Medicare covers home health care, but only under specific conditions
Medicare Part A covers skilled home health care when a doctor orders it, you are homebound, and a Medicare-approved agency provides the care. Skilled care means nursing, physical therapy, occupational therapy, speech therapy, or medical social work — not help with bathing, dressing, or meals unless it is part of a skilled service. You pay nothing for the skilled visits themselves, but you may owe a copay for equipment like walkers or oxygen.
Home health aide services (help with personal care) are covered only when a skilled service is also being provided. Once the skilled need ends, the aide visits stop, even if you still need help at home. This is the most common reason people think Medicare stopped covering them when the real issue is the skilled service ended.
Medicare does not cover custodial care — help with activities of daily living when no skilled service is involved. It also does not cover homemaker services, meal delivery, or home modifications like grab bars or ramps, even if your doctor says you need them.
Key Takeaways
- Medicare Part A covers skilled nursing and therapy visits at home only when a doctor orders them and you meet the homebound requirement, with no copay for the visits themselves.
- Home health aides can only be covered when a skilled service is also happening; once therapy or nursing ends, aide visits end too.
- You must use a Medicare-approved home health agency; care from an unlicensed provider or a family member is not covered.
- Custodial care — help with bathing, dressing, toileting, or meals — is not covered by Medicare unless it is tied to a skilled service.
- You may owe copays for medical equipment and supplies, depending on what is ordered and which supplier you use.
The homebound requirement and what it actually means
To receive Medicare home health care, you must be homebound — meaning leaving home requires considerable and taxing effort, or your condition makes it medically inadvisable to leave. You do not have to be bedridden. You can leave for medical appointments, religious services, or adult day programs, and those trips do not disqualify you.
The homebound rule exists because Medicare assumes that if you can get to an outpatient clinic, you should go there instead. If you are able to shop, run errands, or visit friends regularly, a home health nurse will likely deny the claim. Document your actual mobility — if you can only leave with help, or if leaving causes pain or exhaustion, tell the nurse during the assessment.
How the ordering process works and what your doctor needs to do
Your doctor must write an order for home health care and send it to a Medicare-approved agency. The order must state what skilled service you need (nursing, physical therapy, etc.) and roughly how often. Your doctor does not need to predict exactly how many visits — that is the agency's job during the initial assessment — but the order must justify why home-based care is medically necessary.
If your doctor says "patient needs home health," that is not enough. The order should say something like "patient needs skilled nursing for wound care and physical therapy for mobility after hip surgery." The more specific the order, the faster the agency can start. If the order is vague, the agency will call your doctor for clarification, which delays your first visit.
You can request a specific Medicare-approved agency, or your doctor can choose one. Ask your doctor which agencies they work with regularly — agencies that know your doctor's ordering patterns tend to process claims faster.
What happens during the initial assessment and who pays for it
A nurse or therapist from the agency will visit your home to assess your condition, review your medical history, and determine what services you actually need. This visit is covered by Medicare at no cost to you. During this visit, the clinician decides the frequency and duration of care — not your doctor, and not you.
The assessment determines whether you truly meet Medicare's homebound and skilled-care requirements. If the assessor decides you do not meet the criteria, Medicare will deny coverage, and you will receive a notice explaining why. You can appeal, but the appeal must be filed within 120 days of the denial notice.
The assessor will also ask about your living situation, medications, and any equipment you already have at home. Be honest about what you can and cannot do — if you downplay your limitations, the plan of care may not match your actual needs, and visits could be cut short.
Copays, deductibles, and what you owe for equipment
You pay nothing for the skilled nursing or therapy visits themselves under Medicare Part A. There is no copay per visit and no deductible once you have met your Part A deductible for the hospital stay or may have access to event that led to home health.
You may owe a copay for durable medical equipment (DME) — walkers, wheelchairs, oxygen, hospital beds — ordered as part of your home health plan. The copay is usually 20 percent of the approved amount after you meet your Part B deductible. The equipment supplier, not the home health agency, bills you for this copay.
If the agency orders supplies like wound dressings, catheters, or diabetic testing strips, those are typically covered with no copay. If you need items the agency does not provide — grab bars, shower chairs, or ramps — those are not covered by Medicare, and you pay the full cost out of pocket.
When home health care ends and what to do next
Home health care ends when your doctor determines you no longer need skilled care, when you no longer meet the homebound requirement, or when you have reached the maximum benefit (though this is rare). The agency must give you written notice at least two days before the last visit. If you disagree with the discharge decision, you can appeal within 120 days of the notice.
If you still need help at home after Medicare coverage ends, you have several options. You can hire a private home care aide out of pocket, explore Medicaid coverage (which varies by state and may cover custodial care), or look into programs through your local Area Agency on Aging. Some people transition to adult day programs or assisted living if home care is no longer an option.
Ask the home health agency for a discharge plan before your last visit. A good plan includes what exercises or medications to continue, what warning signs to watch for, and which doctor to call if problems arise. If the agency does not offer one, ask your primary care doctor for follow-up instructions.
Medicare Advantage and Medicaid coverage of home health
If you have a Medicare Advantage plan (Part C), home health coverage rules are the same as Original Medicare — skilled care at home, homebound requirement, no copay for visits — but your plan may have a network of preferred agencies. Check your plan documents or call the plan to find out which agencies are in-network. Out-of-network care may cost more or may not be covered.
Medicaid covers home health in every state, but the rules differ from Medicare. Medicaid often covers custodial care and aide services without requiring a skilled service, and the homebound requirement may be less strict. If you are on both Medicare and Medicaid (dual may be able to access), Medicare is the primary payer, and Medicaid covers what Medicare does not. Contact your state Medicaid office or your local Area Agency on Aging to learn what your state covers.
Frequently Asked Questions
Can I get home health care if I live alone?
Yes. Living alone does not disqualify you. Medicare only requires that you are homebound and have a skilled medical need. If you live alone and cannot safely manage your care, that actually strengthens your case for home health services. The agency will assess whether you have adequate support and may recommend additional services or equipment to keep you safe.
What if my doctor orders home health but the agency says I don't may have access to?
The agency's assessor makes the final decision about whether you meet Medicare's criteria, not your doctor. If you are denied, you will receive a notice explaining the reason. You can appeal by calling the agency and asking for a peer-to-peer review, where your doctor can speak directly to a medical reviewer. You can also file a formal appeal with Medicare within 120 days of the denial notice.
Does Medicare cover physical therapy at home if I don't have skilled nursing?
Yes. Physical therapy, occupational therapy, and speech therapy are skilled services on their own. You do not need nursing care to may have access to for therapy. However, you must still be homebound and have a doctor's order. Once the therapy ends and you no longer need skilled care, home health coverage stops.
Can family members provide the home health care instead of an agency?
No. Medicare only pays a Medicare-approved agency. Care provided by family members, friends, or unlicensed individuals is not covered, even if a nurse supervises them. If you want a family member to be involved, they can help with non-skilled tasks (meals, errands, companionship) while the agency provides the skilled care.
What happens if I need home health care but I'm not homebound?
Medicare will not cover it. If you can leave home without considerable effort or medical risk, you do not meet the homebound requirement. You would need to receive care at an outpatient clinic or hospital instead. If your condition changes and you become homebound later, you can reapply at that time.