Medicare covers some care at home, but not all of it — and the type of coverage depends on whether you need skilled nursing, physical therapy, or help with daily tasks

Medicare Part A and Part B together cover home health care when a doctor orders it for a medical reason and you meet specific conditions. The program pays for skilled nursing visits, physical therapy, occupational therapy, and speech therapy delivered by Medicare-approved agencies. What Medicare does not cover is help with bathing, dressing, meals, or housekeeping — even if you need it — unless that help is part of a skilled service a nurse or therapist is already providing.

The distinction matters because many people need home care for reasons Medicare does not address. If you need someone to help you shower or prepare meals, you will pay out of pocket, use Medicaid (if you may have access to), or purchase long-term care insurance. Understanding which services Medicare will and will not pay for prevents you from expecting coverage that is not there.

Key Takeaways

  • Medicare Part A covers home health care only after a hospital or skilled nursing facility stay of at least three days, and only for the condition you were treated for.
  • Skilled services — nursing care, physical therapy, occupational therapy, and speech therapy — are covered; personal care like bathing and dressing are not, unless a therapist is already in your home for another reason.
  • You must be homebound or have a doctor's order stating home care is medically necessary, and the care must come from a Medicare-approved agency.
  • Medicare covers the full cost of approved home health services with no copay or deductible, but only for as long as the medical need continues.
  • If you need ongoing personal care or help with daily living, you will need to pay privately, use Medicaid, or explore other programs.

What Medicare Part A Covers at Home

Medicare Part A pays for home health care visits after you have spent at least three consecutive days in a hospital or skilled nursing facility. The care must be for the same condition you were hospitalized for, and a doctor must order it. The agency providing the care must be Medicare-approved, which you can verify by calling Medicare at 1-800-MEDICARE or checking the Medicare.gov provider search tool.

Covered services include skilled nursing visits (wound care, medication management, catheter care), physical therapy, occupational therapy, and speech therapy. A home health aide can information during these visits — for example, helping you bathe before a therapy session — but only as part of the skilled service. The aide cannot be sent solely to help you with personal care.

Medicare Part A covers the full cost of these services with no copay or deductible. You pay nothing per visit. Coverage continues as long as your doctor certifies the medical need, typically in 60-day periods that can be renewed.

What Medicare Part B Covers at Home

Medicare Part B covers some home-based services that do not require a prior hospital stay. These include physical therapy, occupational therapy, and speech therapy ordered by your doctor for a medical condition. Part B also covers certain medical equipment and supplies used at home — oxygen, diabetic testing supplies, walkers, and hospital beds — if your doctor orders them.

Part B does not cover routine home health nursing visits the way Part A does. If you need ongoing skilled nursing at home but have not had a may have access to hospital stay, you would need to pay out of pocket or explore other coverage options.

For Part B services, you typically pay 20 percent of the approved amount after you meet your annual deductible. The exact cost depends on what service or equipment you receive.

The Three-Day Hospital Stay Requirement

To receive home health care through Medicare Part A, you must have been admitted to a hospital (not the emergency room alone) and stayed for at least three consecutive calendar days. The stay must end with discharge directly to home or to a skilled nursing facility. If you are discharged from the emergency room without admission, or if you stay fewer than three days, you do not meet the requirement.

The three-day rule applies only to Part A coverage. Part B therapy services do not require a prior hospital stay, but they do require a doctor's order and must be medically necessary. Many people assume they are ineligible for any home care if they have not been hospitalized, but Part B therapy can still be an option.

Personal Care and Daily Living Help Are Not Covered

Medicare does not pay for help with bathing, dressing, grooming, toileting, meal preparation, or housekeeping — even if you cannot do these tasks safely on your own. These are called custodial care or personal care, and they fall outside Medicare's scope. The program covers medical care, not information with the activities of daily living.

If you need this kind of help, you have several options. You can pay privately for a home care aide or housekeeper. If your income and assets are low enough, Medicaid may cover personal care through a home and community-based services waiver in your state. Some people purchase long-term care insurance before they need care, though policies are expensive and have strict underwriting. Others rely on family members or community programs.

The one exception: if a skilled therapist is already visiting your home for a covered reason, a home health aide can help with personal care during that visit as part of the therapy. But the aide cannot be sent to your home solely for personal care.

How to Start Home Health Care Through Medicare

The process begins with your doctor. You cannot request home health care directly from Medicare or an agency — your doctor must order it. If you are being discharged from a hospital or skilled nursing facility, the discharge planner will coordinate with a home health agency. If you are at home and believe you need home care, ask your primary care doctor whether home health services are medically necessary and whether you meet the requirements.

Your doctor will write an order specifying the type of care (nursing, therapy, or both), the frequency of visits, and the duration. The home health agency will contact you to schedule the first visit. Medicare requires the agency to give you a notice of privacy practices and information about your rights as a patient before care begins.

You do not choose which agency provides the care — your doctor or discharge planner typically selects one — but you can request a different Medicare-approved agency if you are unhappy. Ask your doctor or call 1-800-MEDICARE for a list of agencies in your area.

What Happens When Home Health Care Ends

Home health care ends when your doctor determines the medical need no longer exists. This might happen because you have recovered, because you have reached a plateau and are no longer making progress, or because your condition has changed. The agency must notify you in writing before they stop services.

If you still need help at home after Medicare coverage ends, you will need to arrange and pay for private care, explore Medicaid options, or look into other community resources. Some people transition to adult day programs, assisted living, or other settings. Your doctor or a social worker can help you plan for what comes next.

If you believe Medicare ended your coverage too early, you have the right to appeal. Contact the home health agency's quality improvement organization or call 1-800-MEDICARE to file a complaint or request a review.

Frequently Asked Questions

Do I need to be homebound to receive Medicare home health care?

You must have a medical condition that makes it difficult or unsafe to leave home, or your doctor must document that leaving home requires considerable effort. You do not need to be completely unable to leave — you can go out occasionally for medical appointments or therapy. The key is that your doctor certifies home-based care is medically necessary because of your condition.

What if I need help at home but have not been hospitalized?

Part B therapy services (physical therapy, occupational therapy, speech therapy) do not require a prior hospital stay — only a doctor's order. If you need personal care like bathing or meal help, Medicare does not cover it regardless of hospitalization. You would need to pay privately or check whether you may have access to for Medicaid in your state.

Will Medicare pay for a live-in caregiver?

No. Medicare pays for specific skilled services delivered during visits, not for someone to live in your home. If you need 24-hour care, you would need to pay privately, use Medicaid if you may have access to, or explore assisted living or nursing facility options.

Can I choose which home health agency provides my care?

Your doctor or discharge planner typically selects the agency, but you can request a different Medicare-approved provider. Call 1-800-MEDICARE or visit Medicare.gov to find agencies in your area and compare them before your care begins.

What if my home health agency is not Medicare-approved?

Medicare will not pay for services from an agency that is not on its approved list. Before care starts, ask the agency for their Medicare provider number or check Medicare.gov. If an agency is not approved, you can pay out of pocket, but Medicare will not reimburse you.