Medicare covers some home care services, but not all of them — and the type of coverage depends on which part of Medicare you have and whether you meet specific conditions.
Medicare Part A covers skilled nursing care and physical therapy at home, but only after a hospital stay of at least three days and only while you are still recovering from that hospital stay. Medicare Part B covers doctor visits and some therapies at home, but again only for people recovering from illness or injury. Neither part covers long-term personal care — help with bathing, dressing, or housekeeping — unless it is tied to skilled medical care.
The coverage rules are strict and the paperwork matters. A doctor must order the home care, a nurse or therapist must perform it, and Medicare will only pay for visits that are medically necessary. If you need help at home for reasons other than recovery from a recent medical event, Medicare does not cover it, and you will need to look at other sources of payment.
Key Takeaways
- Medicare Part A covers skilled nursing and therapy at home only after a hospital stay of three days or more and only while you are recovering from that stay.
- Medicare Part B covers doctor visits and some therapies at home for people recovering from illness or injury, even without a recent hospital stay.
- A doctor must order home care and a licensed nurse or therapist must provide it for Medicare to pay.
- Medicare does not cover personal care such as bathing, dressing, or housekeeping unless it is part of a skilled nursing or therapy plan.
- If you have a Medicare Advantage plan, your home care coverage may differ from Original Medicare, so check your plan documents.
What Medicare Part A Covers at Home
Part A covers skilled nursing care and home health aide services after you have spent at least three consecutive days in a hospital. The three-day stay must be for the same condition you are being treated for at home. A weekend or observation stay does not count — it must be a full inpatient admission.
Once you come home, Part A will pay for a nurse to visit and perform medical tasks such as wound care, catheter management, or medication monitoring. It will also pay for a home health aide to help with bathing, dressing, and toileting — but only if a nurse is also visiting for skilled care. The aide cannot come alone. Part A also covers physical therapy, occupational therapy, and speech therapy at home if ordered by your doctor.
Coverage lasts as long as your doctor says the care is medically necessary and you are homebound — meaning you cannot leave home without help. Once you no longer need skilled care or are no longer homebound, Part A stops paying. There is no set time limit, but most people receive Part A home care for a few weeks to a few months.
What Medicare Part B Covers at Home
Part B covers doctor visits at home and certain therapies, even if you did not have a recent hospital stay. Your doctor must order the care and document that it is medically necessary. A nurse practitioner or physician assistant can also order it.
Part B pays for physical therapy, occupational therapy, and speech therapy at home. It also covers some medical equipment and supplies — wound dressings, diabetic supplies, oxygen — if your doctor orders them. Part B does not pay for a home health aide or personal care unless a skilled nurse or therapist is also visiting.
Like Part A, Part B home care requires that you be homebound. You must be unable to leave home without considerable help or risk to your health. If you can get out for medical appointments or other activities, Medicare may decide you are not homebound and deny the claim.
When Medicare Does Not Cover Home Care
Medicare does not cover custodial care — help with daily living that does not require a medical professional. This includes bathing, dressing, grooming, toileting, meal preparation, and housekeeping. Even if you need this help every day, Medicare will not pay for it unless a nurse is also visiting for a skilled medical reason.
Medicare also does not cover care ordered by someone other than a doctor. If a social worker, nurse case manager, or family member thinks you need home care, it does not matter — a physician must write the order. Medicare does not cover care that is not medically necessary, even if you want it. And Medicare does not cover 24-hour care or live-in caregivers.
If you need long-term personal care at home, you will need to pay out of pocket, use Medicaid (if you are low-income), or explore long-term care insurance. Some people use a combination of sources.
How to Get Medicare Home Care Started
Your doctor must order home care and specify what type — nursing, therapy, or both — and how often. The doctor will send the order to a home health agency that is Medicare-approved. You do not choose the agency; Medicare assigns you to one in your area, though you can request a different one.
The home health agency will send a nurse to assess you and create a care plan. The nurse will visit regularly, and therapists will come as ordered. You will receive a document called the Home Health Compare information, which shows the agency's performance on quality measures. You can also look up agencies on the Medicare website at Medicare.gov.
Before the first visit, make sure the agency has your insurance information and that you understand what Medicare will and will not pay for. Ask the agency what your out-of-pocket costs will be. Part A home care is covered after you meet your deductible, with no copay per visit. Part B home care requires you to pay 20 percent of the cost after you meet your deductible.
Medicare Advantage Plans and Home Care
If you have a Medicare Advantage plan (Part C), your home care coverage may be different from Original Medicare. Some Advantage plans cover additional services such as personal care or non-medical support. Others have stricter rules about which agencies you can use or how many visits you can receive.
Check your plan's summary of benefits or call the plan directly to find out what home care services it covers. If your doctor orders home care, tell the agency which plan you have so they can verify coverage before the first visit. Some Advantage plans require prior approval before home care begins.
What Happens When Medicare Home Care Ends
Medicare home care ends when your doctor says you no longer need skilled care or when you are no longer homebound. The home health agency will notify you before the last visit. If you still need help at home after Medicare stops paying, you will need another source of payment.
Some people transition to Medicaid home care, which has different rules and may cover personal care. Others hire private caregivers and pay out of pocket. Some use a combination — Medicare for skilled care, Medicaid for personal care, and private pay for extra hours. A social worker at the home health agency can help you plan for what comes next.
If you believe Medicare ended your care too soon, you have the right to appeal. The home health agency can help you file an appeal, or you can contact your state's Patient Advocate Foundation.
Frequently Asked Questions
Does Medicare cover a live-in caregiver?
No. Medicare does not cover 24-hour care or live-in caregivers. It covers visits from nurses and therapists for specific medical needs. If you need round-the-clock personal care, you will need to pay privately, use Medicaid if you are low-income, or explore other options with a social worker.
Can I choose which home health agency Medicare sends me to?
Medicare assigns you to an approved agency in your area, but you can request a different one. Ask your doctor or hospital discharge planner to help you find an agency, or search Medicare.gov for agencies near you. Some Advantage plans limit which agencies you can use.
What if my doctor says I need home care but Medicare denies it?
You can appeal. The home health agency will help you file an appeal, or you can contact Medicare directly at 1-800-MEDICARE. You have the right to a review by an independent reviewer if you disagree with the denial.
Does Medicare cover home care if I live alone?
Yes, as long as your doctor orders it and it is medically necessary. Living alone does not disqualify you. Medicare cares whether you are homebound and need skilled care, not whether you have family nearby.
Will I have to pay anything out of pocket for Medicare home care?
Under Part A, you pay nothing per visit after you meet your deductible. Under Part B, you pay 20 percent of the cost after your deductible. The home health agency can tell you what your costs will be before care begins.