean bedridden, and it does not mean never leaving the house. This single misunderstanding is the most common reason families never call.

Medicare.gov states that a patient must meet both of these conditions:

Leaving your home isn’t recommended because of your condition, or you have trouble leaving your home without help (like using a cane, wheelchair, walker, or crutches; special transportation; or help from another person) because of an illness or injury — and you’re normally unable to leave your home and leaving takes a lot of effort.

The clinical version CMS gives to clinicians is a two-part test. Criteria One: the patient needs supportive devices such as crutches, canes, wheelchairs or walkers, needs special transportation, or needs the assistance of another person in order to leave home — or has a condition such that leaving home is medically contraindicated. Criteria Two: there must also exist a normal inability to leave home, and leaving home must require a considerable and taxing effort.

So your mother can still be homebound while she:

• goes to medical and therapy appointments,
• attends religious services,
• attends adult day care,
• goes to a funeral, a graduation or a family event.

Medicare.gov is explicit: you may leave home for medical treatment, or for short, infrequent absences for non-medical reasons, and you can still get home health care if you attend adult day care. What matters is the pattern over time, not one good afternoon.

Yes — Medicare will not pay without one. But you do not need it in hand before you call us. Getting the order is part of what we do.

Two requirements sit behind the order:

• The order and certification. A physician or allowed practitioner (nurse practitioner, physician assistant or clinical nurse specialist) must order the home health care, certify that the patient is homebound and needs skilled care, and establish the plan of care.
• The face-to-face encounter. There must be an in-person or qualifying telehealth visit related to the primary reason home health is needed, and the timing is strict: no more than 90 days before care starts, or within 30 days after care starts.

That 30-day-after window is the part families miss. If your parent saw their doctor last month about the fall, the hospitalization or the wound, that visit may already satisfy the requirement. If they have not been seen recently, care can still begin and the visit can happen within 30 days.

Changed for 2026

Medicare-covered home health services include:

• Part-time or intermittent skilled nursing care — wound care for pressure sores or a surgical wound, injections, intravenous or nutrition therapy, monitoring serious illness and unstable health status, and teaching the patient and the family caregiver.
• Physical therapy, occupational therapy and speech-language pathology services, if certain conditions are met.
• Medical social services — help with the practical and emotional side: benefits, community resources, planning.
• Part-time or intermittent home health aide care — help with bathing, grooming, walking, feeding, changing bed linens. Covered only while the patient is also receiving skilled nursing or therapy.
• Medical supplies for use at home, and injectable osteoporosis drugs for women who meet certain criteria.
• Durable medical equipment — with the 20% coinsurance noted above.

Medicare does not pay for:

• 24-hour-a-day care at home.
• Home meal delivery.
• Homemaker services such as shopping and cleaning, when unrelated to the plan of care.
• Custodial or personal care that helps with daily living — bathing, dressing, using the bathroom — when that is the only care needed.

Think visits, not shifts. There is no lifetime cap — Medicare.gov confirms that if you qualify you can get unlimited home health visits. What is limited is the intensity in any given week.

Per Medicare.gov:

• In most cases, part-time or intermittent means skilled nursing care and home health aide services up to 8 hours a day combined, to a maximum of 28 hours a week.
• More frequent care is possible for a short time — less than 8 hours a day and up to 35 hours a week — if the practitioner decides it is necessary.

The statute itself (42 U.S.C. §1395x(m)) defines part-time or intermittent services as skilled nursing and home health aide services furnished any number of days per week as long as they are furnished, combined, less than 8 hours each day and 28 or fewer hours each week — or, subject to case-by-case review of the need for care, less than 8 hours each day and 35 or fewer hours per week. The same section defines intermittent skilled nursing as care provided or needed on fewer than 7 days each week, or less than 8 hours of each day for periods of 21 days or less.

What this looks like in a real house: a nurse visit that lasts well under an hour, a few times a week, plus therapy sessions — not a caregiver present all day. And note the flip side, which Medicare.gov states directly: you will not qualify for home health services if you need more than part-time or intermittent skilled care.

The home health benefit still exists — Medicare Advantage plans must cover everything Original Medicare covers. Three practical differences:

1. Prior authorization. An Advantage plan can require approval before care starts. Original Medicare does not require prior authorization for home health. This is the single biggest source of delay.
2. Networks. An Advantage plan may limit you to agencies in its network.
3. Cost sharing. A plan may apply a copay to home health visits where Original Medicare charges nothing. Medicare.gov advises checking directly with your plan.

Protections that work in your favor, per the CMS 2024 Medicare Advantage final rule (CMS-4201-F): Advantage plans must apply coverage criteria consistent with Traditional Medicare and run a utilization management committee that reviews policies annually for that consistency; an approved prior authorization must stay valid for as long as the course of treatment is medically reasonable and necessary; and if you switch plans mid-treatment the new plan must give you a minimum 90-day transition period without requiring new prior authorization for the active course of treatment.

Changed for 2026

Bright Horizon is in network with Dignity Health, AHMC and Southern California IPAs. Call and we will check your specific plan before you commit to anything.

Yes. That is the normal way this starts. You do not need an order, a referral, a diagnosis code or an answer to any of the questions above before you pick up the phone.

Call (818) 818-6293 — the registered nurse who owns the agency answers personally. Here is what happens from there:

1. We listen. What happened, what the discharge papers say, what you are actually worried about at 2am.
2. We tell you honestly whether this looks like a Medicare fit — whether the homebound standard and the skilled-care requirement are likely to be met. An RN makes that judgment, not a call center.
3. If it looks like a fit, we do the chasing. We contact the physician’s office to request the order, and we work out whether the face-to-face requirement is already satisfied by a recent visit or needs to be scheduled.
4. If it is not a Medicare fit, we say so — and walk you through the honest alternatives: a private-duty home care agency for non-medical help at home, our congregate living health facilities for residents needing 24-hour skilled nursing, skilled nursing facility placement, or hospice if that is where things are.

Nothing about the call commits you to anything. Spanish and Armenian spoken. We serve Los Angeles, Orange, Riverside, San Bernardino and Ventura counties.

No — and you should be skeptical of anyone who tells you otherwise. Medicare.gov lists 24-hour-a-day care at your home among the things Medicare does not pay for, and an aide is only covered alongside skilled nursing or therapy, never on its own. So overnight sitting, night-shift supervision and around-the-clock care are not Medicare home health benefits, from any agency in California.

This is exactly the gap most families are standing in: the nurse visits are covered, but the nights are not, and the nights are what nobody can survive.

What we can tell you honestly. Bright Horizon is a home health agency, so we provide the skilled visits Medicare covers — nursing and therapy — not someone who stays through the night. Around-the-clock caregiving in your own home is a different kind of company: a private-duty home care agency, paid privately by the family. We are glad to tell you what to look for and what to ask them.

When the need is medical, not just supervision, there is another route we do operate. Benchmark Health Group runs two Congregate Living Health Facilities — Saint Mariam Congregate in Sylmar and Best Quality Living in Northridge — residential homes providing 24-hour skilled nursing for medically complex residents: brain and spinal cord injury, ventilator dependency and weaning, complex wounds, and neuromuscular conditions. If your family member needs nursing care around the clock rather than help at home, call and we will tell you whether that is the right fit.

Often yes — and importantly, Medi-Cal can cover the everyday help Medicare will not. If your parent has both Medicare and Medi-Cal, Medicare generally pays first for home health, and Medi-Cal may pick up services Medicare excludes as well as some Medicare cost sharing.

The two California programs worth knowing about:

• IHSS (In-Home Supportive Services) — a statewide Medi-Cal benefit administered by each county for people with limited income who are 65 or older, blind or disabled. It can cover housecleaning, meal preparation, laundry, grocery shopping, personal care such as bathing, grooming and bowel and bladder care, paramedical services, accompaniment to medical appointments, and protective supervision for people with cognitive impairment. That is precisely the non-skilled help Medicare home health does not pay for. You apply through your county, not through a home health agency.
• Community Supports — offered through Medi-Cal managed care plans for members at high risk of hospitalization or nursing home placement. One of them, Personal Care and Homemaker Services, can bridge gaps: while an IHSS assessment is pending, when needs exceed the IHSS hours authorized, or as short-term in-home help (limited to 60 days) to avoid a nursing home stay after surgery.

Bright Horizon accepts Medicare and Medi-Cal. Because eligibility and plan contracts vary case by case, the fastest route is to call and let us look at the specifics with you.