How to Choose a Quality Home Health Agency (and Read the Star Ratings)

The hospital hands you a printed list of home health agencies and tells you to “pick one” before she’s discharged tomorrow. What nobody says out loud: the names are usually in alphabetical order, not quality order, and Medicare publishes the quality data free — two star ratings that most families never open. Here’s how to read them in about fifteen minutes, and the questions that separate a good agency from a name on a list.

This is the moment to know how to choose a home health agency, because unlike almost everything else in a discharge, this one is genuinely your choice — and the difference between agencies is real. Home health is the skilled, Medicare-covered care that comes to the house after a hospital or rehab stay: nursing, physical and occupational therapy, wound care. This page walks the Medicare Care Compare home health tool step by step, explains the two separate star ratings families always confuse, and lays out the questions and red flags that matter most.

If you’re still sorting out whether she needs home health (skilled, doctor-ordered, Medicare-covered) or home care (help with daily tasks, usually private-pay), settle that first — they’re different services with different payers. Home health vs. home care explains the difference in plain terms →.

First: the choice is yours, and you can switch

Two rights families rarely know they have. The choice of agency belongs to you. A hospital discharge planner may hand you a list, and Medicare requires that they do — but they generally can’t steer you to one specific agency, and if the hospital system owns an agency, it has to tell you that. You’re entitled to choose any Medicare-certified home health agency that serves her area. It’s completely reasonable to look up two or three on Care Compare before you sign anything.

And the choice isn’t permanent. If the agency that started her care isn’t showing up, isn’t communicating, or isn’t a good fit, you can transfer to a different Medicare-certified agency. You’re not locked in with a team that isn’t working. Knowing that on day one changes the whole tenor of the conversation.

One question before anything else: traditional Medicare, or Medicare Advantage?

Everything on this page about choosing freely applies in full to traditional Medicare. If she’s on a Medicare Advantage plan, the ground rules change, and it’s better to know now than at the kitchen table with a discharge planner waiting: her plan may require prior authorization before home health starts, and it may limit the choice to agencies in the plan’s network. The Care Compare homework below is still worth doing — but do it on the plan’s list. Call the number on her card, ask two questions (“Does home health need prior authorization?” and “Which agencies near her are in-network?”), and then run those names through the star ratings. Skipping that call is how families end up with a surprise denial or a week’s delay at exactly the wrong moment.

The fifteen-minute check: the Medicare Care Compare home health walkthrough

Medicare publishes real quality data on nearly every home health agency in the country, free, and almost no family opens it. Here’s the walkthrough:

• Go to Medicare.gov/care-compare, choose Home Health, and enter her ZIP code. You’ll get every Medicare-certified agency that serves her area — usually far more than the hospital’s list.
• Look at the two star ratings side by side. This is the part that confuses everyone, so here’s the plain version: home health has two separate star ratings, and they answer different questions.
• Compare three or four agencies, not one. The tool lets you select multiple agencies and view them together — that’s the whole point. A single agency’s stars mean little until you see them next to its neighbors.
• Then read past the stars to the individual measures below them, especially timely start of care and whether patients ended up back in the hospital.

Star rating #1: Quality of Patient Care

This one is about clinical results — did patients actually get better. Medicare builds it from seven measures pulled from clinical assessments and Medicare claims: how quickly the agency started care, improvement in managing oral medications, improvement in walking, in getting in and out of bed, in bathing, in breathing, and how often patients had a potentially preventable hospitalization during care. An agency needs data on at least five of the seven to get a rating, and 4 or 5 stars is above the national average. Fewer than half of agencies in a given area may hit 4-plus, so don’t be surprised if strong ones are scarce.

Star rating #2: Patient Survey (the family’s experience)

This one is about what it was actually like — drawn from a national survey (HHCAHPS) of patients and their families after care. It captures how well the team communicated, whether care was delivered in a professional way, and whether the patient would recommend the agency. It’s the closest thing to asking a hundred families down the street, “would you use them again?” More stars mean a better reported experience.

Two honest caveats so the tool doesn’t mislead you. The data lags — the ratings reflect care from a reporting window that ended roughly a year ago, not last month, so a recently improved (or declined) agency won’t show it yet. And the patient survey itself changed in April 2026 — Medicare shortened it from 34 questions to 25 — so survey scores from before and after that change aren’t perfectly comparable, and analysts expect some movement in the numbers that has nothing to do with a given agency getting better or worse. Use the stars as your first filter, then verify with the questions below.

If she just had surgery: the hospital may have money riding on her recovery

Here’s a 2026 development almost no family has heard of, and it changes the temperature of the discharge conversation. Under a mandatory Medicare payment model called TEAM (the Transforming Episode Accountability Model, which began January 1, 2026 and runs through 2030), more than 700 hospitals across 188 markets are now financially responsible for the entire 30 days after discharge for five common surgeries: hip and knee replacement, surgical hip/femur fracture repair, spinal fusion, coronary artery bypass, and major bowel procedures. If her recovery goes well and costs stay reasonable, the hospital can earn a bonus. If she bounces back to the ER, the hospital can be penalized.

What that means for you, plainly. First, expect the hospital to care — visibly — about which home health agency she uses, because its own money now rides on the next 30 days. That’s not sinister; in fact the incentive mostly points the right way, since the hospital is rewarded when she recovers at home and stays out of the ER. But second, know that the list they hand you may be a partner list — the agencies the hospital has chosen to work with — and TEAM does not change your right to pick any Medicare-certified agency. If the hospital’s preferred agency also happens to be the best-rated one on Care Compare, wonderful; take the aligned incentives and run. If it isn’t, you’re allowed to say so and choose differently. The fifteen-minute check above is exactly how you tell the difference.

Why the vetting matters right now

Most home health teams are skilled, decent people doing hard work in strangers’ living rooms. And the sector has a real fraud problem at its edges, which is exactly why a fifteen-minute check is worth it. In May 2026, Medicare froze the enrollment of new home health agencies nationwide for six months — a direct move against fraud concentrated among fast-multiplying new agencies — and can extend that freeze in six-month increments. Alongside it, Medicare added tougher screening for new agencies, including site visits and fingerprint background checks, and expanded review of claims for home health agencies in several states, including Florida, Illinois, North Carolina, Ohio, Oklahoma, and Texas.

What that means for your family is simple: the well-established, Medicare-certified agency with a track record on Care Compare is exactly what the current cleanup is trying to protect, and the fifteen minutes of checking on this page is more due diligence than most referral sources will do for you.

Why a good agency might still say “we can’t take her” — and what to do

One more piece of the 2026 picture, because it explains an experience that blindsides families: you pick a well-rated agency, and the agency declines the referral — no capacity, no staff in her area, can’t start for two weeks. That’s not necessarily a judgment about her. Home health agencies have spent several years under real payment pressure: Medicare has been clawing back what it considers past overpayments — roughly $4.9 billion accumulated through 2025 — and is proposing to keep a temporary 3% reduction on 2027 payments while it recoups. The July 2026 proposed rule was actually gentler than recent years (a 2.4% overall increase, and for the first time in three years no new permanent cut), but it isn’t final until later this year, and the underlying strain — staffing costs, clawbacks, tight margins — hasn’t gone anywhere. Stretched agencies get selective about referrals and slower to start care.

The practical playbook: have the discharge planner send the referral to two or three agencies at once, not one — it’s allowed, it’s common, and it converts “waiting to hear back” into a choice among whoever can actually start. Ask each agency directly, “Can you start within 48 hours, and do you have staff who cover her town?” And if nobody can start promptly, ask the discharge planner to document it and widen the search radius — an agency thirty minutes away that shows up beats a close one that can’t.

The questions to ask a home health agency — before you sign

Interview the agency the way you’d interview anyone you were trusting to care for your mother in her own home. The full printable list is below; here are the ones that do the most work, and why:

• “When will the first visit happen — and who schedules the rest?” Medicare expects care to start promptly, usually within 48 hours of referral. A vague answer here predicts a vague experience.
• “Who do we call at night or on a weekend, and does a nurse actually answer?” You want a clinician on the phone, not an answering service that takes a message until Monday.
• “Will it be the same nurse and therapist each time?” Continuity matters enormously in the home. Some churn is normal; a revolving door is a red flag.
• “How will you keep her doctor — and me — in the loop?” The best agencies close the loop with the physician and the family after visits. Ask exactly how.
• “Are you Medicare-certified, and how long have you served this area?” Certification is non-negotiable for Medicare to pay. Longevity in the area is a quiet quality signal.
• “What are your star ratings — and can you talk me through them?” You already looked them up. Now watch whether they’re straight with you about their weaker numbers.

Home health red flags: keep looking

Most agencies won’t trip these. When one does, believe it:

• They found you. If an agency cold-called, knocked on the door, or offered free groceries or gift cards to sign up — with no doctor’s referral — walk away and keep her Medicare number to yourself. Recruiting patients who weren’t referred is the signature of home health fraud, and it’s the pattern behind the federal crackdown.
• Pressure to sign immediately. Real discharges have real timelines, but a quality agency creates clarity, not panic. “Sign now or lose the slot” is a sales tactic.
• No clear answer on who comes, when, and how often. Specifics are a quality signal; vagueness is the opposite.
• No 24/7 line answered by a nurse. The value of home health is tested at night and on weekends.
• They can’t or won’t discuss their Care Compare ratings. Public data an honest agency will happily walk you through.
• They ask you to sign forms you don’t understand. Never sign what hasn’t been explained, especially anything about what Medicare will and won’t cover.

If Medicare stops paying before she’s ready

One thing worth knowing before it happens: home health coverage can end while you still feel she needs care, and you have appeal rights when it does — a fast, free appeal with a tight deadline. If you get a notice that Medicare is about to stop covering her home health, don’t just accept it. Here’s how the appeal works, and the deadline that’s easy to miss →.

Where to go next

Home health or home care — which does she need? The difference, and the two different payers →

What Medicare actually covers at home: Does Medicare pay for home care? →

They’re discharging her too soon: What to ask and refuse before discharge →

Questions families ask

How do I choose a good home health agency?

Choose a home health agency by comparing agencies on Medicare’s Care Compare website using its two star ratings — Quality of Patient Care and Patient Survey — then interviewing two or three about how quickly care starts, who answers after hours, and whether the same clinicians return each visit. You have the right to choose any Medicare-certified agency that serves the area, regardless of which one the hospital suggests, and you can switch agencies if the first choice isn’t working. Reading both star ratings together, and asking about any gap between them, tells you more than either number alone.

What are the two home health star ratings on Medicare Care Compare?

Home health agencies on Care Compare have two separate star ratings: the Quality of Patient Care Star Rating, which measures clinical results from up to seven care measures such as timely start of care, improvement in walking and bathing, and avoiding preventable hospitalizations; and the Patient Survey Star Rating, which reflects patients’ and families’ experiences from the HHCAHPS survey. The first answers whether patients got better, and the second answers what the care was like. Four or five stars is above the national average on either scale.

What is a good home health star rating?

A rating of 4 or 5 stars is above average on both the Quality of Patient Care and Patient Survey scales, since Medicare sets the ratings relative to how agencies compare with one another nationally. Not every area has a 4- or 5-star agency, so the practical goal is to pick the best-rated agency that serves her area and reads well on the individual measures. Because a rating can be missing when an agency has too few cases to score, a blank rating is a reason to ask more questions rather than an automatic mark against it.

Can I choose my own home health agency, or does the hospital pick?

You choose the agency — the hospital must give you a list of Medicare-certified agencies that serve the area but generally cannot steer you to one specific agency, and it must disclose if it has a financial interest in an agency on the list. You are free to pick any Medicare-certified agency that covers her location, and you can compare them on Care Compare first. If the agency that starts her care isn’t working out, you can transfer to a different one.

What are the red flags of a bad home health agency?

The biggest red flags are an agency that recruited the patient through cold calls, door-knocking, or offers of free goods with no doctor’s referral, pressure to sign paperwork immediately, no clear answer about who visits and how often, and the absence of a 24-hour line answered by a nurse. An agency that won’t discuss its Medicare Care Compare star ratings is another warning sign, since that information is public. Unsolicited recruitment in particular is the pattern behind recent home health fraud enforcement.

Is home health care free with Medicare?

Medicare covers eligible home health care at no cost for the covered skilled services when a person is homebound and a doctor orders the care through a Medicare-certified agency, with no deductible or coinsurance for the home health visits themselves. It does not cover 24-hour care at home, meal delivery, or personal care such as help with bathing and dressing when that is the only care needed. Confirming an agency is Medicare-certified is essential, because Medicare will not pay an agency that is not certified.

Does Medicare Advantage cover home health the same way as traditional Medicare?

Medicare Advantage plans must cover home health, but the rules of choosing differ: the plan may require prior authorization before care starts and may limit the choice to agencies in its network, while traditional Medicare allows any Medicare-certified agency with no prior authorization. Before comparing agencies, call the plan to ask whether home health needs prior authorization and which local agencies are in-network, then compare those agencies on Care Compare. Skipping that call is a common cause of denials and delayed starts.

Can the hospital make me use its home health agency?

No — the hospital cannot require you to use a particular home health agency, even though some hospitals now have a financial stake in the 30 days after discharge under Medicare’s TEAM payment model for certain surgeries. The hospital must provide a list of Medicare-certified agencies serving the area and disclose any agency it owns, and the choice remains yours. If the hospital’s preferred agency is also the best-rated on Care Compare, choosing it is perfectly sensible; if it isn’t, you may choose differently.

How long does it take home health to start after a hospital discharge?

Home health care usually begins within about 48 hours of the referral, and Medicare expects the agency to start care in a timely way, which is one of the measures in its Quality of Patient Care star rating. When you interview an agency, ask specifically when the first visit will happen and who arranges the following visits. A vague answer about scheduling is a common early sign of an agency that will be hard to reach later.

Last verified: 19 August 2026 against CMS Care Compare materials, CMS home health star-rating and HHCAHPS documentation, CMS enrollment-moratorium announcements, the CMS TEAM model materials, and the CY2027 HH PPS proposed rule (CMS-1844-P) · Next review: January 2027, or immediately on a relevant change

This page is educational and is not medical or legal advice. Mark Duda is not a physician, a nurse, or an attorney. Medicare rules, star-rating methods, payment models, and oversight programs change — verify any coverage or program detail with Medicare (1-800-MEDICARE), her plan, or the agency directly. See our disclaimers.