Medicare covers some home care costs, but not all of them, and the rules depend on whether you need medical care or personal help

Medicare will pay for skilled home health care — nursing visits, physical therapy, occupational therapy, and speech therapy delivered at home — if a doctor orders it and you meet specific conditions. Medicare does not pay for custodial care, which is help with daily tasks like bathing, dressing, meals, and housekeeping, even if you need it badly. The difference matters because it determines what you pay and who can help you.

The coverage also depends on which part of Medicare you have. Original Medicare (Parts A and B) covers skilled home health care under Part A if you are homebound and a doctor orders the care. Medicare Advantage plans (Part C) cover home health care but the rules and costs vary by plan. Understanding which type of care you need and which part of Medicare covers it is the first step to knowing what you will actually pay.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy visits at home if a doctor orders them and you are homebound, with no copay for the visits themselves.
  • Medicare does not cover custodial care — help with bathing, dressing, meals, and housekeeping — no matter who provides it or how much you need it.
  • If you need both skilled care and custodial care, you will pay out of pocket for the custodial part, which is often the larger expense.
  • Medicare Advantage plans cover home health care but have different rules, costs, and networks than Original Medicare, so you must check your specific plan.
  • Medicaid, not Medicare, is the program that pays for long-term custodial home care for people who meet income and asset limits.

What Medicare Part A Covers at Home

Original Medicare Part A covers skilled home health services when a doctor orders them and you meet three conditions: you are homebound (leaving home is difficult and medically inadvisable), you need skilled nursing or therapy, and you are under the care of a physician who orders the services. The skilled services covered include registered nurse visits, physical therapy, occupational therapy, speech-language pathology, and medical social work. You pay nothing for these visits — no copay, no deductible — as long as the home health agency is Medicare-certified.

The care must be intermittent, not full-time. Medicare will not pay for a caregiver to live in your home or work set hours every day for custodial tasks. If you need daily skilled nursing — for example, wound care or medication management — Medicare may cover it, but the moment the need becomes primarily custodial (help you could receive from anyone without medical training), the coverage stops.

Home health agencies must be certified by Medicare to bill for these services. Your doctor will refer you to a specific agency, or you can ask your doctor for a referral to a Medicare-certified agency in your area. The agency handles the paperwork and billing; you do not submit claims yourself.

What Medicare Does Not Cover

Medicare does not pay for custodial care, which is the largest category of home care need. Custodial care includes bathing, dressing, grooming, toileting, meal preparation, light housekeeping, laundry, and shopping. It also includes supervision and reminders to take medication, even though medication management is a daily need for many older adults. The reason Medicare excludes it is that custodial care does not require a nurse or therapist — anyone can provide it.

Medicare also does not cover homemaker services (cleaning, laundry, yard work), companion care (sitting with someone for social purposes), or 24-hour care. If you need help with any of these, you pay out of pocket, through Medicaid (if you may have access to), or through long-term care insurance if you have it.

This gap is significant. Many people need both skilled care (covered by Medicare) and custodial care (not covered). For example, someone recovering from a stroke might receive physical therapy from Medicare but need help bathing and dressing every day — and that daily help is their responsibility to pay for.

How Medicare Advantage Plans Handle Home Care

Medicare Advantage (Part C) plans must cover at least the same skilled home health services that Original Medicare covers, but they can add extra benefits and set different rules. Some plans offer additional services like homemaker help, meal delivery, or transportation — benefits Original Medicare does not include. However, these extra benefits vary widely by plan and by year.

Advantage plans also set their own networks of home health agencies. You may be required to use an agency in your plan's network, or you may pay more if you use an out-of-network agency. Some plans have copays for home health visits; others do not. You must check your specific plan's coverage document (called the Summary of Benefits and Coverage) to know what your plan covers and what you will pay.

If you are considering switching to an Advantage plan or comparing plans during open enrollment, ask the plan directly whether it covers any custodial care services. Some plans do offer limited custodial benefits as a supplemental service, though this is not common and the amount of coverage is usually small.

Medicaid Coverage for Home Care

Medicaid, not Medicare, is the program that pays for long-term custodial home care. Medicaid is a joint federal-state program for people with low income and limited assets. Each state sets its own income and asset limits, so what qualifies in one state may not in another. If you are under 65 and disabled, or over 65 with low income, Medicaid may cover in-home custodial care, personal care attendants, and homemaker services.

Medicaid coverage for home care is often more generous than Medicare — it can pay for daily help with bathing, dressing, meals, and housekeeping. However, you must meet your state's financial limits, and the process to establish Medicaid coverage is separate from Medicare. Many people have both Medicare and Medicaid (called "dual may be able to access"), and in that case Medicaid often pays for the custodial care that Medicare does not cover.

To learn whether you may may have access to for Medicaid in your state, contact your state Medicaid office or call 211 to be referred to a local benefits counselor who can help you understand your state's rules.

What You Pay for Home Health Care

Under Original Medicare Part A, you pay nothing for skilled home health visits. However, if you need medical equipment (like a wheelchair or oxygen) or supplies (like wound dressings), you may have a copay. Part B covers some of these items; Part A covers others. Your home health agency will tell you what you owe.

If you have a Medicare Advantage plan, your costs depend on your plan. Some plans charge a copay per visit (typically $0 to $50); others charge nothing. Some plans have a limit on the number of visits covered per year. You should know your plan's rules before you need home care, so call your plan or review your coverage document now.

For custodial care, which Medicare does not cover, you pay the full cost out of pocket unless you have Medicaid, long-term care insurance, or Veterans benefits. The cost of a home caregiver varies by region and the level of care needed, but it typically ranges from $15 to $30 per hour for basic custodial help and more for specialized care. Over time, this becomes a significant expense.

How to Arrange Medicare-Covered Home Care

The process begins with your doctor. Tell your doctor you need help at home and ask whether you meet the criteria for home health care: you are homebound, you need skilled nursing or therapy, and a physician will oversee your care. If your doctor agrees, they will write an order for home health services and send it to a Medicare-certified home health agency.

Your doctor may refer you to a specific agency, or you can ask for a list of Medicare-certified agencies in your area. You can also search for agencies on Medicare.gov by entering your ZIP code. Once you choose an agency, the agency will contact you to schedule an initial assessment visit. The nurse will evaluate what services you need and create a care plan.

The home health agency handles all billing and paperwork. You do not need to submit claims. The agency bills Medicare directly, and Medicare pays the agency. If you have a Advantage plan, the agency will bill your plan instead. Make sure the agency knows which Medicare plan you have before the first visit.

Planning for Custodial Care Costs

Because Medicare does not cover custodial care, you should plan for this cost separately. If you think you may need help at home in the future, consider these options now: long-term care insurance (which must be purchased before you need care), Medicaid planning (which involves understanding your state's rules and possibly restructuring assets), or setting aside savings for future care.

If you are already receiving skilled home health care from Medicare and you also need custodial help, you will need to hire and pay a caregiver separately. Some home health agencies employ caregivers who can provide custodial care for an additional fee, but this is not covered by Medicare. You can also hire a caregiver independently, through an agency, or ask a family member to help.

Talk to a benefits counselor about your specific situation. Many Area Agencies on Aging and local senior centers offer free counseling about Medicare, Medicaid, and home care options. You can find a counselor by calling 211 or visiting the Eldercare Locator at eldercare.acl.gov.

Frequently Asked Questions

Will Medicare pay for a caregiver to help me bathe and dress?

No. Medicare does not cover custodial care like bathing, dressing, grooming, or toileting. If you need this help, you must pay out of pocket, have Medicaid, or have long-term care insurance. Some Medicare Advantage plans offer limited custodial benefits, so check your plan's coverage document.

What if I need both physical therapy and help with daily tasks?

Medicare will pay for the physical therapy visits if your doctor orders them and you are homebound. You will pay out of pocket for the daily help with bathing, dressing, and meals. Many people hire a separate caregiver for the custodial tasks while Medicare covers the therapy.

Can I choose which home health agency provides my care?

Yes. Your doctor will write the order, but you can ask for a specific Medicare-certified agency. If you have a Medicare Advantage plan, check whether the agency is in your plan's network first, or you may face higher costs. You can search for agencies on Medicare.gov.

Does Medicare cover home care after I leave the hospital?

Yes, if your doctor orders it and you meet the homebound requirement. After a hospital stay, you are often automatically considered homebound for a period of time. The home health agency will work with your hospital discharge planner to arrange services. Medicare Part A covers the visits with no copay.

What happens if I need home care but I am not homebound?

Medicare will not cover it. If you can leave home with difficulty but do not need skilled nursing or therapy, Medicare does not pay for custodial care. You would need to pay out of pocket, have Medicaid, or have private insurance that covers this type of care.