Medicare has finalized its 2027 rules for home health care, and while most of the changes are aimed at agencies and equipment suppliers, several touch the millions of older adults who get nursing, therapy and medical equipment at home. The Centers for Medicare & Medicaid Services (CMS) issued the final rule on Nov. 4.
For patients, the most notable pieces are a clarification that Medicare’s home health benefit can cover skilled palliative care, new coverage for certain home infusion pumps and drugs starting April 1, 2027, and an end to repeat doctor visits just to replace the same piece of medical equipment.
Can Medicare home health now cover palliative care?
The rule does not create a new benefit, CMS said, but it spells out that the existing home health benefit can cover skilled palliative care, including pain and symptom management at home, for eligible patients with serious illnesses. According to the CMS announcement, provider uncertainty may have limited the use of these services. Eligibility depends on a patient’s care needs and whether the patient meets Medicare’s home health criteria, rather than on a specific diagnosis.
CMS noted that palliative care under the home health benefit is different from hospice and can support patients who need skilled services during a serious or progressive illness. The agency said it plans to publish examples of covered palliative services in future guidance.
Who qualifies for Medicare home health care?
To qualify, a person must need part-time or intermittent skilled services and be “homebound,” meaning leaving home is not recommended or takes considerable effort, such as needing a cane, wheelchair, walker or another person’s help, according to Medicare.gov. A doctor or other qualified provider must see the patient in person, confirm the need and order the care, and a Medicare-certified agency must provide it.
People with Medicare pay nothing for covered home health services. After the Part B deductible, they generally pay 20% of the Medicare-approved amount for covered medical equipment. Medicare does not pay for 24-hour care at home, meal delivery or homemaker services, or for custodial care when that is the only care someone needs.
What changes for home infusion pumps?
Starting April 1, 2027, Medicare Part B’s durable medical equipment benefit will cover certain external infusion pumps and the home infusion drugs used with them, even if they would not otherwise meet Medicare’s “appropriate for use in the home” test, according to the CMS fact sheet. The change carries out a provision of the Consolidated Appropriations Act, 2026.
To qualify, the drug’s FDA-approved label must call for it to be given by or under the supervision of a health care professional, a qualified home infusion therapy supplier must give or supervise it in the patient’s home, and the label must call for infusions at least 12 times a year, either intravenously or under the skin, or at rates that require a pump.
Do I need a new doctor visit to replace medical equipment?
No, not just for an identical replacement. CMS finalized a clarification that a new face-to-face exam is not required when the item being replaced is the same type of equipment, described by the same billing code, the fact sheet says. The face-to-face requirement still applies when an item is first ordered, and suppliers must keep the original visit records in case of an audit. For families replacing worn-out mobility aids and home medical equipment, that could mean one less appointment.
Will quality ratings for home health agencies change?
Quality information on home health agencies should reach the public up to three months sooner. CMS is shortening the deadline for agencies to submit patient assessment data from 135 days to 45 days, noting that about 98% of agencies already meet that timeline. Families can compare agencies’ quality ratings on Medicare’s Care Compare tool.
What else is in the rule?
CMS estimates Medicare payments to home health agencies will rise about 2.4%, or $415 million, in 2027 compared with 2026. The rule also keeps a temporary 3% reduction to the base payment rate, which CMS is using to recover what it calculates were overpayments in earlier years. CMS also expects to save about $82 million a year by making all Medicare enrollment revocations retroactive to the date a provider’s noncompliance began, and it added new grounds to deny or revoke enrollment. The full text is on the Federal Register.
HNC’s earlier guide to assistive technology and Medicare equipment coverage explains how to borrow or try devices before buying, and our report on the CMS CARE proposed rule covers separate proposed changes for hospitals and nursing homes.
Key Takeaways
- Medicare’s 2027 home health rule confirms the existing benefit can cover skilled palliative care at home for eligible patients; it is not a new benefit.
- Certain external infusion pumps and home infusion drugs gain Part B coverage starting April 1, 2027.
- Replacing an identical piece of medical equipment no longer requires a new face-to-face doctor visit.
- Home health quality data will be posted up to three months sooner.
- Covered home health services cost patients nothing; covered equipment generally carries 20% coinsurance after the Part B deductible.
Frequently Asked Questions
Does Medicare pay for palliative care at home?
Medicare’s home health benefit can cover skilled palliative care, such as pain and symptom management, for patients who meet the home health criteria, including being homebound and needing part-time skilled care. The 2027 rule clarifies this; it does not create a new benefit.
Is palliative care the same as hospice?
No. CMS says palliative care under the home health benefit is distinct from hospice and can support people who need skilled services during a serious or progressive illness.
When does the new home infusion pump coverage start?
April 1, 2027, for external infusion pumps and associated home infusion drugs that meet the criteria in the rule.
Do I need to see my doctor again to replace a wheelchair or other equipment?
Not for an identical replacement described by the same billing code, under the final rule. A face-to-face visit is still required when the equipment is first ordered.
How much does Medicare home health care cost?
Covered home health services cost nothing. After the Part B deductible, you generally pay 20% of the Medicare-approved amount for covered medical equipment.
Sources: CMS press release and fact sheet (Nov. 4, 2026); Federal Register public inspection document 2026-22750; Medicare.gov: Home health services.
Featured image: A nurse checks a patient’s blood pressure. (Linda Bartlett, National Cancer Institute, public domain, via Wikimedia Commons)
