Medicare covers some at-home care, but not all of it, and the type of coverage depends on whether you need skilled nursing or personal care

Medicare Part A covers skilled nursing care and home health aide services when you meet specific conditions: you must be homebound, a doctor must order the care, and you must need it because of a recent hospital stay or skilled nursing facility stay. Part B covers some equipment and services. What Medicare does not cover is custodial care — help with bathing, dressing, toileting, or meals when that is the only thing you need — or ongoing care that is not tied to recovery from an illness or injury.

The difference matters because many people need help at home but do not may have access to for Medicare coverage. If you fall into that gap, you will need to pay out of pocket, use Medicaid (which does cover custodial care in most states), or explore other options like long-term care insurance or Veterans benefits.

Key Takeaways

  • Medicare Part A covers skilled nursing and home health aide visits after a hospital or skilled nursing facility stay, as long as you are homebound and a doctor orders the care.
  • Medicare does not cover custodial care — help with daily living tasks like bathing or dressing — even if you need it full-time.
  • You typically pay nothing for Medicare-covered home health services, but you may owe a copay for certain equipment or services covered under Part B.
  • Medicaid covers custodial care in most states and does not require a prior hospital stay, but income and asset limits explore.
  • If you do not meet Medicare or Medicaid requirements, you can pay privately, use long-term care insurance, or explore Veterans benefits if you served.

What Medicare Part A Covers at Home

Medicare Part A covers home health services when all of these conditions are met: you are homebound (meaning leaving home is difficult and requires help), a doctor has ordered the care, you need skilled nursing or therapy, and the care is related to a condition that sent you to the hospital or a skilled nursing facility. The services must be provided by a Medicare-certified home health agency.

Covered services include skilled nursing visits (wound care, medication management, monitoring), physical therapy, occupational therapy, speech-language pathology, and home health aide services (personal care and light housekeeping). You pay nothing for these services — Medicare covers the full cost. The agency bills Medicare directly.

The catch is that you must have been an inpatient in a hospital for at least three consecutive days before the home health care begins, or you must have been discharged from a skilled nursing facility. If you need home care but have never been hospitalized or in a skilled facility, Medicare Part A will not cover it.

What Medicare Part B Covers at Home

Medicare Part B covers certain equipment and services you use at home, but not the personal care itself. This includes durable medical equipment (wheelchairs, walkers, oxygen equipment, hospital beds), diabetic supplies, and certain therapies ordered by your doctor. You typically pay 20 percent of the cost after you meet your Part B deductible.

Part B does not cover a caregiver or aide to help you use this equipment or to provide personal care. It covers the tools, not the hands-on help.

What Medicare Does Not Cover

Custodial care is the largest gap. This is help with activities of daily living — bathing, dressing, toileting, eating, grooming — when that is the primary reason you need care. Even if you need it eight hours a day, Medicare will not pay for it. Medicare only pays for skilled care or care that is part of your recovery from an acute illness or injury.

Also not covered: ongoing homemaker services (cleaning, laundry, shopping), meal preparation, medication reminders (as opposed to skilled medication management by a nurse), and care that is not ordered by a doctor or is not related to a recent hospitalization. If you need care but do not meet the homebound requirement, Medicare will not cover it either.

How to Start Medicare Home Health Services

Your doctor must order home health care and document that you are homebound and need skilled services. You do not order it yourself. Your doctor will either contact a Medicare-certified home health agency directly or give you a list of agencies in your area. You can choose which agency provides your care.

Once an agency is chosen, a nurse will visit your home to assess your needs and create a care plan. The agency handles all billing to Medicare. You will receive a notice explaining what services are covered and for how long. Home health services are usually temporary — typically a few weeks to a few months — while you recover. If you need ongoing care after that, you will need to explore other options.

To find Medicare-certified agencies in your area, visit Medicare.gov and use the Care Compare tool, or call 1-800-MEDICARE.

When Medicaid Covers At-Home Care Instead

Medicaid is a joint federal and state program that covers custodial care at home in most states, and it does not require a prior hospital stay. If you have low income and limited assets, Medicaid may cover the personal care help that Medicare does not. Each state runs its own Medicaid program, so coverage and income limits vary.

In many states, Medicaid offers a home and community-based services waiver that lets you receive care at home instead of in a nursing facility. You may be able to hire a family member as your caregiver, though rules differ by state. To learn what your state offers, contact your state Medicaid office or call 211 for a local referral.

If you are on both Medicare and Medicaid (called "dual may be able to access"), Medicaid typically covers the costs Medicare does not, including custodial care and the copays or coinsurance you owe to Medicare.

Private Pay and Other Options

If you do not meet Medicare or Medicaid requirements, you can hire and pay for care privately. Costs vary widely by location and the type of care needed — from $15 to $30 per hour for a home health aide to $100 or more per hour for specialized nursing care. You can hire through an agency (which handles payroll and insurance) or independently (which is cheaper but requires you to manage employment taxes and liability).

Long-term care insurance, if you bought it before you needed care, may cover some at-home services. Check your policy for what it includes and what the daily or monthly benefit is.

If you are a veteran or the spouse or dependent of a veteran, the Veterans Health Administration and Aid and Attendance benefits may cover home care. Contact the VA at 1-800-827-1000 or visit VA.gov to learn what you may be may have access to to.

Frequently Asked Questions

Do I have to pay anything for Medicare home health services?

No. If the services are covered by Medicare Part A, you pay nothing — Medicare covers 100 percent of the cost. If equipment or services are covered under Part B, you pay 20 percent after your deductible. The home health agency bills Medicare directly.

How long does Medicare cover home health care?

There is no set limit, but coverage is based on medical need. A nurse and your doctor review your progress regularly. If you are improving and no longer need skilled care, coverage ends. Most people receive home health services for a few weeks to a few months after leaving the hospital.

Can I get Medicare to cover a live-in caregiver?

Not through Medicare Part A or Part B. Medicare only covers skilled nursing and therapy, not custodial care or personal care aides on a live-in basis. Medicaid may cover this in your state if you meet income limits. Otherwise, you would need to pay privately or use long-term care insurance.

What if I need help at home but was never hospitalized?

Medicare Part A will not cover home health services without a prior hospital or skilled nursing facility stay. You may be covered by Medicaid if you have low income, or you can pay privately. Talk to your doctor about whether hospitalization or a skilled nursing stay is medically necessary.

Does Medicare cover home care for chronic conditions like diabetes or heart disease?

Medicare covers skilled nursing and therapy related to managing these conditions, but only if you are homebound and the care was ordered after a hospital or skilled nursing facility stay. Ongoing management by your regular doctor is covered under Part B, but not a home health aide for daily help unless it is part of recovery from an acute event.