What Medicare covers at home
Medicare Part A covers skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services when a doctor orders them and you meet specific conditions. Part B covers some services that Part A does not — mainly certain therapies and medical equipment — under different rules. The key difference is that Part A requires you to be homebound and recently discharged from a hospital or skilled nursing facility, while Part B has looser requirements but covers fewer service types.
Medicare does not cover custodial care — help with bathing, dressing, toileting, or meal preparation — unless it is part of a skilled service a nurse or therapist is already providing. It also does not cover housekeeping, yard work, or services that could be done by someone without medical training, even if you need them.
Key Takeaways
- Medicare Part A covers skilled nursing, physical therapy, occupational therapy, and speech therapy at home if a doctor orders them and you are homebound after a hospital or nursing facility stay.
- Part B covers some therapies and medical equipment at home without requiring a recent hospital discharge, but the rules and covered services differ from Part A.
- You must be confined to your home by illness or injury — able to leave only with difficulty and medical information — for Medicare to pay for home health visits.
- Medicare does not cover non-skilled help like bathing information, meal preparation, or housekeeping unless a nurse or therapist is providing it as part of their skilled care.
- Your doctor must order home health services and recertify the need every 60 days for Part A coverage to continue.
Part A coverage: skilled nursing and therapy after hospital discharge
Part A covers home health services only if you have been an inpatient in a hospital for at least three consecutive days (not counting the discharge day) within the past 30 days, or if you are being discharged from a skilled nursing facility. This is called the three-day may have access to stay. Without it, Part A will not pay, even if your doctor orders home care.
Once you meet that requirement, Part A covers skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology. A skilled nursing visit includes wound care, injections, catheter management, or monitoring of a medical condition. Therapy visits focus on restoring function — a physical therapist helping you walk again after a stroke, or an occupational therapist teaching you to dress yourself after surgery.
You must also be homebound. This means leaving home is medically contraindicated or requires supportive information and medical equipment. You do not have to be bedbound; you can leave for medical appointments or, in some cases, religious services. But your primary residence must be your home, and leaving it must be difficult and require help.
Part A covers the full cost of home health services with no copay or coinsurance — you pay nothing out of pocket. Coverage continues as long as your doctor certifies the need every 60 days and you remain homebound. Once you no longer need skilled care or can leave home without difficulty, coverage stops.
Part B coverage: therapy and equipment without a hospital stay
Part B covers some home health services without requiring a three-day hospital stay. You can receive physical therapy, occupational therapy, or speech-language pathology at home if your doctor orders it and you are homebound — but the homebound requirement is the same as for Part A. Part B does not cover skilled nursing visits the way Part A does.
Part B also covers durable medical equipment (DME) used at home: wheelchairs, walkers, hospital beds, oxygen equipment, and similar items. You pay 20 percent of the Medicare-approved amount after you meet your annual Part B deductible. The supplier must be Medicare-enrolled.
Unlike Part A, Part B does not require a recent hospital discharge. Your doctor can order home therapy directly. However, Part B therapy is subject to annual visit limits and requires you to pay coinsurance on each visit. These limits and costs change year to year, so check your current plan documents or call Medicare at 1-800-MEDICARE to confirm what applies to you.
The homebound requirement and what it means
Being homebound is the gate that opens Medicare home health coverage. You cannot straightforward prefer to stay home or find it inconvenient to leave — you must be unable to leave without considerable and taxing effort, or unable to leave safely without help. A doctor must document this in your medical record.
Homebound status includes people who are bedbound, those who cannot walk without a walker or cane and have no one to help them, those whose medical condition makes leaving dangerous, and those whose medications or treatments make travel risky. It also includes people who can leave home only with information from another person and medical equipment.
You can still be homebound and attend a medical appointment, dialysis, or chemotherapy. Some programs allow a single outing per week for religious services. But these outings do not disqualify you — the standard is whether leaving home for daily activities is possible, not whether you never leave.
How to start home health services through Medicare
Your doctor must order home health services and specify what type (nursing, physical therapy, occupational therapy, or speech therapy) and how often. The doctor also certifies that you are homebound and that the services are medically necessary. Without a doctor's order, Medicare will not pay.
Once your doctor places the order, you or your doctor can contact a Medicare-certified home health agency. The agency will arrange an intake visit, verify your homebound status, and begin services. You can choose which agency to use — you are not locked into one — and you can change agencies if you are unhappy.
For Part A coverage, make sure the agency knows about your three-day hospital or nursing facility stay and the dates. The agency will use this information to determine whether you meet the may have access to requirement. If you do not have documentation of the stay, ask the hospital or facility to provide it.
The home health agency bills Medicare directly. You should receive no bill for Part A services. If you do, contact the agency and Medicare to report it.
Services Medicare does not cover at home
Custodial care — help with activities of daily living like bathing, dressing, grooming, toileting, and eating — is not covered by Medicare, even if you need it. The exception is when a nurse or therapist provides it as part of a skilled service. For example, a physical therapist may help you bathe as part of teaching you safe bathing techniques after a stroke, but Medicare is paying for the therapy instruction, not the bathing itself.
Medicare also does not cover housekeeping, meal preparation, laundry, yard work, or transportation to appointments. It does not cover homemaker services or personal care attendants hired to help with non-skilled tasks. If you need these services, you may be able to pay out of pocket, use Medicaid (if you may have access to), or look into local aging services programs.
Continuous care — a nurse or aide in your home all day — is not a Medicare home health benefit. If you need round-the-clock care, you would need to arrange and pay for it privately, or explore whether you may have access to for Medicaid, which has different rules in each state.
What happens when home health services end
Medicare home health coverage ends when your doctor determines you no longer need skilled care, when you no longer meet the homebound requirement, or when you have received the maximum number of visits allowed under your plan. Your doctor and the home health agency will discuss this with you before services stop.
If you still need help at home after Medicare coverage ends, you have several options. You can hire a home care aide privately and pay out of pocket. You can explore whether you may have access to for Medicaid, which covers custodial care in some states. You can also contact your local Area Agency on Aging to learn about community programs, meal delivery, transportation, or other services that may help.
If you believe Medicare ended your coverage too early, you have the right to appeal. Contact your home health agency or Medicare directly to request a review.
Frequently Asked Questions
Do I have to use a home health agency, or can I hire someone myself?
Medicare only pays agencies that are Medicare-certified. You cannot hire an individual nurse or therapist and have Medicare reimburse you. The agency handles billing and ensures the provider meets Medicare standards. You can choose which certified agency to use.
What if my doctor says I need home health but I do not think I am homebound?
The homebound information is made by your doctor and the home health agency, not by you. If you disagree, you can ask your doctor to explain the reasoning or get a second opinion from another doctor. Medicare's definition is specific — it is not about preference, but about medical inability to leave home safely.
How long does Medicare home health coverage last?
There is no set time limit. Coverage continues as long as your doctor certifies every 60 days that you need skilled care and remain homebound. Some people receive home health for a few weeks after surgery; others receive it for months or longer. It depends on your condition and recovery.
If I have both Part A and Part B, which one pays for my home health?
Part A is primary if you meet the three-day may have access to stay requirement. If you do not meet that requirement, Part B may cover therapy services. Your home health agency will determine which part applies based on your situation and will bill accordingly.
Can I receive home health services if I live in an assisted living facility or nursing home?
Generally, no. Medicare home health is for people whose primary residence is their own home. If you live in a facility, that facility is responsible for providing care. However, rules vary, so ask your facility or call Medicare to confirm your specific situation.