Medicare Doesn’t Cover That: The Reality Behind Home Health Limitations

Let’s get one thing straight: if you’re expecting Medicare to fully cover your in-home nursing care, you might be in for a rude awakening. I don’t say that to scare you—I say it because you deserve the truth.

For years, I’ve worked in and around home health, watching families scramble to navigate a broken system. Behind the paperwork and phone trees is a simple fact: our healthcare policies often make it harder—not easier—for people to stay home and heal. And it’s not just frustrating. It’s dangerous.

Let’s talk about what’s really going on—and why private care might be the safer, saner option.

1. Medicare Reimbursement Cuts Are Shutting Down Agencies

Home health agencies aren’t turning people away because they want to. They’re turning people away because they can’t afford to stay open.

The Centers for Medicare and Medicaid Services (CMS) has slashed reimbursement rates so deeply that many agencies are closing or drastically reducing services. And when agencies shut down, the people who lose the most are patients—especially those who need skilled care at home to avoid rehospitalization.

2. Nurses Are Drowning in Paperwork, Not Providing Care

Every minute I spend filling out CMS forms is a minute I’m not caring for a patient. That’s the reality of compliance overload. The amount of documentation, billing complexity, and regulation hoops we have to jump through is absurd. It doesn’t protect patients—it delays care and burns out providers.

Worse, when payment is denied (which happens more often than you’d think), the agency has to eat the cost or the patient is left with the bill. Either way, nobody wins.

3. There’s a Workforce Crisis, and CMS Made It Worse

We’re not just dealing with a nursing shortage—we’re dealing with a mass exodus from home health. Nurses and aides are leaving in droves because the pay is low, the workload is unmanageable, and there’s little support.

CMS’s reimbursement policies have made it harder to hire and retain skilled professionals. That means even if you qualify for home health services under Medicare, there might not be anyone available to provide them.

4. CMS Is Pushing Patients Into Facilities

Here’s the kicker: CMS talks a big game about “value-based care” and “aging in place,” but their funding decisions say otherwise.

Instead of supporting affordable, effective care at home, more money is being funneled into hospitals and long-term care facilities. This forces people into places they don’t want to be, even when home care would be safer, more comfortable, and less expensive.