When you need hospital-level medical care, most people assume that means a stay in a hospital bed. But a growing number of Medicare beneficiaries are receiving that same level of acute care in a place they know well: their own home.
The Acute Hospital Care at Home (AHCAH) initiative, run by the Centers for Medicare and Medicaid Services (CMS), allows approved hospitals to deliver inpatient-level treatment to qualifying patients at home. Since launching in November 2020, the program has expanded to hundreds of hospitals across the country and was recently extended through September 30, 2030, under the Consolidated Appropriations Act of 2026.
In March 2026, CMS released a second round of program data covering nearly five years of operation, giving researchers and the public the most comprehensive look yet at how hospital-at-home care is performing. Here is what Medicare beneficiaries should know about this program, how it works, and whether it may be an option for you or a loved one.
What Is the Acute Hospital Care at Home Program?
The AHCAH program is a CMS initiative that grants individual hospitals a waiver to provide acute (hospital-level) medical care to patients in their homes rather than in a traditional hospital setting. It was created during the COVID-19 public health emergency to reduce strain on hospital capacity and has continued because of its demonstrated benefits for patients and the health care system.
This is not the same as traditional home health care, which covers intermittent skilled nursing and therapy visits for people recovering at home. Hospital at home is a step above that. It is designed for patients who would otherwise be admitted to a hospital for conditions that require active, ongoing medical treatment, but whose condition is stable enough to be safely managed at home with close monitoring.
Under the program, the hospital remains responsible for the patient's care. The patient is formally admitted as a hospital inpatient, even though they are physically at home. This distinction matters for billing, coverage, and the level of care provided.
How Does Hospital-at-Home Care Work?
If you are admitted to the AHCAH program, your experience will look something like this:
Initial Assessment
You first visit or are evaluated at a hospital emergency department or are seen by a physician who determines you need inpatient care. If your hospital participates in the AHCAH program and your condition qualifies, the care team will discuss the option of receiving treatment at home instead of being admitted to a traditional hospital bed.
You must consent to participate. No one is placed into the program without agreeing to it.
Care Delivery at Home
Once admitted, the hospital sends a care team to your home. Under CMS waiver requirements, hospitals must provide:
- At least two in-person clinical visits per day, conducted by a registered nurse, mobile integrated health practitioner, or community paramedic
- A daily physician visit, which may be conducted in person or through a secure video connection
- Around-the-clock nursing availability (24 hours a day, 7 days a week), either virtually or in person as clinically appropriate
Your home is equipped with the monitoring devices and supplies needed for your treatment. This typically includes:
- A blood pressure cuff
- A pulse oximeter (to measure blood oxygen levels)
- A thermometer
- A weight scale
- A cellular-enabled tablet that transmits your vital signs directly to your care team
You do not need home internet access. The monitoring equipment connects through its own cellular network. You will be asked to check your vitals multiple times a day, and the tablet may also prompt you to complete symptom surveys so your nurse has a clear picture of how you are doing.
Additional Services
Depending on your condition, you may also receive:
- Intravenous (IV) medications and fluids
- Oral medications
- Portable diagnostic testing, including bloodwork, X-rays, and ultrasounds
- Oxygen therapy
- Specialty consultations via telehealth
- Physical, occupational, or speech therapy
Discharge
When your physician determines that you are stable enough to resume daily activities, you are formally discharged from the hospital-at-home program. Follow-up care is then coordinated with your primary care physician, and if needed, you may transition to traditional home health care services.
Which Conditions Qualify?
The AHCAH program treats patients with acute medical conditions that would typically require a hospital admission but can be safely managed at home. Based on CMS data, the most common conditions treated through the program include:
- Heart failure
- Chronic obstructive pulmonary disease (COPD) exacerbations
- Pneumonia and other respiratory infections
- Sepsis (certain cases)
- Kidney and urinary tract infections
- Cellulitis (serious skin infections)
- Asthma exacerbations
- Deep vein thrombosis (DVT)
- Inflammatory bowel disease flares
- COVID-19 (when hospital-level care is needed)
Not every condition qualifies, and not every patient with a qualifying condition will be eligible. Your medical team evaluates your individual circumstances, including the severity of your illness, the safety of your home environment, and whether you have adequate support at home.
Who Is Eligible?
To be considered for the AHCAH program, you generally must:
- Be a Medicare beneficiary (Original Medicare or, in many cases, Medicare Advantage)
- Require inpatient hospital-level care for an eligible acute condition
- Be assessed as clinically stable enough to be safely treated at home
- Live within the geographic service area of a participating hospital (typically within a certain driving distance)
- Have a safe and suitable home environment for receiving medical care
- Consent to participate in the program
There is no age requirement beyond standard Medicare eligibility. Both younger beneficiaries who qualify for Medicare through disability and those 65 and older can participate.
How Is This Different from Regular Home Health Care?
This is an important distinction. Medicare's home health care benefit and the AHCAH program serve different patient populations and provide different levels of care.
| Feature | Home Health Care | Hospital at Home (AHCAH) | |---|---|---| | Level of care | Intermittent skilled nursing and therapy | Acute hospital-level care | | Patient status | Outpatient | Inpatient (formally admitted) | | Homebound requirement | Yes | No | | Physician visits | Periodic oversight | Daily (in person or virtual) | | Nurse visits | Intermittent (a few times per week) | At least twice daily, with 24/7 availability | | IV medications | Typically not provided | Yes, when clinically needed | | Monitoring | Periodic check-ins | Continuous remote monitoring with devices | | Prior hospital visit | Not required | Patient is typically evaluated at a hospital or ED first | | Duration | Can continue for weeks or months | Typically a few days (similar to a hospital stay) |
In short, hospital at home replaces a hospital admission. Home health care supports ongoing recovery after you leave the hospital or a skilled nursing facility.
Which Hospitals Participate?
As of early 2026, more than 370 hospitals across 139 health systems in 37 states have been approved by CMS to participate in the AHCAH program. The program includes major academic medical centers, community hospitals, and health systems of various sizes.
To find out whether a hospital near you participates, you can:
- Ask your physician or hospital discharge team
- Visit the CMS QualityNet website at qualitynet.cms.gov/acute-hospital-care-at-home for the latest list of approved hospitals
- Call 1-800-MEDICARE (1-800-633-4227) for assistance
Keep in mind that not every approved hospital is actively running the program at full capacity. Availability may vary depending on staffing, your location, and your specific medical needs.
Coverage Under Original Medicare vs. Medicare Advantage
Original Medicare (Parts A and B)
Because you are formally admitted as a hospital inpatient under the AHCAH program, your care is billed under Medicare Part A, just as a traditional hospital stay would be. This means the standard Part A cost-sharing applies:
- Part A deductible: $1,736 per benefit period (2026)
- Days 1 through 60: $0 coinsurance after the deductible
- Days 61 through 90: $434 per day coinsurance (2026)
In practice, most hospital-at-home stays are shorter than a traditional admission, often lasting just a few days. This means many patients will only pay the Part A deductible and nothing beyond that.
If you have a Medigap (Medicare Supplement) policy, it may cover some or all of your Part A deductible and coinsurance, depending on your plan.
Medicare Advantage (Part C)
Many Medicare Advantage plans also participate in or cover hospital-at-home services. However, coverage details, including copays, prior authorization requirements, and network restrictions, vary by plan.
If you are enrolled in a Medicare Advantage plan, contact your plan directly to ask:
- Whether hospital-at-home care is covered
- Which hospitals in your plan's network offer the program
- What your out-of-pocket costs would be
Medicare Advantage plans must cover at least the same services as Original Medicare, but they may structure cost-sharing differently. One advantage of Medicare Advantage is the annual maximum out-of-pocket limit ($9,250 for in-network services in 2026), which caps your total spending.
What the CMS Data Shows
In March 2026, CMS released its second batch of program data, covering the period from April 2023 through September 2025. Combined with the first data release, researchers now have access to nearly five years of information on the AHCAH initiative.
Key findings from published studies and CMS reports on the program include:
- Low mortality rates: In-hospital mortality for AHCAH patients was approximately 0.5%, with 30-day mortality at 3.2%
- Low readmission rates: Roughly 15.6% of patients were readmitted within 30 days
- Low escalation rates: About 6.2% of patients needed to be transferred back to a traditional hospital setting
- Reduced costs: A randomized controlled trial found that hospital-at-home care reduced overall costs by approximately 38% compared with traditional inpatient stays
- Fewer complications: Patients experienced fewer lab orders, fewer imaging studies, and increased physical activity compared with those in traditional hospital settings
- Lower post-discharge spending: CMS found that hospital-at-home patients generally had lower spending in the 30 days following discharge
These data points are available to researchers through the Research Data Assistance Center (ResDAC) with an approved Data Use Agreement.
Benefits of Hospital-at-Home Care
For many patients, receiving hospital-level care at home offers meaningful advantages:
Lower infection risk. Hospitals carry a well-documented risk of hospital-acquired infections, including MRSA, C. difficile, and catheter-associated infections. Recovering at home significantly reduces exposure to these pathogens.
Greater comfort and familiarity. Being in your own home, sleeping in your own bed, and having access to your personal belongings and routines can support emotional well-being during a difficult time.
More physical activity. Studies show that patients treated at home tend to move around more than those confined to a hospital room, which can support faster recovery and reduce complications like blood clots and muscle weakness.
Reduced delirium risk. Older adults are especially susceptible to hospital-induced delirium, a state of confusion that can develop when patients are in unfamiliar, high-stimulus environments. Staying home can lower this risk.
Potential cost savings. With lower overall care costs and shorter effective stays, patients may face lower out-of-pocket expenses, particularly if they have supplemental coverage.
Family involvement. Loved ones can be more present and involved in the care process without the logistical challenges of hospital visiting hours and travel.
Concerns and Considerations
While the program has shown strong results in clinical studies, it is not without concerns. Patients and families should weigh these factors carefully.
Caregiver Burden
Although the hospital provides the medical care team, family members or other household members may feel a sense of responsibility for the patient. Some caregivers report that having medical equipment and frequent clinical visits in their home can be stressful. Industry groups have called for more uniform standards around screening for caregiver readiness before patients are admitted to the program.
If you live alone, you may still be eligible, but your care team will assess whether your home situation is suitable for safe treatment.
Safety in the Home Environment
Not every home is set up to accommodate medical equipment and frequent clinical visits. Factors such as stairways, bathroom accessibility, cleanliness, and the availability of reliable electricity can affect whether the program is appropriate.
Emergency Response Times
In a hospital, emergency resources are immediately available. At home, if your condition suddenly worsens, there may be a delay before a care team can respond in person, even with 24/7 virtual monitoring. The program does include protocols for rapid escalation and hospital transfer when needed.
Limited Availability
With roughly 370 hospitals approved across 37 states, the program is not yet available everywhere. Rural areas, in particular, may have limited access due to distance from participating hospitals.
Not Suitable for All Conditions
Patients with highly unstable conditions, those requiring intensive care, or those needing complex surgical interventions are not candidates for hospital-at-home care. The program is designed for a specific range of acute conditions that can be safely managed with close monitoring outside the hospital walls.
How to Enroll
You cannot sign up for the AHCAH program on your own. Enrollment happens through the treating hospital when a physician determines that you meet the medical criteria. Here is how the process typically works:
- You are evaluated at a hospital or emergency department for an acute medical condition.
- Your physician determines you need inpatient care and assesses whether your condition qualifies for hospital-at-home treatment.
- The hospital team discusses the option with you, explaining what the program involves, how monitoring works, and what to expect.
- You provide informed consent to participate.
- The hospital arranges for equipment delivery and care team visits to begin at your home.
If you are interested in the program, you can ask your doctor or hospital team whether hospital-at-home care is available at their facility and whether it might be appropriate for your condition.
Looking Ahead
The five-year extension of the AHCAH waiver through September 2030 signals strong Congressional support for this model of care. With nearly five years of data now available and hundreds of hospitals participating, the program continues to grow.
CMS has indicated that it will continue monitoring outcomes and may use the data to inform future rulemaking. Some advocates have called for making the program permanent rather than relying on repeated waiver extensions.
For Medicare beneficiaries, this program represents an additional option worth knowing about. If you or a loved one faces a hospital admission for a qualifying condition, it is worth asking whether hospital-at-home care is available.
For more information about Medicare coverage options, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Representatives are available 24 hours a day, 7 days a week.