Medicare covers home health care, but only when a doctor says you need it and you meet specific conditions
Medicare Part A and Part B together cover home health care services — nursing visits, physical therapy, occupational therapy, speech therapy, and some medical equipment — but only if a doctor determines you are homebound and need skilled care. You do not pay a copay or deductible for these services. The catch is that Medicare will not cover custodial care (help with bathing, dressing, or meals alone), and the services must be ordered by your doctor and provided by a Medicare-certified agency.
Home health care is different from in-home support services you might hire privately. Medicare's definition of "homebound" is strict: you must have a medical condition that makes leaving home difficult or impossible without help, and leaving home requires considerable effort. Sitting on your porch counts as leaving home, so Medicare uses a high bar.
Key Takeaways
- Your doctor must order home health care and state that you are homebound; Medicare will not cover services you arrange on your own.
- Medicare covers skilled nursing, physical therapy, occupational therapy, speech therapy, and some medical equipment and supplies, with no copay.
- Custodial care — help with bathing, dressing, toileting, or meals — is not covered by Medicare, even if you need it.
- A Medicare-certified home health agency must provide the services; care from a family member or a non-certified provider is not covered.
- Your doctor and the home health agency together decide how often you are visited and for how long; Medicare does not set a fixed number of visits.
What Medicare Part A and Part B cover at home
Medicare Part A covers home health care if you have been in a hospital or skilled nursing facility for at least three consecutive days and are discharged directly to home. Part B covers home health care even if you have not been hospitalized, as long as your doctor orders it and you meet the homebound requirement. In both cases, the services must be medically necessary — meaning they treat or manage a health condition, not straightforward help you live independently.
Covered services include skilled nursing (wound care, injections, catheter management), physical therapy (regaining strength or mobility after injury or surgery), occupational therapy (relearning daily tasks), speech therapy (swallowing or speech problems), and medical social services (counseling related to your medical condition). Medicare also covers medical equipment such as wheelchairs, walkers, oxygen, and hospital beds, as well as medical supplies like wound dressings and catheters.
Home health aides can visit to help with personal care, but only if a skilled service (nursing or therapy) is also being provided. If you need only bathing and dressing help, Medicare will not cover it, even if a nurse visits for another reason.
What Medicare does not cover
Medicare does not cover custodial care — the help most people think of when they imagine home care. This includes bathing, dressing, toileting, meal preparation, housekeeping, laundry, and shopping. Even if you cannot do these tasks alone, Medicare will not pay for someone to help you with them unless a skilled service is also being delivered.
Medicare also does not cover 24-hour care, live-in companions, or services provided by family members. If you need round-the-clock supervision or personal care, you will need to pay out of pocket or explore Medicaid (which varies by state and may cover some custodial care for people with low income).
Services that are not medically necessary — such as help organizing your home, transportation to appointments, or meal delivery — are not covered. Your doctor must document that each service is needed to treat or manage a medical condition.
How to start home health care through Medicare
Your doctor must order home health care and submit the order to a Medicare-certified home health agency. You cannot request home health care on your own or hire an agency directly and expect Medicare to pay. Your doctor will fill out a form stating that you are homebound, what services you need, and why. The agency then contacts you to schedule visits.
If you are leaving a hospital or skilled nursing facility, the discharge planner will often arrange home health care before you go home. If you are at home and your doctor thinks you need home health care, ask your doctor to place the order. Your doctor will choose an agency, or you can ask for a list of Medicare-certified agencies in your area and request one by name.
Once the agency begins services, a nurse will assess your needs and create a care plan. Medicare will cover the services outlined in that plan as long as your doctor continues to order them and you remain homebound. The agency bills Medicare directly; you should receive no bill for covered services.
How long Medicare covers home health care
There is no set limit on how long Medicare will cover home health care. Coverage continues as long as your doctor orders it, you remain homebound, and the services are medically necessary. Some people receive home health care for a few weeks after surgery; others receive it for months or years if they have a chronic condition.
Your doctor and the home health agency review your progress regularly. If you improve and no longer need skilled care, or if you are no longer homebound, the services will stop. If your condition changes and you need more or different services, your doctor can adjust the order.
Medicare does conduct reviews of home health care to make sure it is medically necessary. If Medicare questions whether your care should continue, the agency will tell you and may ask your doctor for more information. You have the right to appeal if Medicare denies coverage.
Medicare Advantage and home health care
If you have a Medicare Advantage plan (Part C), your coverage for home health care is the same as Original Medicare — no copay for skilled services — but you must use an agency in your plan's network. Check your plan's provider directory or call the plan to find out which home health agencies are covered.
Some Medicare Advantage plans offer additional benefits, such as coverage for some custodial care or non-medical services like meal delivery or transportation. These vary by plan and by year, so review your plan's benefits or call the plan to ask what home care services are covered beyond what Original Medicare covers.
Paying for home care Medicare does not cover
If you need custodial care or services Medicare does not cover, you have several options. You can pay out of pocket for private home care agencies or hire caregivers independently. Costs vary widely by region and type of care; a home health aide might cost $20 to $30 per hour, while a live-in caregiver can cost $150 to $300 per day or more.
Long-term care insurance, if you have it, may cover some home care costs. Medicaid covers home and community-based services for people with low income and assets, though the services and income limits vary by state. Veterans may be covered through the VA. Ask your doctor, social worker, or local Area Agency on Aging about programs in your state.
Frequently Asked Questions
Do I have to pay anything for home health care Medicare covers?
No. If the services are covered by Medicare and provided by a Medicare-certified agency, you pay nothing — no copay, no deductible, no coinsurance. You should receive no bill. If you do, contact the agency and Medicare to report it.
What if my doctor says I need home care but I am not homebound?
Medicare will not cover it. You must be unable to leave home without considerable effort or help due to a medical condition. If you can leave home with information or for medical appointments, you may not meet the homebound requirement. Your doctor and the home health agency will assess this.
Can I choose which home health agency provides my care?
Yes. Ask your doctor for a list of Medicare-certified agencies in your area, or search the Medicare Care Compare tool on Medicare.gov. You can request a specific agency by name, and your doctor can place the order with that agency.
Will Medicare cover a live-in caregiver?
No. Medicare does not cover 24-hour care or live-in companions. If you need round-the-clock help, you will need to pay privately or explore whether Medicaid in your state covers this service.
What happens if I improve and no longer need home health care?
Your doctor and the home health agency will stop the services. You can request to restart them later if your condition changes and your doctor orders them again. There is no penalty for stopping and restarting.