Medicare's Home Rehabilitation Coverage: What You Need to Know

Medicare does cover some rehabilitation services at home, but only under specific conditions. You must be homebound or unable to leave home without considerable effort, your doctor must order the services, and you must need skilled care — not just help with daily tasks. Medicare pays for physical therapy, occupational therapy, and speech-language pathology when a home health agency provides them. It does not pay for custodial care, which is help with bathing, dressing, or meals without a medical component.

The coverage comes through Medicare Part A (if you are in a hospital or skilled nursing facility first) or Medicare Part B (directly, without a prior stay). The route you use affects what you pay and how long services last. Understanding which path applies to your situation determines whether your costs are minimal or substantial.

Key Takeaways

  • Medicare covers skilled rehabilitation at home only if you are homebound, your doctor orders it, and a Medicare-certified home health agency provides it.
  • Part A covers home health services with no copay if you were hospitalized or in a skilled nursing facility for at least three days first.
  • Part B covers home health services with a 20 percent copay on equipment and supplies, but requires you to meet the homebound definition.
  • Custodial care — help with bathing, dressing, or meals — is not covered, even if a nurse provides it.
  • Your doctor must recertify your need for services every 60 days, and Medicare reviews whether you remain homebound.

Part A Coverage: After Hospital or Skilled Nursing Facility Stay

If you spent at least three consecutive days in a hospital or skilled nursing facility, Medicare Part A covers home health services with no copay. This is the most generous path. You pay nothing for the skilled nursing visits, therapy sessions, medical equipment, or supplies the home health agency provides.

Part A coverage lasts up to 60 days from the day you leave the facility, though your doctor can extend it if you still need skilled care. The agency must be Medicare-certified, and your doctor must order the services in writing before you leave the hospital or facility. If you do not have a home health agency lined up, the hospital discharge planner can refer you to one in your area.

Common mistakes: waiting until after discharge to find an agency (delays start of services), or assuming all home health agencies are Medicare-certified (they are not — always ask). Another error is thinking Part A covers unlimited visits. It does not. Medicare pays for medically necessary visits only, and the agency must document why each visit is needed.

Part B Coverage: Without a Prior Facility Stay

If you did not spend three days in a hospital or facility, Medicare Part B covers home health services directly. You pay a 20 percent copay on equipment and supplies, and nothing for the skilled nursing and therapy visits themselves. This route is slower to set up and requires your doctor to certify that you are homebound.

Part B does not have a time limit the way Part A does. Services can continue as long as your doctor certifies the need and you remain homebound. However, Medicare reviews your case every 60 days. If the reviewer decides you no longer meet the homebound definition or no longer need skilled care, coverage stops.

The homebound definition is strict: you must be unable to leave home without considerable and taxing effort, or leaving home would be medically contraindicated. Being able to go to a doctor's appointment or church once a week does not disqualify you, but being able to walk to the mailbox or drive yourself to therapy does. Your doctor's statement about your mobility matters more than your own assessment.

What Rehabilitation Services Medicare Covers at Home

Medicare covers three main types of skilled rehabilitation through home health:

  • Physical therapy: exercises and mobility training after surgery, stroke, or injury; assessment of your home for fall risks; gait training with a walker or cane.
  • Occupational therapy: retraining for daily tasks like dressing, cooking, or using the bathroom after illness or injury; assessment of adaptive equipment you might need.
  • Speech-language pathology: swallowing therapy after stroke; voice or speech retraining; cognitive retraining after brain injury.

Medicare also covers skilled nursing visits when they are tied to rehabilitation — for example, wound care after surgery, catheter management, or monitoring for complications. It does not cover nursing visits for routine blood pressure checks or medication reminders unless they are part of a skilled treatment plan.

Medical equipment and supplies are covered if your doctor orders them as part of your rehabilitation plan. This includes walkers, canes, grab bars, shower chairs, and commodes. You pay 20 percent of the approved amount for equipment under Part B. Supplies like wound dressings or catheter kits are covered at no cost.

What Medicare Does Not Cover at Home

Medicare does not cover custodial care, which is the largest gap in home rehabilitation coverage. Custodial care means help with activities of daily living — bathing, dressing, grooming, toileting, eating — when there is no medical or skilled component. Even if a nurse provides this help, Medicare will not pay for it.

Medicare also does not cover homemaker services (cleaning, laundry, shopping), meal delivery, or transportation to appointments. It does not cover therapy or services ordered by someone other than a doctor — for example, a physical therapist cannot order their own follow-up visits. It does not cover services from an agency that is not Medicare-certified, even if the therapist is may have access to.

If you need custodial care alongside rehabilitation, you will need to pay out of pocket, use Medicaid (if you may have access to), or explore long-term care insurance. Some people combine Medicare-covered rehabilitation with privately paid custodial help from the same agency, though costs add up quickly.

How to Start Home Rehabilitation Services

If you are leaving a hospital or facility, the discharge planner will ask which home health agency you prefer or will refer you to one. You can request a specific agency if you know one, but it must be Medicare-certified. Ask the planner to confirm this before you leave.

If you are starting services under Part B without a prior stay, your doctor must order home health first. Call your doctor's office and ask them to submit a home health order to a Medicare-certified agency. You can find certified agencies in your area through Medicare.gov's Care Compare tool or by calling your local Area Agency on Aging.

The home health agency will contact you to schedule an initial assessment. A nurse will visit your home, review your medical history, assess your mobility and safety, and create a care plan. This visit is covered by Medicare. The agency will tell you how many visits per week you can expect and what your out-of-pocket costs will be.

Bring your Medicare card and any other insurance cards to the first visit. Tell the agency if you have a supplemental insurance policy (Medigap) or Medicare Advantage plan, as this affects your copay amounts. Ask the agency to provide an estimate of your costs in writing.

Costs and Copays

Under Part A, you pay nothing for home health services if you meet the three-day requirement. Under Part B, you pay 20 percent of the Medicare-approved amount for equipment and supplies only. Skilled nursing and therapy visits are covered at no cost.

If you have a Medigap supplemental policy, it may cover the 20 percent copay on equipment. If you have a Medicare Advantage plan, your copays depend on your specific plan — some charge per visit, others charge a flat copay, and some charge nothing. Call your plan before services start to confirm your costs.

If you run out of Part A coverage (after 60 days) and do not may have access to for Part B, you will pay the full cost of home health services out of pocket. This is why understanding which path you may have access to for matters. Some people transition from Part A to Part B coverage; others need to arrange private pay. Your home health agency can explain the transition when it approaches.

Frequently Asked Questions

Can I choose which home health agency provides my rehabilitation?

Yes. If you are leaving a hospital or facility, you can request a specific Medicare-certified agency. If your doctor is ordering home health under Part B, you can also choose the agency. Medicare.gov's Care Compare tool lets you search agencies in your area and see their inspection records. Always confirm the agency is Medicare-certified before agreeing to services.

What happens when my Part A coverage ends after 60 days?

If you still need rehabilitation and meet the homebound definition, you may transition to Part B coverage. Your doctor must recertify your need, and you will start paying the 20 percent copay on equipment. If you do not meet the homebound definition or no longer need skilled care, coverage ends and you pay out of pocket or explore other options like Medicaid or private pay.

Does Medicare cover home rehabilitation after an accident or fall?

Yes, if your doctor orders it and you meet the homebound requirement. You do not need a hospital stay first to may have access to for Part B coverage. Your doctor must document that you cannot leave home without considerable effort due to the injury and that you need skilled physical or occupational therapy to recover.

Will Medicare pay for a home health aide to help me bathe and dress?

Not directly. Medicare does not cover custodial care like bathing or dressing. However, if a home health aide is visiting for a skilled reason — such as assisting a nurse with wound care or helping you practice exercises ordered by a physical therapist — that visit may be covered. Ask your home health agency whether your specific needs may have access to.

Can my family member provide the rehabilitation services instead of a home health agency?

No. Medicare only pays for services from a Medicare-certified home health agency. Family members can help you with exercises or daily tasks, but Medicare will not reimburse them. If you want a family member involved, they can work alongside the agency therapist and learn techniques during visits.