Medicare Part A covers home health care when you meet specific conditions
Medicare Part A is the part that pays for home health care, but only under certain circumstances. You must be homebound (meaning leaving home is difficult without help), under a doctor's care, and have a medical reason for skilled nursing or therapy at home. Part A covers the full cost of visits from nurses, physical therapists, occupational therapists, and speech therapists — you pay nothing out of pocket for these services.
The catch is that Part A will not pay for custodial care, which is help with daily activities like bathing, dressing, or meal preparation. It also will not pay for ongoing care if you no longer need skilled medical services. Once your condition stabilizes and you no longer require nursing assessment or therapy, your coverage ends, even if you still need someone to help you at home.
Home health care under Part A is ordered by your doctor and must be provided by a Medicare-certified home health agency. Your doctor writes the order, the agency arranges the visits, and Medicare pays the agency directly. You do not need to submit claims yourself.
Key Takeaways
- Part A covers skilled nursing and therapy visits at home when you are homebound and under a doctor's care, with no copayment required.
- Part A does not cover help with bathing, dressing, meals, or other daily activities unless a nurse or therapist is also providing skilled care.
- Your doctor must order home health care and it must come from a Medicare-certified agency for Part A to pay.
- Coverage ends when you no longer need skilled medical services, even if you still need help at home.
- Part B covers some home health services if Part A does not, but only after you have met your Part B deductible.
What counts as skilled care that Part A will pay for
Skilled care means services that require a nurse, therapist, or other trained professional — not just someone to help you. Examples include wound care after surgery, injections, catheter management, physical therapy after a fall or stroke, occupational therapy to regain function, and speech therapy after a stroke or swallowing problem. Monitoring your condition when you have a new diagnosis or recent hospitalization also counts as skilled care.
The key word is "skilled." If the service could be done by someone without medical training, Part A will not pay for it. Helping you bathe, dress, take medications you can manage yourself, or prepare meals does not count as skilled care, even if you need help. Neither does housekeeping, yard work, or shopping.
Some services sit in a gray area. For example, if you need insulin injections and cannot give them to yourself, a nurse can do it as part of skilled care. But if you can manage your own medications, a home health aide cannot straightforward remind you to take them and have Part A pay for that visit.
Part B coverage for home health when Part A does not explore
Medicare Part B can cover some home health services when Part A does not, but the rules are stricter and you pay more. Part B covers doctor visits at home and some therapy services, but only if you are homebound and the services are medically necessary. You must have met your Part B deductible (which changes each year) and you pay 20 percent of the approved amount after that.
Part B home health coverage is less common than Part A because most people who need home health care are covered under Part A after a hospital stay. Part B becomes relevant if you need ongoing therapy but do not may have access to for Part A — for example, if you are homebound due to a chronic condition but do not have a recent acute illness requiring skilled nursing.
Unlike Part A, Part B does not cover home health aide services or custodial care at all. It covers only the professional services themselves: the doctor's visit or the therapist's session.
How to start home health care through Medicare
The process begins with your doctor. Tell your doctor you need help at home and discuss whether home health care makes sense for your condition. Your doctor will write an order for home health services and specify what type of care you need — nursing, physical therapy, occupational therapy, or speech therapy.
Your doctor will either refer you to a specific home health agency or you can choose one yourself. Medicare maintains a list of certified agencies in your area, which you can search on the Medicare website. Once you have chosen an agency, give them your doctor's order and your Medicare information. The agency handles all the paperwork with Medicare and schedules your first visit.
The first visit is usually an assessment visit where the nurse or therapist evaluates your condition and creates a care plan. This visit is longer than follow-up visits. After that, the frequency of visits depends on your condition — some people receive visits several times a week, others once a week or less.
What you pay for home health care under Part A
Under Part A, you pay nothing for the home health visits themselves. There is no copayment per visit and no deductible. However, you may have costs related to other parts of your care. If the home health agency provides medical equipment like a wheelchair or oxygen, you may owe a copayment for the equipment (usually 20 percent of the approved amount).
If you are still in a hospital or skilled nursing facility when home health is ordered, you may owe copayments for those settings, but the home health visits themselves are free. Once you are discharged home, the home health care is covered at no cost to you.
Part A home health coverage is limited to 60 days per benefit period, though in practice most people receive fewer visits. If you need care beyond 60 days, your doctor can request an extension and Medicare will review whether you still meet the homebound and skilled care requirements.
When home health care coverage ends
Your home health coverage under Part A ends when one of three things happens: your doctor determines you no longer need skilled care, you no longer meet the homebound requirement, or you move to a facility like a nursing home or assisted living. It also ends if you stop receiving services for 60 days in a row.
If your condition improves and you no longer need skilled nursing or therapy, the home health agency will discharge you. This does not mean you cannot receive help at home — it means Medicare will not pay for it. You can hire a home health aide or caregiver privately, or you may be able to receive services through Medicaid if you meet income limits, but Medicare Part A will not cover it.
If you are discharged and your condition worsens again, your doctor can order home health care again. There is no limit to how many times you can receive home health care during your lifetime, as long as you meet the requirements each time.
Frequently Asked Questions
Does Medicare pay for a home health aide to help me bathe and dress?
Only if a nurse or therapist is also providing skilled care during the same time period. Part A will not pay for an aide to help with bathing, dressing, or meals alone. If you need ongoing help with daily activities but no longer need skilled care, you would need to pay privately or explore Medicaid options.
Can I choose any home health agency or does it have to be one my doctor recommends?
You can choose any Medicare-certified agency in your area. Your doctor does not have to recommend a specific one. You can search for certified agencies on the Medicare website or ask your doctor for suggestions. The agency you choose will contact your doctor to get the order for services.
What happens if I need home health care but I am not homebound?
Medicare will not pay for home health care if you are not homebound, even if you need skilled nursing or therapy. Homebound means leaving home is difficult without help due to illness or injury. If you can leave home with information, you may be able to receive the same services at an outpatient clinic or therapy center instead.
Will Medicare pay for home health care after I leave the hospital?
Yes, if your doctor orders it and you meet the homebound and skilled care requirements. Most home health care is ordered right after a hospital discharge. Part A covers it at no cost to you. You do not have to stay in a hospital for a certain number of days first — your doctor can order home health care based on your medical need.
What if I need home health care but my doctor has not ordered it?
You need to talk to your doctor about it. Medicare will not pay for home health care without a doctor's order. If your regular doctor is not available, you can see another doctor — at an urgent care clinic, hospital, or your local health department — and ask them to evaluate whether home health care is medically necessary for your condition.