Does Medicare Cover Home Health Care in Texas? (2026 Guide)

If you’re wondering whether Medicare will pay for home health care for your parent or loved one in Texas, the short answer is yes — but only if certain conditions are met. As a registered nurse who ran a home health agency in Texas for 13 years, I’ve helped hundreds of families understand exactly what Medicare covers and what it doesn’t. This guide breaks it all down in plain language.

What Is Home Health Care?

Home health care is skilled medical care provided in your loved one’s home by licensed professionals. This includes registered nurses, physical therapists, occupational therapists, speech therapists, and home health aides — all working under a physician’s plan of care.

This is different from non-medical home care (like a companion or housekeeper). Medicare covers home health care. It generally does not cover non-medical home care — that’s usually private pay.

Does Medicare Pay for Home Health in Texas?

Yes. Medicare Part A and Part B both cover home health services in Texas. And here’s the part that surprises most families: there is no copay and no deductible for Medicare home health services. If your loved one qualifies, it’s covered at 100%.

That said, qualifying is where it gets tricky.

The 4 Requirements to Qualify for Medicare Home Health

Your loved one must meet all four of these criteria:

1. A doctor must order it.
   A physician must certify that your loved one needs home health care and create a plan of care. This usually happens after a hospital stay, but it can also be ordered by their primary care doctor at any time — you do not need a hospital stay to qualify.
2. Your loved one must be “homebound.”
   This is the requirement that confuses families the most. Homebound does not mean bedridden. It means leaving home requires a considerable and taxing effort. Your parent can still go to church, attend adult day care, get a haircut, or go to medical appointments. They’re considered homebound if they need help from another person or a device (walker, wheelchair, cane) to leave the house, or if their doctor advises against leaving home due to their condition.
3. They must need skilled care.
   Medicare requires that your loved one needs at least one of these skilled services: skilled nursing care (wound care, medication management, injections, IV therapy, catheter care, disease education), physical therapy, speech therapy, or occupational therapy. Simply needing help with bathing and dressing alone does not qualify — there must be a skilled need.
4. The care must be part-time or intermittent.
   Medicare covers home health when care is needed on a part-time basis — typically fewer than 8 hours per day and fewer than 28 hours per week. It does not cover 24-hour home care or live-in caregivers.

What Services Does Medicare Cover at Home?

Once your loved one qualifies, Medicare covers these services at no cost:

Skilled nursing visits (wound care, medication management, IV therapy, patient education, disease management)
Physical therapy
Occupational therapy
Speech-language pathology
Medical social work services
Home health aide services (bathing, dressing, personal care — but only if skilled care is also being provided)
Medical supplies and durable medical equipment related to the plan of care

What Medicare Does NOT Cover

This is where I’ve seen the most frustration from families:

24-hour home care or live-in caregivers
Homemaker services (cooking, cleaning, laundry) unless a home health aide provides them alongside skilled care
Personal care only — if your parent just needs help bathing but has no skilled nursing or therapy need, Medicare won’t pay
Meal delivery
Non-medical companionship
Custodial care (long-term help with daily activities without a skilled need)

For these services, families typically pay privately or explore Medicaid options.

How Long Does Medicare Home Health Last?

There is no fixed time limit. Medicare covers home health as long as your loved one continues to meet the four qualifications above and their doctor recertifies the need every 60 days. I’ve had patients receive Medicare home health for months — sometimes over a year — as long as there was a documented skilled need and they remained homebound.

However, Medicare will stop coverage when the skilled need has been met (goals achieved), the patient is no longer homebound, or the doctor discontinues the order.

What About Texas Medicaid (STAR+PLUS)?

If your loved one has both Medicare and Texas Medicaid, they may qualify for additional services through the STAR+PLUS program. STAR+PLUS can cover what Medicare doesn’t — including personal attendant services, ongoing non-skilled home care, and community-based support.

If your loved one only has Medicaid (no Medicare), STAR+PLUS may still cover home health-type services through its Community Attendant Services or other waiver programs. Eligibility depends on income, assets, and the level of care needed. The application process goes through the Texas Health and Human Services Commission.

How to Get Medicare Home Health Started

Here’s the step-by-step process:

Step 1: Talk to your loved one’s doctor. Tell them what you’re observing at home — falls, difficulty managing medications, trouble walking, wound healing issues, recent hospitalization. Ask if a home health referral is appropriate.

Step 2: The doctor writes an order and creates a face-to-face encounter document. This is required by Medicare — the doctor must have seen the patient and documented why home health is needed.

Step 3: Choose a home health agency. This is where the quality of care varies enormously. Look for agencies that are Medicare-certified, have good patient satisfaction scores, and have experienced clinical staff. Ask how many patients their nurses carry — lower caseloads mean more attention for your parent.

Step 4: The agency sends a nurse to do an initial assessment (called the OASIS assessment in Texas). This comprehensive evaluation determines your loved one’s care needs and establishes the plan of care.

Step 5: Services begin, typically within 24-48 hours of the assessment.

How to Choose a Good Home Health Agency in Texas

After 13 years running an agency, here’s what I’d tell any family:

Check Medicare’s Home Health Compare at medicare.gov/care-compare — look at star ratings and patient survey results.

Ask how many patients each nurse carries. Under 25 is good. Over 35 means your parent won’t get much time per visit.

Ask if the agency has a dedicated intake coordinator. Disorganized intake means disorganized care.

Ask what happens after hours and on weekends. Good agencies have 24/7 on-call nursing.

Ask about staff turnover. High turnover means different faces every week — bad for your parent’s comfort and care continuity.

Trust your instincts when you meet the nurse. If they’re rushing through the assessment, imagine how they’ll be on regular visits.

Common Questions Texas Families Ask Me

“Mom was just discharged from the hospital. Does she automatically get home health?”
No. The hospital discharge planner may recommend it, but a doctor still has to write the order. Don’t leave the hospital without asking about a home health referral if you think your parent needs one.

“Dad doesn’t want strangers in his house. Can we provide the care and get paid?”
Medicare does not pay family members to provide home health care. However, Texas Medicaid’s Consumer Directed Services (CDS) option under STAR+PLUS can allow a family member to be paid as an attendant in some cases.

“The agency said Medicare won’t cover it anymore. Is that right?”
Maybe, maybe not. If the skilled need has been met and your parent has reached their therapy goals, then yes — coverage ends appropriately. But if your parent still has a documented skilled need and is still homebound, you have the right to request continued coverage. If services are denied, you can appeal.

“Can we get home health while Mom is in assisted living?”
Yes. Medicare home health can be provided wherever your parent lives — their own home, your home, an assisted living facility, or an independent living community. The only place it doesn’t apply is a skilled nursing facility, because that facility provides the skilled care directly.

Need Help Finding Home Health in Texas?

Navigating Medicare home health shouldn’t require a nursing degree — but it often feels like it does. At RightCareFinder, we help Texas families find the right home health agency based on their loved one’s specific needs, location, and insurance.

It’s free, and every case is personally reviewed by a registered nurse.

Get free, nurse-guided help finding home health care — visit RightCareFinder.com or click Get Free Help Now.

This article is for informational purposes only and does not constitute medical or legal advice. Medicare rules and coverage can change. Always verify current eligibility with Medicare directly at 1-800-MEDICARE (1-800-633-4227) or at medicare.gov.