Medicare covers home health care when you meet specific medical conditions, but only for skilled nursing or therapy — not for help with daily tasks like bathing or cooking

Medicare Part A and Part B together pay for home health services if a doctor orders them, you are homebound or have difficulty leaving home, and a Medicare-approved home health agency provides the care. The services must be skilled — meaning a nurse, physical therapist, occupational therapist, or speech-language pathologist performs them. Medicare does not cover custodial care, which is help with activities of daily living, even if you need it urgently.

You pay nothing out of pocket for covered home health services under Part A. If services are billed to Part B instead, you pay 20 percent of the approved amount after you meet your Part B deductible. The key is understanding which services may have access to and how to set them up through the right channel.

Key Takeaways

  • Medicare covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy ordered by your doctor and delivered by a Medicare-approved agency.
  • You must be homebound or have a documented medical reason you cannot leave home, and a doctor must order the services as medically necessary.
  • Medicare does not cover personal care like bathing, dressing, or meal preparation, even if you live alone and cannot do these tasks yourself.
  • You pay nothing for Part A home health services; Part B services cost 20 percent of the approved amount after your deductible.
  • Your doctor must refer you to a Medicare-approved agency; you cannot straightforward hire a home health worker and bill Medicare.

What Medicare Part A Covers at Home

Part A covers home health services with no cost to you when all conditions are met. These include skilled nursing care (wound care, medication management, catheter care), physical therapy (exercises to regain strength after surgery or stroke), occupational therapy (relearning daily tasks after injury), and speech-language pathology (swallowing therapy or speech recovery). Part A also covers medical equipment like oxygen, wheelchairs, and hospital beds, and supplies like wound dressings.

The services must be ordered by your doctor and delivered by employees of a Medicare-approved home health agency — not by an independent worker you hire yourself. Your doctor must document that the services are medically necessary and that you cannot receive them in an outpatient setting. Part A typically covers up to 60 days of home health services following a hospital stay of at least three days, though coverage can extend beyond 60 days if medical need continues.

What Medicare Part B Covers at Home

Part B covers some home health services that Part A does not, or covers them when Part A has ended. These are the same skilled services — nursing, therapy, medical equipment — but billed under Part B rules. You pay 20 percent of the Medicare-approved amount after you meet your annual Part B deductible (which varies by year). Part B does not require a hospital stay first, so if you need home health care without having been hospitalized, Part B may be the route.

Part B home health is less common than Part A because most people who need home health have recently left a hospital. However, if your doctor orders home health care for a condition like diabetes management or post-surgical wound checks and you have not been hospitalized, your claim will go to Part B.

Services Medicare Does Not Cover at Home

Medicare does not pay for custodial care or personal care services, even if you live alone and cannot perform them. This includes bathing, dressing, grooming, toileting, meal preparation, housekeeping, laundry, and shopping. These services are considered non-skilled and are the responsibility of family, friends, or paid caregivers you hire privately. Many people assume that because they cannot bathe themselves after a stroke, Medicare will pay for a home aide — it will not, unless the aide is there to provide skilled nursing or therapy at the same time.

Medicare also does not cover homemaker services, yard work, or transportation to medical appointments. If you need ongoing personal care, you may be able to pay out of pocket, use Medicaid (which does cover some personal care in many states), or explore long-term care insurance or veterans benefits if you may have access to.

How to Get Home Health Care Through Medicare

Your doctor must order home health care and document the medical reason. Contact your doctor's office and explain that you need home health services — for example, wound care after surgery or physical therapy after a fall. Your doctor will write an order and send it to a Medicare-approved home health agency. You do not choose the agency; your doctor typically refers you to one they work with, though you can ask for a different Medicare-approved agency in your area.

The home health agency will contact you to schedule an initial assessment. During this visit, a nurse will review your medical history, current medications, and the specific services your doctor ordered. The agency will explain what Medicare covers, what you will pay, and how often the therapist or nurse will visit. Services usually begin within a few days of the assessment.

To find Medicare-approved home health agencies in your area, visit Medicare.gov and use the Home Health Compare tool, or call 1-800-MEDICARE. You can also ask your doctor's office for a referral.

What Happens If You Do Not Meet the Homebound Requirement

Medicare requires that you be homebound or have a documented medical reason you cannot leave home. Homebound means leaving home requires considerable and taxing effort, or leaving home is medically contraindicated (your doctor has said you should not leave). If you can leave home regularly — even if it is difficult — Medicare may deny the claim.

If you are not homebound but still need skilled care, you may be able to receive services in an outpatient setting instead: at a therapy clinic, your doctor's office, or a hospital outpatient department. These services are also covered by Medicare under the same rules. If you are denied home health care because you do not meet the homebound requirement, the home health agency must tell you in writing and explain your right to appeal.

Paying for Personal Care When Medicare Does Not Cover It

If you need help with bathing, dressing, or meal preparation and Medicare does not cover it, you have several options. You can hire a home care aide privately and pay out of pocket; costs vary widely by region and agency, typically ranging from $15 to $30 per hour for non-medical personal care. Some people use family and friends, or explore whether Medicaid covers personal care in their state — many states do cover personal care services for low-income seniors.

If you are a veteran, you may be may be able to access for Aid and Attendance benefits through the Department of Veterans Affairs, which can help pay for home care. Long-term care insurance, if you have a policy, may also cover personal care. Discuss your options with a social worker at your hospital or local Area Agency on Aging, which can connect you with local resources and programs.

Frequently Asked Questions

Will Medicare pay for a home health aide to help me bathe and dress?

No. Medicare covers skilled nursing and therapy only. Personal care like bathing and dressing is not covered, even if you cannot do it yourself. You would need to pay privately, use Medicaid if you may have access to, or explore other programs like veterans benefits or long-term care insurance.

Do I have to use the home health agency my doctor refers me to?

No. You can request a different Medicare-approved agency. Ask your doctor's office for the order, then contact another agency in your area. Both must be Medicare-approved. You can find approved agencies on Medicare.gov or by calling 1-800-MEDICARE.

What if I need home health care but was not hospitalized first?

You can still receive home health care through Part B if your doctor orders it and you meet the homebound requirement. Part B will cover the services, and you will pay 20 percent of the approved amount after your deductible. You do not need a hospital stay to may have access to.

How long does Medicare pay for home health care?

There is no set limit. Medicare pays as long as your doctor orders the services and they remain medically necessary. After a hospital stay, Part A typically covers up to 60 days, but coverage can continue if your condition requires it. Your doctor and the home health agency review your progress regularly to determine if services should continue.

What should I do if Medicare denies my home health claim?

The home health agency must provide a written notice explaining why the claim was denied. You have the right to appeal. Contact the agency's patient advocate or call 1-800-MEDICARE to understand your options and file an appeal if you believe the denial was incorrect.