Medicare covers some home care services, but not all, and the coverage depends on which part of Medicare you have and whether a doctor orders the care as medical treatment

Medicare Part A covers skilled nursing care and home health aide services — but only if you meet strict conditions. You must have been in a hospital for at least three days, be homebound, need part-time or intermittent care (not 24-hour care), and have a doctor order the services as medically necessary. The care must be for a condition related to your hospital stay or an existing condition that worsened because of it.

Medicare Part B covers some home health services under the same homebound and doctor-order rules, but typically only physical therapy, occupational therapy, or speech-language pathology — not general personal care or housekeeping. If you need full-time live-in care, help with bathing and dressing, or housecleaning, Medicare does not pay for those services at all, no matter which part you have.

Many people assume Medicare covers home care the way it covers hospital stays. It does not. Understanding what is actually covered — and what you will pay out of pocket — changes how you plan and budget.

Key Takeaways

  • Medicare Part A covers skilled nursing and home health aide visits after a hospital stay of at least three days, as long as a doctor orders the care and you are homebound.
  • Medicare Part B covers some therapy services (physical, occupational, speech) at home under the same homebound and doctor-order rules, but not personal care or housekeeping.
  • Medicare does not cover 24-hour live-in care, help with bathing and dressing, meal preparation, or housecleaning under any circumstance.
  • You pay a copay for each home health visit under Part B, and Part A covers the first 60 days with no copay, then charges copays after that.
  • If you need ongoing home care that Medicare does not cover, you may need to pay out of pocket, use Medicaid (if you may have access to), or purchase a long-term care insurance policy.

What Medicare Part A Covers at Home

Part A covers skilled nursing visits and home health aide services after you leave a hospital. Skilled nursing means a registered nurse or licensed practical nurse performing medical tasks — wound care, injections, catheter management, medication monitoring — that require a nurse's training. A home health aide can help with bathing, dressing, toileting, and grooming, but only if a nurse is also visiting you for skilled care.

The three-day hospital stay rule is strict. You must have been admitted as an inpatient (not observation status) for at least three consecutive days before discharge. Observation stays do not count, even if you spent three days in the hospital. This is a common source of confusion and denied coverage.

Part A covers up to 60 days of home health services per benefit period with no copay. After 60 days, you pay a copay for each visit. The services must be ordered by your doctor, and you must be homebound — meaning you cannot leave home without considerable effort or help, and leaving home is medically contraindicated.

What Medicare Part B Covers at Home

Part B covers physical therapy, occupational therapy, and speech-language pathology at home, but only if a doctor orders the services and you are homebound. These are therapy services aimed at restoring function or managing a medical condition — not general personal care.

You pay 20 percent of the Medicare-approved amount for each visit after you meet your Part B deductible. There is no limit on the number of visits, but Medicare reviews the medical necessity of ongoing therapy. If therapy is not showing progress toward a specific functional goal, Medicare may stop paying.

Part B does not cover nursing care, aide services, or any non-therapy home care. If you need a nurse at home but do not may have access to for Part A (because you did not have a may have access to hospital stay), Part B will not pay for it.

What Medicare Does Not Cover at Home

Medicare does not cover 24-hour live-in care, personal care information (bathing, dressing, toileting, grooming when not part of a skilled nursing plan), housekeeping, meal preparation, medication reminders, or companionship. These services are considered custodial care — help with activities of daily living — rather than medical treatment.

If you need ongoing help with personal care after your Part A home health benefit ends, or if you never may have access to for Part A, Medicare will not pay. This is where many people face unexpected costs. A home health aide costs $20 to $30 per hour on average, and 24-hour care can run $5,000 to $10,000 per month or more, depending on your location and the agency.

Medicare also does not cover home modifications (grab bars, ramps, stair lifts), medical equipment beyond what is ordered as part of a skilled care plan, or preventive home visits aimed at keeping you healthy rather than treating an existing condition.

How to Know if You may have access to for Medicare Home Care

Start by checking whether you meet the basic requirements: a may have access to hospital stay (for Part A), a doctor's order for the care, and homebound status. Your discharge planner at the hospital should tell you whether home health services are being ordered. If you are unsure, call your hospital's discharge planning department or your doctor's office and ask directly.

If you are already home and think you need home care, contact your doctor. Your doctor can assess whether the care is medically necessary and order it. Medicare will not pay for home care without a doctor's order, even if you need it.

Once a home health agency is involved, they will handle the paperwork with Medicare. You do not need to submit anything yourself. The agency bills Medicare directly. You will receive an explanation of benefits (EOB) showing what Medicare paid and what you owe.

What You Pay Out of Pocket

Under Part A, you pay nothing for the first 60 days of home health services per benefit period. After 60 days, you pay a copay (the amount varies by year) for each visit. The copay applies to both skilled nursing and aide visits.

Under Part B, you pay 20 percent of the Medicare-approved amount for therapy services after you meet your annual deductible. If the home health agency is billing Part B instead of Part A (which happens when you do not have a may have access to hospital stay), you will see these copays on your bill.

If you need home care that Medicare does not cover — personal care, housekeeping, 24-hour care — you pay the full cost out of pocket. Some people use Medicaid to cover these services if they may have access to based on income and assets. Others purchase long-term care insurance before they need care, though policies are expensive and have waiting periods.

Medicaid and Other Options When Medicare Does Not Pay

Medicaid (the joint federal-state program for low-income people) covers personal care and custodial home care in most states, but you must meet income and asset limits. These limits vary by state. If you are on Medicare and have limited income, you may may have access to for both Medicare and Medicaid (called "dual may be able to access"). Contact your state Medicaid office to learn the income and asset limits in your state.

Veterans benefits may cover home care if you are a veteran. The VA offers Aid and Attendance benefits and other programs that can pay for in-home care. Contact your local VA office or call 1-800-827-1000 to learn what you may be may have access to to.

Long-term care insurance covers home care, assisted living, and nursing home care if you purchased a policy before you needed care. Policies are expensive (premiums can run $1,500 to $3,000 per year or more) and have waiting periods, so this is a planning tool for people who want to protect assets before a health crisis.

Out-of-pocket payment is the reality for many people. If you need home care that Medicare and Medicaid do not cover, you pay the agency directly. Some agencies offer sliding-scale fees based on income, and some nonprofits offer subsidized care, but availability varies by location.

Common Mistakes That Delay or Deny Coverage

The most common mistake is not realizing that an observation stay does not count toward the three-day hospital requirement. You can spend three days in the hospital under observation status and still not may have access to for Part A home health coverage. Ask your hospital whether you were admitted as an inpatient or placed on observation before you leave.

Another mistake is waiting too long to request home health services. Medicare covers home health only while you are homebound and the care is medically necessary. If you wait weeks after discharge and are no longer homebound, Medicare will deny the claim. Request home health services before you leave the hospital or within a few days of discharge.

A third mistake is assuming that a home health aide can help you without a nurse also visiting. Part A covers aide services only as part of a skilled nursing plan. If you need only personal care and no skilled nursing, Medicare will not pay for the aide.

Frequently Asked Questions

Does Medicare cover home care after I leave the hospital?

Medicare Part A covers skilled nursing and home health aide services after a hospital stay of at least three days, as long as a doctor orders the care and you are homebound. Part B covers some therapy services under the same conditions. Personal care, housekeeping, and 24-hour care are not covered under any circumstance.

What if I was on observation status in the hospital, not admitted as an inpatient?

Observation status does not count toward the three-day requirement for Part A home health coverage. You must have been admitted as an inpatient for at least three consecutive days. If you were on observation, you do not may have access to for Part A home health services, though you may still may have access to for Part B therapy services if a doctor orders them.

How long does Medicare cover home care?

Part A covers up to 60 days per benefit period with no copay, then charges a copay for each visit after that. There is no set end date — coverage continues as long as a doctor orders the care and you remain homebound and medically may be able to access. Part B therapy services have no visit limit, but Medicare reviews whether therapy is making progress toward a functional goal.

What happens when Medicare stops paying for home care?

When Medicare coverage ends, you pay out of pocket for any ongoing care, or you explore Medicaid (if you may have access to), Veterans benefits (if you are a veteran), or other local programs. Some home health agencies offer reduced rates for uninsured patients, and some nonprofits provide subsidized care. Contact your local Area Agency on Aging to learn what programs exist in your area.

Can I get home care if I never went to the hospital?

Part A requires a hospital stay, so no. Part B covers therapy services (physical, occupational, speech) at home if a doctor orders them and you are homebound, even without a hospital stay. If you need personal care or nursing care without a hospital stay, Medicare does not pay. Medicaid may cover it if you may have access to based on income and assets.