Medicare covers some ankle surgery recovery care at home, but not all of it — and what you pay depends on which type of Medicare you have and what your doctor orders.
If your doctor says you need skilled nursing care or physical therapy after ankle surgery, Medicare Part A (hospital insurance) or Part B (medical insurance) will cover those services when they happen in your home. Medicare will not cover custodial care — help with bathing, dressing, or meals — unless it is tied to a skilled service your doctor has ordered. You will also have out-of-pocket costs: a copay for each physical therapy visit under Part B, or a daily coinsurance amount under Part A if you are in a home health episode that includes an overnight hospital or skilled nursing stay in the three days before discharge.
Key Takeaways
- Medicare Part A covers home health services (nursing, therapy, medical equipment) with no copay if you meet the homebound requirement and your doctor orders skilled care within three days of hospital or skilled nursing discharge.
- Medicare Part B covers outpatient physical therapy and occupational therapy at home, but you pay 20 percent of the approved amount after you meet your annual deductible.
- Medicare does not cover help with daily living tasks such as bathing or meal prep unless those tasks are part of a skilled nursing visit your doctor has ordered.
- You will need a written order from your doctor stating that home health or therapy is medically necessary, and a home health agency must be Medicare-certified to bill Medicare.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower, but coverage rules vary by plan.
What Medicare Part A Covers for Home Recovery
Medicare Part A covers home health services after ankle surgery if three conditions are met: your doctor orders the care in writing, you are homebound (unable to leave home without considerable effort or help), and the care begins within three days of your discharge from a hospital or skilled nursing facility. Home health includes skilled nursing visits, physical therapy, occupational therapy, and medical equipment such as crutches, walkers, or compression devices.
You pay nothing per visit under Part A, but you may owe a daily coinsurance amount — currently $194 per day — if the home health episode includes a medical supply or equipment charge. This coinsurance applies only to the days you receive supplies or equipment, not to nursing or therapy visits. The coinsurance stops after you have paid the Part A deductible for the year, which is $1,676 in 2024 (this amount changes yearly).
Home health under Part A is time-limited. Medicare will cover the services as long as your doctor certifies they are medically necessary, but the agency must recertify your need every 60 days. If your recovery plateaus or your doctor determines you no longer need skilled care, coverage ends.
What Medicare Part B Covers for Home Therapy
Medicare Part B covers physical therapy and occupational therapy in your home when ordered by your doctor. Unlike Part A home health, Part B therapy does not require you to be homebound or to have been hospitalized in the three days before. Your doctor can order Part B therapy directly, and a Medicare-certified therapist can come to your home.
You pay 20 percent of the Medicare-approved amount for each therapy visit after you meet your annual Part B deductible, which is $240 in 2024. If your therapist charges more than Medicare's approved amount, you may owe the difference as well. There is no limit on the number of therapy visits Medicare will cover, but your therapist and doctor must document that each visit is medically necessary and that you are making progress toward your recovery goals.
Part B therapy is often the route for people who did not spend a night in the hospital before surgery or who need therapy beyond what Part A home health covers. You can receive Part B therapy at the same time as Part A home health, but Medicare will not pay twice for the same service on the same day.
Medical Equipment and Supplies Medicare Covers at Home
Medicare covers durable medical equipment (DME) needed for ankle surgery recovery, including crutches, walkers, canes, wheelchairs, and compression devices. Your doctor must write an order stating the equipment is medically necessary, and you must rent or buy the equipment from a Medicare-approved DME supplier.
Under Part B, you pay 20 percent of the Medicare-approved rental or purchase price after your deductible. For some items — such as crutches or a cane — Medicare covers the full cost of purchase. For others — such as a wheelchair or continuous passive motion machine — Medicare may cover rental, and you pay 20 percent. The supplier will tell you whether Medicare covers purchase or rental for your specific item.
Compression socks, elastic bandages, and over-the-counter pain relievers are not covered by Medicare, even if your doctor recommends them. You will pay out of pocket for these items.
What Medicare Does Not Cover at Home
Medicare does not cover custodial care — help with bathing, dressing, grooming, toileting, or meal preparation — unless a nurse is present to provide skilled care at the same time. If you need someone to help you bathe because you cannot put weight on your ankle, Medicare will not pay for that help alone. However, if a home health nurse visits to change a wound dressing and also helps you bathe as part of that skilled visit, the bathing is covered as part of the nursing visit.
Medicare also does not cover homemaker services, yard work, grocery shopping, or transportation to therapy appointments. Some Medicaid programs or local Area Agencies on Aging may help with these services, but Medicare itself does not.
If you live alone and need daily help with tasks unrelated to skilled care, you will need to hire a private aide, ask family members, or look into community resources. Your hospital discharge planner or social worker can point you toward local programs that may help.
How to Start Home Health or Therapy Services
Your doctor must write an order for home health or therapy before you leave the hospital or skilled nursing facility, or within three days of discharge. The order should state what services you need, how often, and for how long. Give this order to the home health agency or therapy provider you choose — they will verify your Medicare coverage and handle the billing.
You can choose any Medicare-certified home health agency or therapy provider. Ask your hospital discharge planner for a list, or search the Medicare Care Compare tool on Medicare.gov. Before you sign up, confirm that the agency is Medicare-certified and ask about your out-of-pocket costs based on your specific plan.
If you have a Medicare Advantage plan (Part C), the rules are different. Your plan may require you to use in-network providers, may have different copays, or may cover services Part A and Part B do not. Check your plan documents or call your plan's customer service line before you schedule services.
Out-of-Pocket Costs by Medicare Type
| Medicare Type | Home Health Nursing & Therapy | Part B Therapy (if not in home health) | Durable Medical Equipment |
|---|---|---|---|
| Original Medicare (Part A + B) | No copay; daily coinsurance for supplies/equipment ($194/day in 2024) | 20% of approved amount after $240 deductible | 20% of approved amount after deductible |
| Medicare Advantage (Part C) | Varies by plan; may be $0 or a copay per visit | Varies by plan; often $0–$50 per visit | Varies by plan; often $0–$50 per item |
| Original Medicare + Medigap | Medigap may cover daily coinsurance | Medigap may cover 20% copay | Medigap may cover 20% copay |
Your actual costs depend on your plan, your deductible status, and what your provider charges. Ask your home health agency or therapist to give you an estimate before services begin.
Frequently Asked Questions
Do I have to be homebound to get home health after ankle surgery?
Yes, for Medicare Part A home health. You must be unable to leave home without considerable effort or help. Part B therapy does not have a homebound requirement, so you can receive therapy at home even if you could leave the house. Ask your doctor which type of coverage makes sense for your situation.
What if my doctor did not order home health before I left the hospital?
You can still receive Part B therapy at home if your doctor orders it within a reasonable time after discharge. However, you will not be covered under Part A home health because that requires an order within three days of discharge. Call your doctor's office and ask them to write an order for Part B therapy if you need it.
Will Medicare pay for someone to help me at home if I live alone?
Medicare will not pay for a personal aide or housekeeper. If you need daily help with bathing, meals, or household tasks, you will need to hire someone privately, ask family, or contact your local Area Agency on Aging to learn about community programs that may help.
Can I use a family member as my home health aide?
No. Medicare requires home health services to be provided by a Medicare-certified agency with trained, licensed staff. Family members cannot bill Medicare for care, even if they are trained. However, family members can help you with non-skilled tasks while a professional provides the skilled care Medicare covers.
What happens if I need therapy longer than Medicare covers?
Medicare covers therapy as long as your doctor certifies it is medically necessary and you are making progress. If you reach a point where Medicare stops covering visits, you can continue therapy by paying out of pocket, through a supplemental insurance plan, or through a Medicare Advantage plan that offers additional therapy benefits. Ask your therapist about the cost before coverage ends.