Introduction

If you or a loved one needs medical care at home, you might wonder: Does Medicare cover home health care in Texas? The short answer is yes—but there are important rules and conditions to understand.

Medicare provides coverage for home health care across the United States, including Texas, following federal guidelines. However, coverage isn’t automatic for everyone. To qualify, a patient must meet specific eligibility requirements, including being under a doctor’s care, needing skilled medical services, and being considered homebound. Additionally, Medicare will only cover care provided by a Medicare-certified home health agency.

This article will break down everything you need to know, including:

• Who qualifies for Medicare-covered home health care in Texas?
• What services are covered—and what’s not.
• How much Medicare pays (and potential out-of-pocket costs).
• Common limitations of Medicare home health benefits.

Understanding these details can help you make informed decisions about your health care options. Let’s take a closer look at how Medicare home health coverage works in Texas.

What Home Health Services Does Medicare Cover?

Medicare provides coverage for a variety of home health services, but only if they are considered medically necessary and prescribed by a doctor. These services are designed to help patients recover from illness or injury, manage chronic conditions, and maintain independence at home.
Here’s what Medicare typically covers:

• Skilled Nursing Care – This includes part-time or intermittent nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN). It covers wound care, injections, catheter care, monitoring of serious illnesses, and other medical needs. However, it does not include around-the-clock nursing care.
• Therapy Services – If your doctor certifies that therapy is needed to improve or maintain your condition, Medicare will cover:
  

  • Physical therapy to help with mobility, strength, and coordination.
  • Occupational therapy to assist with regaining daily living skills, such as dressing or eating.
  • Speech-language pathology services to aid in communication and swallowing disorders.

• Medical Social Services – If you or your family need counseling or social work assistance to cope with a medical condition, Medicare may cover medical social services. This can include mental health support, resource planning, and help with navigating community programs.
• Home Health Aide Services – Medicare will cover part-time assistance with activities of daily living (such as bathing, dressing, and toileting), but only if the patient also requires skilled nursing care or therapy services. Home health aides do not provide standalone personal care.

Medical Supplies and Durable Medical Equipment (DME) – Medicare covers necessary medical supplies like wound dressings and catheters, as well as durable medical equipment such as wheelchairs, walkers, hospital beds, and oxygen equipment. However, some of these items require a 20% coinsurance payment.

How Much Does Medicare Pay for Home Health Care in Texas?

For most Medicare-approved home health services, patients do not have to pay out of pocket. Medicare Part A (Hospital Insurance) or Part B (Medical Insurance) will typically cover these services at 100%, as long as eligibility requirements are met.

However, there are some costs to keep in mind:

• Durable Medical Equipment (DME) – While home health services are covered in full, Medicare only pays 80% of the approved cost for durable medical equipment like wheelchairs, walkers, and hospital beds. Patients are responsible for the remaining 20% coinsurance, unless they have supplemental insurance to cover the difference.
• Medicare Does Not Cover 24/7 Home Care – Medicare home health care is designed for part-time or intermittent services. It does not pay for round-the-clock home care, long-term custodial care, or services like meal delivery and housekeeping.

Understanding these cost details can help families plan accordingly and explore additional coverage options, such as Medicaid or long-term care insurance, if more extensive care is needed.

Conclusion

Yes, Medicare does cover home health care in Texas—but only if specific eligibility criteria are met. Patients must be under a doctor’s care, require intermittent skilled services, and use a Medicare-certified home health agency. While most services are covered at no cost, there may be out-of-pocket expenses for durable medical equipment.
If you’re considering home health care for yourself or a loved one, it’s best to verify coverage details directly with Medicare or the home health agency you plan to use.
For more information on covered services, eligibility, and costs, visit the official Medicare Home Health Services page.