Medicare's Coverage of In-Home Care
Medicare covers some in-home care, but not all of it, and the type of care matters. Medicare Part A covers skilled nursing care and physical therapy at home if you meet specific conditions: you must have been in a hospital for at least three days, your doctor must order home care, and you must need skilled care — not just help with daily tasks. Medicare Part B covers some home health services under the same skilled-care rule, plus certain medical equipment and supplies used at home.
What Medicare does not cover is custodial care — help with bathing, dressing, eating, or toileting when that is the only thing you need. It also does not cover homemaking services like cleaning or cooking, or care provided by a family member you pay. If you need help with daily living tasks and nothing more, Medicare will not pay for it, and you will need to look at Medicaid, private pay, or long-term care insurance instead.
Key Takeaways
- Medicare Part A and Part B both cover skilled home health care — nursing, therapy, and medical equipment — but only if ordered by your doctor and only after a may have access to hospital stay for Part A.
- Medicare does not cover custodial care, which is help with bathing, dressing, eating, or toileting when no skilled care is involved.
- You pay nothing for Medicare-covered home health services if the home health agency is Medicare-approved and you meet the conditions.
- Medicaid, Veterans benefits, and long-term care insurance are the main sources of payment for custodial in-home care that Medicare will not cover.
- Your doctor must order home care and certify that you are homebound or unable to leave home without considerable effort.
What Counts as Skilled Care Under Medicare
Skilled care means a nurse or therapist must provide it because it requires medical training. Examples include wound care after surgery, injections, physical therapy after a stroke, speech therapy, occupational therapy to regain function, and monitoring of a medical condition like heart failure or diabetes. If a home health aide helps you during these visits — for instance, helping you bathe after a therapy session — that aide visit is covered as part of the skilled care plan.
The key word is skilled. If you need someone to help you get dressed or take a shower because you are weak or have arthritis, but you do not need a nurse or therapist, Medicare will not pay. The same applies if you need someone to cook, clean, shop, or do laundry. These are custodial tasks, and Medicare treats them as personal care, not medical care.
How to Get Medicare-Covered Home Care
Your doctor must order home health care and state in writing that you are homebound or unable to leave home without considerable effort and help. Homebound does not mean you never leave — it means leaving requires a major effort, like a medical appointment or religious service. Your doctor sends the order to a Medicare-approved home health agency, which then contacts you to set up visits.
You do not choose the agency yourself in most cases. Your doctor may recommend one, or your hospital discharge planner may assign one. If you want a different agency, ask your doctor to send the order to that agency instead. The agency will schedule an initial assessment visit, usually within a few days, where a nurse evaluates your needs and creates a care plan. Medicare then reviews the plan to confirm it is medically necessary.
The entire process — from doctor's order to first visit — usually takes one to two weeks. If you are being discharged from a hospital, the discharge planner can speed this up by arranging the home health agency before you leave.
What You Pay for Home Health Services
If the home health agency is Medicare-approved and the care is covered, you pay nothing for the skilled nursing visits, therapy visits, or medical equipment. There is no copay, coinsurance, or deductible for home health services covered by Medicare Part A or Part B.
However, if you have a Medigap or Medicare Advantage plan, your plan may have different rules or may require you to use certain agencies. Check your plan documents or call your plan to confirm what is covered before the agency starts visits. If the agency is not Medicare-approved, or if the care is not considered skilled, you will be billed directly and Medicare will not pay.
When Medicare Coverage Ends
Medicare covers home health care only as long as your condition requires skilled care and your doctor certifies that you still need it. Once you no longer need skilled nursing or therapy — for example, your wound has healed or you have regained enough function to manage on your own — the home health agency will discharge you. This can happen after a few weeks or several months, depending on your recovery.
If you still need help at home after skilled care ends, you will need to pay out of pocket, use Medicaid if you are low-income, or rely on family. Some people transition to a home care aide paid privately, or they move to assisted living or a nursing home. Your home health nurse or social worker can discuss these options with you before discharge.
Medicaid and Other Sources for Custodial Care
Medicaid is the main program that covers custodial in-home care — the help with bathing, dressing, and daily tasks that Medicare will not pay for. Medicaid is a joint federal and state program, so coverage and income limits vary by state. Some states cover in-home personal care services; others do not. You must meet income and asset limits, and in most states you must be age 65 or older, disabled, or blind.
Veterans benefits may cover in-home care if you are a veteran or the surviving spouse of a veteran. The VA Aid and Attendance benefit and the Housebound benefit both can pay for in-home care, including custodial care. Long-term care insurance, if you have a policy, may cover in-home care depending on the terms of your policy. Private pay — paying out of pocket — is also an option if you have the funds.
How to Find a Medicare-Approved Home Health Agency
Your doctor or hospital discharge planner will usually arrange this for you. If you want to find an agency on your own, you can search the Medicare Care Compare tool on Medicare.gov, which lists all Medicare-approved agencies in your area and shows their inspection results and patient ratings.
When you contact an agency, confirm that it is Medicare-approved and ask whether it accepts your insurance plan. Ask about the types of services it offers — some agencies specialize in wound care or cardiac care, while others offer general nursing and therapy. Ask how quickly it can schedule an initial visit and whether it has evening or weekend availability if you need it. Get the name of the nurse or coordinator who will manage your care, and ask how to reach them if you have questions.
Frequently Asked Questions
Can Medicare cover a home health aide to help me bathe and dress if I do not need a nurse?
No, not on its own. Medicare covers a home health aide only as part of a skilled care plan — for instance, if a nurse is also visiting to do wound care and the aide helps you bathe on those same days. If you need only custodial help, Medicare will not pay. You would need Medicaid, Veterans benefits, long-term care insurance, or private pay.
What if my doctor says I need in-home care but I was not in the hospital for three days?
Medicare Part A requires a three-day hospital stay, but Medicare Part B does not. If your doctor orders home health care and you are homebound, Part B may cover it even without a hospital stay. Your doctor must still certify that you need skilled care and are homebound. Ask your doctor to specify which Medicare part should cover the care.
Can I choose which home health agency comes to my house?
Your doctor can send the order to a specific Medicare-approved agency if you request it. If you are unhappy with the agency assigned to you, ask your doctor to change the order. You have the right to choose, but the agency must be Medicare-approved and must serve your area.
What happens if the home health agency says I am no longer homebound and stops my care?
You can ask your doctor to review the decision and certify that you are still homebound and need skilled care. If your doctor agrees, the agency should continue. If your doctor agrees that you no longer need skilled care, the agency will discharge you, and you will need to find another source of payment for any ongoing help you need.
Does Medicare cover 24-hour in-home care?
No. Medicare covers visits from a nurse or therapist, not round-the-clock care. If you need 24-hour supervision or care, you would typically need to move to a nursing home or assisted living facility, or pay privately for in-home caregivers. Some Medicaid programs cover 24-hour in-home care in certain states, but this varies widely.