Medicare covers home health care after hospitalization, but only if your doctor orders it and you meet specific conditions
Yes, Medicare Part A will pay for home health care after you are discharged from the hospital — but not automatically. Your doctor must order it as part of your discharge plan, you must be homebound or unable to leave home without considerable effort, and you must need skilled care (nursing, physical therapy, or similar services). Medicare does not pay for custodial care, which is help with bathing, dressing, or meals when that is the only service you need.
The coverage begins while you are still in the hospital. Before you are discharged, the hospital's discharge planner will work with your doctor to decide whether home health care is medically necessary. If it is, Medicare will cover the cost of the home health agency's visits — you pay nothing for the visits themselves, though you may owe a copay for certain equipment or services.
Key Takeaways
- Your doctor must order home health care as part of your hospital discharge plan for Medicare to cover it.
- You must be homebound or unable to leave home without considerable effort, and you must need skilled nursing or therapy services.
- Medicare Part A covers the full cost of home health visits when ordered by your doctor; you pay nothing per visit.
- Coverage typically lasts as long as your doctor says the skilled care is medically necessary, which can be weeks or months.
- If you need only help with daily activities like bathing or meals, Medicare does not cover that type of care.
What "Homebound" Means and Why It Matters
Medicare's definition of homebound is stricter than you might think. You do not have to be bedridden, but you must be unable to leave home without considerable and taxing effort, or leaving home must be medically contraindicated (meaning your doctor says you should not). If you can go to a doctor's appointment or to the grocery store with help, you may still be homebound. If you are going out regularly for activities that are not medical, Medicare may stop covering your home health care.
The homebound requirement exists because Medicare is paying for skilled care that must happen in your home. If you are well enough to leave regularly, Medicare's position is that you are well enough to go to an outpatient clinic or rehabilitation center instead. Your home health agency will monitor this and report to Medicare if your status changes.
Types of Skilled Care Medicare Covers at Home
Medicare Part A covers visits from nurses, physical therapists, occupational therapists, and speech-language pathologists when these services are ordered by your doctor and are medically necessary. A nurse might visit to monitor your wound, change a dressing, or manage medication. A physical therapist might help you regain strength after a hip replacement or stroke. An occupational therapist might work with you on tasks like dressing or cooking after a hand injury.
Medicare also covers home health aide visits, but only if a skilled professional (like a nurse or therapist) is also visiting. A home health aide can help with bathing, dressing, and toileting, but Medicare will not pay for aide-only visits. The aide's work must be tied to the skilled care your doctor ordered.
Medical equipment and supplies — such as oxygen, a hospital bed, a walker, or wound care supplies — may also be covered under Medicare Part B, though this is separate from the home health visits themselves.
How Long Medicare Covers Home Health Care
There is no set time limit. Medicare covers home health care for as long as your doctor says it is medically necessary. For some people, that is two weeks; for others, it is several months. Your home health agency will work with your doctor to reassess your progress regularly. When your doctor determines that you no longer need skilled care, or that you are well enough to go to an outpatient setting, Medicare coverage ends.
You will receive notice before coverage ends. If you disagree with the decision, you have the right to appeal. Your home health agency can tell you how to file an appeal and what information you need to provide.
What You Pay Out of Pocket
If you have already met your Part A deductible during your hospital stay, you pay nothing for home health visits. If you have not met the deductible, you will owe it before Medicare begins paying. Once the deductible is met, Medicare covers 100 percent of the cost of skilled home health visits.
You may owe a copay for certain equipment or services. For example, if your home health agency provides oxygen or a hospital bed, you typically pay 20 percent of the approved amount for that equipment under Part B. Ask your home health agency or call Medicare at 1-800-MEDICARE to find out what you might owe for specific items.
How to Arrange Home Health Care Before You Leave the Hospital
The hospital's discharge planner will start this process before you are discharged. Tell the planner about your home situation — whether you live alone, whether someone will be there to help you, and whether your home has stairs or other barriers. The planner will work with your doctor to decide what services you need and will contact a Medicare-certified home health agency to arrange visits.
You can request a specific agency if you have one in mind, but the hospital may have preferred partners. Make sure the agency is Medicare-certified; you can check this on Medicare's website or by calling 1-800-MEDICARE. Before you leave the hospital, you should know which agency will be visiting, when the first visit will happen, and what services are ordered.
If you are discharged on a weekend or holiday and need urgent care, tell the hospital staff. Some home health agencies have on-call nurses available for urgent situations, and the hospital can help coordinate that.
What Happens If You Need Care But Were Not Hospitalized
If you need home health care but have not been in the hospital, Medicare may still cover it — but the rules are different and stricter. Your doctor must order it, you must be homebound, and you must need skilled care. However, you do not have the automatic pathway that hospitalization provides. Your doctor will need to document why home health care is medically necessary and submit that information to Medicare. This process takes longer and is denied more often than home health care ordered after hospitalization.
If you are in a skilled nursing facility after hospitalization, Medicare Part A covers that stay for up to 100 days. Home health care is a separate benefit and may be ordered after you leave the facility.
Frequently Asked Questions
Can I choose which home health agency provides my care?
You can request a specific Medicare-certified agency, and the hospital should honor that request if possible. However, the agency must be in your area and must be able to start visits on the timeline your doctor ordered. If your preferred agency cannot serve you, the hospital will work with you to find one that can.
What if I live alone and need help at home?
Medicare covers skilled nursing and therapy visits regardless of whether someone else is home. However, if you need help with daily activities and no one is available, you may need to hire a private caregiver or explore other community resources. The hospital social worker can discuss options with you before discharge.
Does Medicare cover home health care if I go to a rehabilitation center instead of home?
No. Home health care is specifically for care provided in your home. If you go to a skilled nursing facility or rehabilitation center, Medicare Part A covers that stay instead. Once you are discharged from the facility to your home, home health care can be ordered at that point if medically necessary.
What if my doctor says I need home health care but Medicare denies it?
You have the right to appeal. Your home health agency or doctor can file an appeal on your behalf, or you can contact Medicare at 1-800-MEDICARE to start the process. You can also ask for a detailed explanation of why the claim was denied, which will help you understand what information Medicare needs.
Can Medicare cover home health care if I am also receiving Medicaid?
Yes. If you are may be able to access for both Medicare and Medicaid, Medicare is the primary payer for home health care. Medicaid may cover additional services or fill gaps, depending on your state's rules. Your home health agency can help coordinate benefits between the two programs.