Does Medicare Cover Home Health Care? A Berks County Answer
What Medicare pays for in home health care and what it doesn't, who qualifies, how Medical Assistance and the Berks County Area Agency on Aging fit in, and how to choose an agency.
Yes, Medicare covers home health care when your parent qualifies, and there's nothing to pay for the covered visits themselves. The one bill that can show up is for medical equipment, where Medicare pays 80 percent and your parent pays 20 percent after the yearly Part B deductible, the amount you pay each year before Part B starts paying. If what your parent needs is help bathing, dressing and with meals, and nothing a nurse or therapist has to do, Medicare won't pay for it, and the sections below on home care and on Medical Assistance are the ones for you. The catch is in two words, qualifies and covered, so I'll walk through both, then show you how to pick an agency from the county home health care page.
Under Original Medicare, the kind that comes straight from the government rather than through a private plan, the covered services cost your parent nothing. If your parent has a Medigap policy (Medicare supplement insurance) or other coverage, tell the agency so the bills go to the right place.
Who qualifies for home health care under Medicare?
Two things both have to be true. First, your parent has to be what Medicare calls homebound, and that test has two parts of its own, both of which have to be true. One: leaving home isn't recommended because of their condition, or they can't leave without help such as a cane, walker, wheelchair, special transportation or another person. Two: they're normally unable to leave home, and leaving takes a lot of effort. Trips for medical treatment, religious services or adult day care are allowed, and so are short, infrequent ones.
Second, your parent has to need part-time or intermittent care that has to be done by a nurse or therapist, which Medicare calls skilled care. That means skilled nursing such as wound care, injections, IV or nutrition therapy, or monitoring an unstable condition, or it means physical therapy or speech-language pathology, or occupational therapy once it was first ordered along with nursing care, physical therapy or speech-language pathology. Someone who needs a nurse full time doesn't qualify for home health.
A doctor, nurse practitioner, clinical nurse specialist or physician assistant has to order the care under a plan of care, and an agency Medicare has approved to bill it provides it. Someone on the care team, a doctor, nurse practitioner, clinical nurse specialist, physician assistant or nurse-midwife, also has to have seen your parent about the reason for home health, in person or by video. That visit has to fall in a window, no more than 90 days before care starts or within 30 days after it starts, and the doctor who signs off on the need (Medicare calls it certifying) writes down the date.
What does Medicare pay for at home, and what won't it cover?
Medicare pays for part-time or intermittent skilled nursing, for physical, occupational and speech therapy, for medical equipment and supplies, and for a home health aide's help with bathing, grooming, walking, changing linens or feeding. The aide comes with one condition: Medicare only covers the aide while your parent is also getting skilled nursing or therapy.
Medicare doesn't pay for 24-hour-a-day care at home, for meals delivered to the home, or for homemaker services like shopping, cleaning and laundry that aren't part of the care plan. It also doesn't pay for personal care, meaning help bathing, dressing or using the bathroom, when that's the only care your parent needs.
Before the agency gives a service Medicare probably won't pay for, it has to hand you a written notice saying so and what it will cost, called an Advance Beneficiary Notice. Before it reduces or stops services, it owes you a written notice of that too.
How much home health care does Medicare cover, and how do you choose an agency in Berks County?
There's no cap on the number of visits if your parent qualifies, but part-time or intermittent has a definition. Skilled nursing and aide hours combined have to stay under 8 hours a day and at or below 28 hours a week in most cases, with up to 35 allowed for a short time when the doctor says it's needed. The plan of care is reviewed and the doctor signs off on the need again at least every 60 days, so the coverage isn't open-ended, but there's no set day it stops.
When the doctor decides home health is needed, they should hand you a list of Medicare-approved agencies that serve your area, and they have to tell you if their organization has a financial interest in any agency on it. Your parent has a say in which one is used, and the hospital or the doctor's office should honor that choice if the agency can take your parent. If your parent is on a Medicare Advantage plan, call the plan first, because it may require an agency it contracts with and approval in advance; how the two kinds of Medicare differ is in Medicare plans in Berks County. Medicare's list for Berks runs to dozens of agencies, a dozen or more for each of the towns in the table below.
| Area | Approved agencies that say they serve it |
|---|---|
| Berks County, every ZIP code | 54 (10 with Berks addresses) |
| Reading, 19601 | 20 |
| Wyomissing, 19610 | 12 |
| Kutztown, 19530 | 20 |
| Hamburg, 19526 | 13 |
| Boyertown, 19512 | 21 |
| Fleetwood, 19522 | 14 |
| Birdsboro, 19508 | 18 |
| Douglassville, 19518 | 20 |
From the October 2026 data behind Medicare's own agency finder, Care Compare; the counts change every month and nothing here is ranked.
A name with "Home Care" in it tells you nothing about whether Medicare has approved it, so ask the agency whether Medicare has approved it before you choose. Most of the agencies on the list are based elsewhere in Pennsylvania and serve Berks from there. To compare, Medicare's own agency finder, Care Compare, lists every approved agency that serves your ZIP code, and the county home health care page has the county's home health and home care listings by town.
What's the difference between home health and home care?
Pennsylvania licenses the two separately. A home health care agency is licensed by the Department of Health to provide skilled nursing and at least one other service, such as physical, occupational or speech therapy, medical social work or home health aides, part-time in the home, and the Medicare-approved ones are the agencies Medicare pays. A home care agency is licensed to provide non-skilled help: personal care such as bathing, dressing, feeding, toileting and help with medications the person takes themselves, plus household tasks, companionship and respite, a break for the family caregiver. The county home health care page lists both kinds of agency, so it's the right list either way; ask each one which kind it is.
Home care is what a family pays for privately when the only need is personal care and no program is paying. In the Reading area the median for a non-medical caregiver was $34 an hour in the 2025 national Cost of Care Survey, and the Pennsylvania median for a private-duty nurse at home was $71 an hour. If the question is whether your parent should stay home at all, the senior services guide covers assisted living and nursing homes.
Does Medical Assistance pay for home care in Pennsylvania?
If your parent has Medical Assistance, which is Pennsylvania's name for Medicaid, as well as Medicare, there's a second payer for care at home. Community HealthChoices is the program Medical Assistance uses to pay for long-term care at home, for people 21 and older who have both Medicare and Medical Assistance or who need as much help as a nursing home gives. If your parent is found to need that long-term help, it covers personal assistance, home health aide and nursing visits, home-delivered meals, respite, a personal emergency response system and home adaptations.
Applying starts with a call to the statewide contractor the state uses to process these applications, the Independent Enrollment Broker, at 1-877-550-4227. The broker takes the referral, the doctor completes a certification form, the Area Agency on Aging (the county's office for older adults, more on it below) does an in-home assessment, the County Assistance Office, which handles Medical Assistance locally, decides financial eligibility, and the decision comes within 90 days. Whether your parent qualifies for Medical Assistance at all is its own question, answered in Medical Assistance and CHIP in Berks County.
Who helps with home care in Berks County?
For anyone 60 or older who needs help at home, the county office is the Berks County Area Agency on Aging at 400 E. Wyomissing Avenue in Mohnton, 610-478-6500, weekdays 8 to 5, with 24-hour emergency service. Its assessors do the in-home needs assessment for the OPTIONS program, which is for people 60 and over who aren't Medicaid-eligible and carries a sliding cost share tied to income. The office also runs the Care at Home program, which arranges personal care, meals, home modifications and emergency response buttons.
For the Medicare side, free Medicare counseling from PA MEDI is where to take your questions, and our guide to the Berks County Area Agency on Aging explains what the office does. One call to the Area Agency on Aging early on is a sensible first move.
Frequently asked questions.
Does Medicare pay for a home health aide?
Yes, for help with bathing, grooming, walking, changing linens or feeding, but only while your parent is also getting skilled nursing or therapy. Once the skilled care ends, the aide's hours aren't covered.
Does Medicare pay for 24-hour care at home?
No. Home health is part-time or intermittent by definition, and round-the-clock care is on the list Medicare doesn't pay for. Two other ways to pay for more hours are Medical Assistance, if your parent qualifies, and paying a home care agency privately.
Does a Medicare Advantage plan cover home health?
Yes. An Advantage plan has to cover every medically necessary service Original Medicare covers, home health included, but it may require an agency it contracts with and approval in advance, so the plan is your first call.
What if the agency says Medicare won't cover something?
Ask for it in writing. The Advance Beneficiary Notice the agency has to give you says what it will cost, so you decide before the bill exists. This is general information about how the benefit works; your parent's doctor, the agency and a free Medicare counselor answer the questions about their own case.
Sources
- Medicare.gov, "Home health services" (read October 30, 2026): what Medicare covers and doesn't cover at home, the homebound definition, the no-cost rule, the 20 percent on equipment, the hours limits and the list-of-agencies duty.
- Centers for Medicare & Medicaid Services, "Medicare & Home Health Care" (CMS Product No. 10969, July 2025): the eligibility wording, the examples of allowed absences, the 30-day periods, the 60-day plan review, the Advance Beneficiary Notice, the change-of-care notice and the patient's choice of agency.
- 42 CFR § 409.42, Beneficiary qualifications for coverage of services (eCFR, read October 30, 2026): the five conditions for Medicare home health coverage.
- 42 CFR § 424.22, Requirements for home health services (eCFR, read October 30, 2026): the face-to-face visit within 90 days before or 30 days after the start of care, its telehealth clause and the 60-day recertification.
- CMS Provider Data Catalog, "Home Health Care - Zip Codes" and "Home Health Care Agencies" (October 2026 release, read October 30, 2026): the count of Medicare-certified agencies serving Berks County ZIP codes and the number with Berks addresses; the same data drives Medicare's Care Compare finder.
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" (read October 30, 2026): network, referral and prior authorization rules a Medicare Advantage plan may apply.
- 28 Pa. Code § 601.6 (home health care agency definitions): what a licensed home health care agency is; and 28 Pa. Code § 611.5 (home care agency definitions): what home care services are (both read October 30, 2026).
- Pennsylvania Department of Health, "Home Care Agencies and Registries" (read October 30, 2026): home care agencies provide non-skilled services.
- Pennsylvania Department of Human Services, "Apply for Community HealthChoices" (read October 30, 2026): who the program is for and the home services it covers for long-term care participants.
- Pennsylvania Independent Enrollment Broker, "Apply for waiver services" (read October 30, 2026): the application steps, the Area Agency on Aging's assessment, the County Assistance Office's decision and the 90-day clock; the broker's number is on the department's long-term care contacts page.
- County of Berks, Area Agency on Aging (read October 30, 2026): address, phone and hours; its "Assessments for Funded Services" sheet: the in-home needs assessment and who the OPTIONS program serves; and the Care at Home services.
- Pennsylvania Department of Aging, "Apply for the OPTIONS Program" (read October 30, 2026): who OPTIONS serves and its sliding co-payment scale.
- CareScout, Cost of Care Survey, 2025 data (Reading Metropolitan Area, read October 30, 2026): the median hourly rate for a non-medical caregiver in the Reading area and the Pennsylvania median for a private-duty nurse at home.