Medicare does cover in-home health care, but only under specific conditions
Medicare Part A and Part B together cover skilled nursing care, physical therapy, occupational therapy, and speech-language pathology services delivered in your home — but only if a doctor orders the care, you meet medical necessity requirements, and you use a Medicare-certified home health agency. The coverage is not automatic. Your doctor must document that you are homebound or have difficulty leaving home, that skilled care is medically necessary, and that you need intermittent (not full-time) services. If those conditions are met, Medicare typically covers the full cost of the skilled services themselves, though you may owe a copayment for certain supplies or equipment.
Key Takeaways
- Medicare covers skilled nursing, physical therapy, occupational therapy, and speech-language pathology in your home only when ordered by a doctor and delivered by a Medicare-certified agency.
- You must be homebound or have significant difficulty leaving home, and the care must be medically necessary and intermittent rather than full-time.
- Medicare does not cover custodial care — help with bathing, dressing, toileting, or meal preparation — unless it is provided alongside a skilled service.
- Your doctor must submit an order and a home health plan of care; the agency then submits this to Medicare for review before services begin.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs and coverage rules may differ from Original Medicare.
What Medicare Part A and Part B actually cover at home
Skilled nursing care includes wound care, catheter management, medication administration, and monitoring of medical conditions. Physical therapyOccupational therapySpeech-language pathology
All of these services must be ordered by your doctor and delivered by a licensed professional employed by or contracted with a Medicare-certified home health agency. Medicare covers the cost of the service itself; you typically pay nothing for the visit. However, you may owe a copayment for medical equipment like oxygen, walkers, or hospital beds — usually 20 percent of the approved amount after you have met your Part B deductible.
Home health services are covered under Part A if you are in a hospital or skilled nursing facility first, or under Part B if you go directly from your home. The distinction matters for billing but not for what you pay out of pocket.
What Medicare does not cover in your home
Custodial care — help with bathing, dressing, toileting, grooming, and meal preparation — is not covered by Medicare, even if you need it daily. This is the most common gap. If you live alone and cannot bathe yourself, Medicare will not pay for someone to help you bathe unless that person is also providing a skilled service like wound care at the same visit.
Homemaker services (cleaning, laundry, shopping), personal care attendants, and live-in companions are also not covered. Neither is medication reminders, transportation to appointments, or monitoring for safety reasons alone. If you need these services, you pay out of pocket, or you may find them covered under Medicaid if you meet income and asset limits in your state.
The homebound requirement and what it means
To receive home health services, Medicare requires that you be homebound — meaning you cannot leave home without considerable and taxing effort, or you have a medical contraindication to leaving. You do not have to be bedbound. You can leave home occasionally for medical appointments or religious services, and you can sit on your porch. But you must have a documented medical reason why leaving home is difficult or unsafe.
Your doctor certifies this in the home health plan of care. If you are seen leaving home regularly for non-medical reasons — grocery shopping, socializing, exercise — Medicare may deny coverage or ask the agency to recertify. The rule exists to prevent overuse, but it also means you should be honest with your doctor about your actual ability to leave home.
How to start home health services through Medicare
The process begins with your doctor. Tell your primary care doctor or specialist that you need help at home and ask whether home health services would be appropriate. If the doctor agrees, they will write an order and create a plan of care that describes what services you need, how often, and for how long.
Your doctor will refer you to a Medicare-certified home health agency. You can ask for a specific agency if you have a preference, or your doctor can choose one. Once the agency receives the order, they will contact you to schedule an initial assessment. The agency then submits the plan of care to Medicare for review. Services typically begin within a few days if Medicare approves the plan.
You will receive a notice explaining what services Medicare will cover and what you may owe. If you disagree with the decision, you have the right to request an appeal through Medicare.
How Medicare Advantage and Medigap plans affect your coverage
If you have a Medicare Advantage plan (Part C), your coverage for home health services is the same as Original Medicare — no copayment for the skilled service itself — but you must use an agency in your plan's network. Some Advantage plans also cover some custodial care or homemaker services that Original Medicare does not, so check your plan documents or call the plan to ask.
If you have a Medigap policy, it does not change what Medicare covers, but it may help pay your copayments for equipment or supplies. Medigap does not cover custodial care either.
If you have both Medicare and Medicaid, Medicaid may cover custodial care and homemaker services that Medicare does not. Contact your state Medicaid office or your caseworker to learn what is available in your state.
What happens when home health services end
Medicare covers home health services for as long as they are medically necessary and you remain homebound. Your doctor and the home health agency review your progress regularly. If you improve and no longer need skilled care, or if you become able to leave home safely, services will end.
When services end, ask your agency about other resources. Many agencies can refer you to community programs, senior centers, or volunteer services that offer companionship, transportation, or meal delivery at low or no cost. Your local Area Agency on Aging can also help you find services in your community.
Frequently Asked Questions
Can I choose which home health agency Medicare sends to my home?
Yes. Your doctor can refer you to a specific agency, or you can ask your doctor to refer you to one you choose. The agency must be Medicare-certified. You can find certified agencies in your area through Medicare.gov or by calling 1-800-MEDICARE.
What if I need help at home but my doctor says I am not homebound?
Medicare home health will not cover you. You may be able to pay out of pocket for a home care aide, or you may find services through Medicaid, your local Area Agency on Aging, or community organizations. Some states also have programs that help pay for in-home care based on income.
Do I have to pay anything for home health visits?
No copayment for the skilled service itself. You may owe 20 percent of the cost of medical equipment like oxygen or a walker after you meet your Part B deductible. If you have Medigap, it may cover that copayment.
Can Medicare cover a live-in caregiver?
No. Medicare does not cover custodial care or personal care attendants, whether they visit a few hours a week or live in your home. If you need full-time help, you pay out of pocket or explore Medicaid coverage in your state.
What if the home health agency says Medicare denied my services?
You have the right to appeal. The agency must give you a written notice explaining why. You can request a peer-to-peer review (your doctor talks to a Medicare doctor) or a formal appeal. Call 1-800-MEDICARE to start the appeal process.