Medicare covers some in-home care, but not all of it, and the rules are strict about what kind
Medicare will pay for skilled nursing care and physical therapy in your home if a doctor orders it and you meet specific conditions. It will not pay for help with bathing, dressing, meals, or housekeeping — even if you need it every day. The difference comes down to whether the care requires a trained medical professional or is personal information anyone could provide.
To get Medicare to cover in-home care, you must be homebound (leaving home is medically difficult), have a doctor's written order, and receive care from a Medicare-approved agency. Medicare Part A covers the full cost for the first 100 days after a hospital or skilled nursing facility stay. Part B covers some ongoing services if you do not may have access to for Part A. Neither covers custodial care — the day-to-day help most seniors actually need at home.
Key Takeaways
- Medicare Part A covers skilled nursing and therapy at home for up to 100 days after a hospital or facility stay, with no copay for the first 20 days.
- After 100 days, Part B may cover some skilled services, but you pay 20 percent of the cost and must meet the homebound requirement.
- Medicare does not cover personal care like bathing, dressing, meal preparation, or housekeeping, even if ordered by a doctor.
- You must use a Medicare-approved home health agency, and a doctor must order the care in writing for a specific medical reason.
- If you need help with daily living tasks, Medicaid, long-term care insurance, or out-of-pocket payment are the main options.
What Medicare Part A covers at home after a hospital stay
If you spend at least three nights in a hospital and are then discharged home, Medicare Part A will cover skilled home health services for up to 100 days. Skilled services mean nursing care that requires a licensed nurse — wound care, catheter management, medication injections, or monitoring after surgery. Physical therapy, occupational therapy, and speech therapy also count as skilled services.
During the first 20 days, Medicare pays 100 percent of the cost. From day 21 through day 100, you pay a copay per visit (the amount changes yearly). After day 100, Part A coverage ends. The clock resets only if you return to the hospital for at least three nights and are discharged again.
The agency must be Medicare-approved, and a doctor must order the services in writing. You do not choose the agency — Medicare assigns you to one in your area, though you can request a different one. The nurse or therapist visits your home on a schedule the doctor sets, usually two to three times per week.
What Medicare Part B covers for ongoing home care
If you do not may have access to for Part A coverage (because you were not hospitalized for three nights), Part B may cover some skilled home health services. Part B also continues coverage after your Part A 100 days run out, if a doctor still orders it and you remain homebound.
Under Part B, you pay 20 percent of the Medicare-approved amount for each visit after you meet your annual deductible. The deductible resets every January. Like Part A, the care must be skilled (nursing or therapy), ordered by a doctor, and delivered by a Medicare-approved agency. Part B does not cover personal care or custodial services.
Homebound status is stricter under Part B than many people expect. You must have a medical condition that makes leaving home difficult without help, and leaving home must be medically contraindicated — meaning a doctor would advise against it. Taking a trip to the grocery store or a doctor's appointment can disqualify you, depending on how often you do it and why.
Personal care and daily living help are not covered by Medicare
Medicare does not pay for help with activities of daily living, no matter who orders it or how much you need it. This includes bathing, dressing, grooming, toileting, meal preparation, feeding, housekeeping, laundry, and shopping. A nurse can teach you how to bathe yourself after a stroke, but Medicare will not pay a person to bathe you.
This is the biggest gap in Medicare coverage for seniors who need in-home support. Many people assume that if a doctor says they need help at home, Medicare will pay for it. In reality, doctors cannot order custodial care into coverage — it is straightforward not a Medicare benefit, no matter the medical reason.
If you need personal care, your options are Medicaid (if you may have access to based on income and assets), long-term care insurance (if you bought a policy before you needed care), paying out of pocket, or a combination of these. Some agencies offer both skilled services (covered by Medicare) and personal care (paid privately), so you may work with the same company for both.
How to request in-home care through Medicare
Your doctor must start the process by writing an order for home health services. You cannot request it yourself or call Medicare directly. Tell your doctor you want to receive care at home, and ask whether you meet the medical criteria — homebound status and a need for skilled services.
Once your doctor writes the order, they will send it to a Medicare-approved home health agency. The agency will contact you to schedule an initial assessment. During this visit, a nurse will review your medical history, current medications, and what care you need. The agency will create a care plan and tell you how often a nurse or therapist will visit.
If you are in the hospital or a skilled nursing facility, the discharge planner will help arrange home health services before you leave. This is the easiest time to set it up, because the facility has already coordinated with agencies. If you are at home and need services, ask your primary care doctor to write the order.
What happens when Part A coverage ends at 100 days
When you reach day 100 of Part A coverage, the home health agency must notify you that Medicare will no longer pay. At that point, you have three options: stop services, switch to Part B coverage (if a doctor still orders it and you remain homebound), or pay out of pocket.
If you switch to Part B, you will pay 20 percent of the cost per visit. If you want to continue with personal care that was never covered by Medicare, you can hire the same agency privately and pay them directly. Some agencies bill Medicare for the skilled portion and you pay out of pocket for the personal care portion on the same visit.
Before day 100 arrives, talk to your doctor about whether you will still need services and whether Part B coverage is realistic for your situation. Ask the home health agency what their private-pay rates are, in case you want to continue some services without Medicare coverage.
Medicare-approved agencies and how to find one
All home health agencies that bill Medicare must be Medicare-certified. You can search for agencies in your area on Medicare.gov by entering your zip code in the Home Health Compare tool. This tool shows which agencies are in your area, their inspection records, and patient ratings.
When Medicare assigns you to an agency, you can ask for a different one if you have concerns about quality or fit. You have the right to choose your agency, though in rural areas there may be only one or two options. If you are unhappy with the agency after services begin, you can request a change.
Ask the agency about their experience with your specific condition, how they handle emergencies after hours, and whether they offer both skilled and personal care services. If you will need personal care eventually, it is helpful to work with an agency that offers both, so you can transition smoothly when Medicare coverage ends.
Frequently Asked Questions
Does Medicare cover a home health aide to help me bathe and dress?
No. Medicare does not cover personal care aides for bathing, dressing, grooming, or toileting. A nurse can teach you how to do these tasks after an illness, but Medicare will not pay someone to do them for you. If you need this help, Medicaid, long-term care insurance, or private payment are your options.
What if my doctor says I need in-home care but I was not in the hospital?
You may still receive services under Part B if your doctor orders them and you are homebound. You will pay 20 percent of the cost after your deductible. Part B covers skilled nursing and therapy but not personal care. The homebound requirement is strict — you must have a medical reason that makes leaving home difficult.
Can I choose which home health agency Medicare sends to my house?
Medicare will assign you to an agency in your area, but you have the right to request a different one. If you are unhappy with the agency assigned, ask your doctor or call Medicare to request a change. In some areas, only one or two agencies are Medicare-certified, so your choices may be limited.
Do I have to pay anything if Medicare covers my home health care?
Under Part A, you pay nothing for the first 20 days after a hospital stay. From day 21 to day 100, you pay a copay per visit (the amount changes yearly). Under Part B, you pay 20 percent of the cost per visit after you meet your annual deductible. Personal care is never covered, so you pay the full cost if you need it.
What should I do if I need help at home but do not may have access to for Medicare coverage?
Talk to your doctor about whether you meet the homebound requirement and whether your condition qualifies for skilled services. If not, ask about Medicaid (which covers personal care if you may have access to by income), long-term care insurance (if you have a policy), or private-pay agencies. Some seniors use a combination — Medicare for skilled care and private payment for personal care.