Medicare covers some in-home care, but not all of it — and what you pay depends on which type of care you need and which part of Medicare you're on.

Medicare Part A covers skilled nursing care and home health aide services if you meet specific conditions: you must be homebound, a doctor must order the care, and you must need it for a medical reason — not just help with daily tasks. Part B covers some physical therapy, occupational therapy, and speech therapy at home under the same homebound requirement. Part A pays for up to 60 days of skilled nursing per benefit period with no copay; after that, you pay a daily copay. Home health aide visits covered by Part A have no copay. Therapy covered by Part B requires you to meet your annual deductible and then pay 20 percent of the cost.

Medicare does not cover custodial care — help with bathing, dressing, toileting, or meals when that is the only service you need. It does not cover homemaker services like cleaning or laundry, or care provided by family members. If you need only custodial care, you pay out of pocket, or you may turn to Medicaid (which varies by state) or a Medigap or Medicare Advantage plan, some of which offer limited coverage for services Medicare does not.

Key Takeaways

  • Medicare Part A covers skilled nursing and home health aide visits if you are homebound and a doctor orders the care for a medical reason.
  • Medicare Part B covers therapy services — physical, occupational, and speech — at home under the same homebound and doctor-order requirements.
  • Medicare does not cover custodial care (help with bathing, dressing, meals) unless it is part of a skilled nursing plan, and does not cover family caregivers.
  • Some Medicare Advantage and Medigap plans offer additional in-home services, so reviewing your plan documents or calling your plan is the fastest way to learn what you have.
  • To start, ask your doctor whether you meet the homebound requirement and what type of care they recommend; your doctor's order is the first step toward coverage.

What "Homebound" Means Under Medicare

To receive in-home care covered by Medicare, you must be homebound — a term Medicare defines narrowly. You are homebound if leaving home requires considerable and taxing effort, or if your medical condition makes it medically inadvisable to leave. This does not mean you never leave; it means you cannot leave without help, or leaving causes you significant physical difficulty or risk.

Examples include someone recovering from hip surgery who cannot walk without a walker, or someone with severe heart disease whose doctor has advised against exertion. If you can get to a doctor's office or a senior center on your own, Medicare may decide you are not homebound. The information is made by the home health agency and your doctor together, not by Medicare directly, but Medicare can deny the claim if it later reviews the case and disagrees.

Medicare Part A: Skilled Nursing and Home Health Aides

Part A covers skilled nursing visits — care that requires a licensed nurse, such as wound care, catheter management, medication injection, or monitoring after hospitalization. It also covers home health aide visits when they are ordered as part of a skilled nursing plan. A home health aide can help with bathing, dressing, toileting, and meals, but only if a nurse is also visiting for a skilled need.

You do not pay a copay for Part A home health services. However, you must have been in a hospital for at least three consecutive days before the care begins (with limited exceptions), and the care must start within 60 days of hospital discharge. Part A covers up to 60 days of skilled nursing per benefit period; after 60 days, you pay a daily copay for days 61 through 100, and you pay all costs after day 100.

To start, your hospital discharge planner or your doctor will refer you to a home health agency. The agency will assess whether you meet Medicare's homebound requirement and whether the care is medically necessary. If approved, the agency sends nurses and aides on a schedule your doctor sets — often several times per week, though frequency varies.

Medicare Part B: Therapy Services at Home

Part B covers physical therapy, occupational therapy, and speech-language pathology when ordered by your doctor and delivered at home. Physical therapy helps you regain strength and mobility after injury or surgery. Occupational therapy helps you relearn daily tasks like dressing or cooking. Speech therapy addresses swallowing or communication problems.

You must meet your Part B annual deductible (which changes each year) before coverage begins, and then you pay 20 percent of the Medicare-approved amount for each visit. There is no limit on the number of visits, but Medicare reviews claims to may support the therapy is medically necessary and making progress. If Medicare decides the therapy is not helping or is no longer needed, it may stop covering it.

Like skilled nursing, therapy at home requires a doctor's order and the homebound requirement. Your doctor can refer you to a home health agency or a therapy provider directly; many agencies employ therapists and can coordinate all services in one visit schedule.

What Medicare Does Not Cover at Home

Custodial care — help with bathing, dressing, toileting, eating, and grooming — is not covered by Medicare unless it is part of a skilled nursing plan. If you need only custodial care and no skilled nursing or therapy, Medicare will not pay. This is the most common gap in coverage for people who need help at home.

Medicare also does not cover homemaker services (cleaning, laundry, shopping), meal delivery, transportation, or care provided by a family member or friend, even if they are trained. It does not cover 24-hour care or live-in caregivers. If you need these services, you pay out of pocket, hire a private caregiver, or explore Medicaid (which covers more in-home services in many states but has strict income and asset limits).

Medicare Advantage and Medigap: Extra In-Home Coverage

Medicare Advantage plans (Part C) are run by private insurers and often include coverage for services Original Medicare does not — such as some custodial care, meal delivery, or transportation. The specific services vary widely by plan and by state. To learn what your plan covers, check your plan documents or call the plan's customer service number on your insurance card.

Medigap plans (supplemental insurance) do not typically add in-home services; they mainly cover the copays and deductibles that Original Medicare leaves you responsible for. However, some Medigap insurers offer riders or add-ons for in-home services, so it is worth asking your Medigap provider what options exist.

If you are considering a Medicare Advantage plan or shopping for Medigap, in-home care needs are worth discussing with an agent or the plan directly. Plans change their benefits each year, so even if your current plan does not cover custodial care, a different plan might.

How to Start the Process

The first step is to talk with your doctor. Tell them you need help at home and describe what you need — whether it is wound care, help after surgery, therapy, or daily information. Your doctor will determine whether you meet the homebound requirement and what type of care is medically necessary. If your doctor agrees, they will write an order for home health services.

Your doctor can refer you to a specific home health agency, or you can choose one yourself. Medicare maintains a list of Medicare-certified home health agencies in your area; you can search by ZIP code at Medicare.gov under "Find Care Providers." Once you contact an agency, they will schedule an intake visit to assess your needs and confirm that you meet Medicare's requirements.

The agency will handle the paperwork and billing. You should receive a document explaining what services are covered, what you will pay, and how long the care is expected to last. If you have questions about coverage or costs, ask the agency before services begin.

Frequently Asked Questions

Will Medicare cover a live-in caregiver?

No. Medicare does not cover 24-hour or live-in care. It covers skilled nursing and therapy visits on a schedule set by your doctor, typically a few times per week. If you need round-the-clock help, you would need to pay privately, hire through an agency, or explore Medicaid in your state.

What if I need help but I'm not homebound?

Medicare will not cover in-home care if you can leave home without considerable difficulty. You would need to pay out of pocket, explore Medicaid (if you meet income limits), or check whether your Medicare Advantage plan offers any coverage for non-homebound in-home services.

Do I have to use a Medicare-certified agency?

Yes, for Medicare to pay. If you hire a private caregiver or use a non-certified agency, Medicare will not cover the cost. Using a certified agency also protects you because the agency is inspected and must meet quality standards.

How long does it take to get approved for home health care?

Once your doctor places the order, the home health agency typically schedules an intake visit within a few days. If you meet the requirements, services can begin within a week or two. The exact timeline depends on the agency's schedule and how quickly your doctor's paperwork reaches them.

Can I switch home health agencies if I'm not happy with the first one?

Yes. You can ask your doctor to refer you to a different Medicare-certified agency, or you can contact one directly. There is no penalty for switching. Tell your current agency you are discontinuing services, and notify the new agency of your doctor's order.