Medicare covers home health care, but only under specific conditions

Medicare Part A and Part B together cover home health services when a doctor orders them and you meet certain requirements. The key condition is that you must be homebound — meaning you cannot leave home without considerable effort or help, or leaving would be medically inadvisable. You also need a doctor's order, and the services must be medically necessary rather than custodial (like help with bathing or dressing alone).

What Medicare actually pays for includes skilled nursing visits, physical therapy, occupational therapy, speech-language pathology, and medical social work. It does not cover ongoing personal care, housekeeping, meal preparation, or companionship — even if you need those things. If you need help with activities of daily living and nothing else, Medicare will not cover it, and you will need to pay out of pocket or look into Medicaid or other programs.

Key Takeaways

  • Medicare covers home health only when a doctor orders it, you are homebound, and the care is skilled nursing or therapy — not personal care alone.
  • Part A covers the full cost of home health visits with no copay or deductible, as long as you meet the homebound requirement and have been in a hospital or skilled nursing facility within the past 60 days.
  • Part B covers home health visits when Part A does not explore, but you pay 20 percent of the Medicare-approved amount after you meet your deductible.
  • Home health agencies must be Medicare-certified, and you can change agencies at any time without penalty.
  • If you need only personal care or housekeeping help, you will need to pay privately or explore Medicaid, which covers custodial care in some states.

When Part A covers home health with no out-of-pocket cost

Part A covers home health visits at no cost to you when three conditions are all true: you are homebound, a doctor has ordered the care, and you have been an inpatient in a hospital or skilled nursing facility for at least three consecutive days within the past 60 days. This is called the three-day may have access to stay. Once you meet these conditions, Part A pays 100 percent of the cost of covered services — no copay, no deductible.

The three-day stay does not have to be recent. If you were hospitalized or in a skilled nursing facility 59 days ago, you still may have access to. But if 60 days have passed since you left the facility, the three-day requirement no longer applies, and Part B rules take over instead.

Part A coverage continues as long as you remain homebound and your doctor says the care is medically necessary. There is no set limit on the number of visits, though Medicare reviews your case regularly to confirm you still need skilled care.

When Part B covers home health and what you pay

Part B covers home health visits when you do not have a may have access to three-day hospital or skilled nursing facility stay, or when that 60-day window has closed. You must still be homebound and have a doctor's order, but Part B does not require the prior hospitalization.

Under Part B, you pay 20 percent of the Medicare-approved amount for each visit, after you have met your annual Part B deductible. The deductible amount changes each year. Once you reach it, you pay the 20 percent coinsurance for the rest of the calendar year. If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower.

What services Medicare counts as skilled care

Medicare distinguishes between skilled care — which it covers — and custodial care — which it does not. Skilled care requires the judgment and training of a licensed nurse or therapist. This includes wound care, catheter management, medication management, physical therapy to regain function after an illness or injury, occupational therapy, and speech therapy.

Custodial care is help with activities of daily living: bathing, dressing, toileting, eating, and moving around the house. Even if you need this help every day, Medicare will not cover it. Neither will Medicare cover housekeeping, meal preparation, shopping, or companionship. If you need only these services, you will need to pay privately or look into Medicaid, which covers custodial care in some states.

The line between skilled and custodial can blur. For example, if a nurse teaches you how to manage your catheter so you can do it yourself, that is skilled care. If a home health aide straightforward changes your catheter for you every day, that is custodial. Medicare looks at whether the service requires a licensed professional and whether it is tied to a medical condition or recovery from an acute event.

How to start home health services

Your doctor must order home health care. You cannot request it on your own or have a family member request it. Your doctor will write an order and send it to a Medicare-certified home health agency. The agency will contact you to schedule an initial assessment, usually within a few days.

You can choose which Medicare-certified agency provides your care. Ask your doctor for a list, or search the Medicare Care Compare tool on Medicare.gov to see agencies in your area, their inspection records, and patient ratings. You can change agencies at any time without penalty — just tell your current agency and your doctor.

At the first visit, a nurse will assess your medical condition, your home environment, and what skilled care you need. This assessment determines what services Medicare will cover. If the agency determines you do not meet the homebound requirement or do not need skilled care, they will tell you and your doctor, and Medicare will not cover the visits.

What happens if you are no longer homebound

If you improve and can leave home without considerable effort or medical risk, you are no longer homebound, and Medicare will stop covering home health visits. The home health agency is required to reassess you regularly — usually every 60 days — to confirm you still meet the homebound requirement.

If you disagree with the agency's decision that you are no longer homebound, you can ask for a second opinion from your doctor or request a Medicare review. Your doctor can also appeal the decision on your behalf. Keep in mind that improvement is a good sign — it means the therapy and nursing care are working.

Medicare Advantage and home health coverage

If you have a Medicare Advantage plan (Part C), your coverage for home health is the same as Original Medicare — the plan must cover all medically necessary home health services ordered by your doctor. However, some Advantage plans may require you to use agencies in their network, or they may have different copay amounts than Original Medicare.

Check your plan's summary of benefits or call the plan directly to understand your out-of-pocket costs for home health. If your plan denies coverage for home health that your doctor ordered, you have the right to appeal.

Frequently Asked Questions

Does Medicare cover home health if I live alone?

Yes. Living alone does not disqualify you. What matters is whether you are homebound and have a doctor's order for skilled care. Many people who live alone receive Medicare-covered home health services.

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

Only if a nurse or therapist is also providing skilled care at the same time. A home health aide can information with bathing and dressing as part of a skilled nursing or therapy visit, but Medicare will not cover an aide visit on its own. If you need only personal care, you will need to pay privately or explore Medicaid.

How long does Medicare cover home health?

There is no set time limit. Medicare covers home health as long as you are homebound, have a doctor's order, and need skilled care. Your case is reviewed regularly — usually every 60 days — to confirm you still meet these requirements. If you improve and no longer need skilled care, coverage ends.

Can I choose my home health agency?

Yes. You can choose any Medicare-certified agency. If you want to change agencies, tell your current agency and your doctor. You can switch at any time without penalty. Use the Medicare Care Compare tool on Medicare.gov to compare agencies in your area.

What if my doctor says I need home health but the agency says I am not homebound?

You can ask your doctor to clarify in writing why you cannot leave home safely, or request a second opinion from another doctor. You also have the right to appeal Medicare's decision. Your doctor can file an appeal on your behalf if you disagree with the agency's assessment.