Medicare covers in-home nursing care, but only under specific conditions and for limited periods
Medicare Part A and Part B together cover skilled nursing visits in your home, but the coverage is not open-ended. You must be homebound or have severe mobility limits, need skilled care (not just help with daily tasks), and be under a doctor's order for home health services. Medicare will not pay for custodial care — help with bathing, dressing, or meals when that is all you need — or for ongoing nursing visits after you have recovered enough to manage on your own.
The visits are covered at no cost to you when you meet these conditions. You pay nothing for the nursing visit itself, the medical supplies the nurse brings, or the equipment Medicare approves. However, if you use a home health agency that is not Medicare-approved, or if you need care that falls outside Medicare's rules, you will pay the full cost out of pocket.
Key Takeaways
- Medicare covers skilled nursing visits at home only if a doctor orders them, you are homebound or have severe mobility limits, and the care is medical in nature — wound care, injections, catheter management, or therapy.
- Coverage is temporary and tied to your recovery; once you no longer need skilled care, Medicare stops paying, even if you still want nursing visits.
- You must use a Medicare-approved home health agency, and your doctor must recertify the need for home health every 60 days for coverage to continue.
- Medicare does not cover help with bathing, dressing, meals, or housekeeping unless those tasks are part of a skilled nursing visit.
- If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may differ, so check your plan documents.
What counts as skilled nursing care under Medicare
Skilled nursing means care that requires a licensed nurse — a registered nurse (RN) or licensed practical nurse (LPN) — and cannot safely be done by an untrained person. Examples include wound care (cleaning and dressing surgical wounds or pressure sores), injections (insulin, antibiotics, or other medications), catheter insertion and management, tube feeding, colostomy care, and monitoring after hospitalization or surgery.
Physical therapy, occupational therapy, and speech therapy also count as skilled services and are covered under the same home health benefit. If a nurse visits to teach you how to manage your condition — for example, how to check your blood sugar or use an inhaler correctly — that teaching visit is covered as skilled care.
Help with bathing, dressing, grooming, or meals is not skilled care, even if you cannot do these things yourself. If a home health aide comes to help with these tasks, Medicare covers the aide's visit only if a nurse is also visiting you for a skilled reason. Once the skilled nursing visits end, the aide visits stop too.
How to start home health services through Medicare
Your doctor must order home health services and document that you are homebound or have severe mobility limits. Homebound means you cannot leave your home without considerable and taxing effort, or leaving would be medically contraindicated (dangerous to your health). You do not have to be bedridden; you can leave for medical appointments or occasional outings, but your primary residence must be your home.
Once your doctor writes the order, ask them to refer you to a Medicare-approved home health agency. Your doctor may have a preferred agency, or you can search the Medicare website for agencies in your area. When you contact the agency, they will schedule an intake visit to assess your needs and confirm that Medicare will cover your care.
The agency handles all the paperwork with Medicare. You do not submit claims yourself. The agency bills Medicare directly, and you receive the care at no cost as long as you remain may be able to access. If your condition changes or you no longer need skilled care, the agency will notify Medicare and the visits will stop.
How long Medicare covers home nursing visits
There is no set number of visits Medicare will pay for. Coverage depends on your medical need and your progress toward recovery. Some people receive visits for a few weeks after hospitalization; others may receive them for several months if they have a chronic wound or complex medication management.
Your doctor must recertify that you still need home health care every 60 days. If you are improving and no longer require skilled nursing, your doctor will not recertify, and Medicare coverage ends. If your condition is stable or worsening and skilled care is still medically necessary, your doctor will recertify and visits continue.
Once you no longer need skilled care — for example, your wound has healed or you have learned to manage your medications independently — Medicare stops paying. At that point, if you want ongoing nursing visits, you would need to pay out of pocket or check whether your state's Medicaid program covers long-term home care.
What you pay and what Medicare pays
When you receive home health services from a Medicare-approved agency and meet all the coverage rules, you pay nothing. Medicare covers the full cost of the nursing visits, therapy visits, medical supplies, and durable medical equipment (such as a hospital bed or oxygen concentrator) that the agency provides or arranges.
If you have a Medigap (supplemental insurance) plan, it may cover costs that Medicare does not, but there are usually no out-of-pocket costs for the home health service itself. If you have a Medicare Advantage plan, check your plan documents, because some plans have different rules or may require you to use agencies in their network.
If you use a home health agency that is not Medicare-approved, Medicare will not pay anything, and you will be responsible for the full cost. Before you hire an agency, confirm that it is Medicare-certified. You can check the Medicare website or ask the agency directly for its Medicare certification number.
When Medicare does not cover home nursing
Medicare does not cover nursing visits if you do not meet the homebound requirement. If you can leave your home without considerable effort, you are not homebound, and Medicare will not pay for home health services, even if you have a medical condition.
Medicare also does not cover custodial care — help with activities of daily living such as bathing, dressing, grooming, toileting, or eating — unless a nurse is visiting for a skilled reason. If you need only custodial care, you would pay out of pocket or explore whether Medicaid or a long-term care insurance policy covers these services.
Nursing visits for monitoring or supervision alone (without hands-on skilled care or therapy) are not covered. For example, a nurse visiting only to check your blood pressure and report to your doctor would not be a covered visit. The visit must involve skilled care or skilled teaching.
Alternatives if Medicare does not cover your situation
If you need in-home care but do not meet Medicare's homebound requirement or skilled care definition, you have several options. Many states offer Medicaid-funded home care programs for people with low income and assets, though the rules vary by state. Contact your state's Medicaid office or your local Area Agency on Aging to learn what programs exist where you live.
Some people purchase long-term care insurance or use savings to pay for private home care agencies. Others rely on family members or hire caregivers directly. If cost is a barrier, your local Area Agency on Aging can connect you with programs that may help, such as Older Americans Act services or state-funded home care programs.
If you have a Medicare Advantage plan, review your plan documents to see whether it covers additional home care services beyond what Original Medicare covers. Some plans offer supplemental benefits such as non-medical in-home support or additional therapy visits.
Questions to ask your doctor before home health services start
Ask your doctor whether your condition meets Medicare's homebound requirement and whether the care you need is skilled nursing or custodial care. Ask how long they expect you to need home health services and how often they plan to recertify your need. Ask which home health agencies they recommend and whether they have a preferred provider.
If you are unsure whether Medicare will cover your situation, ask your doctor to explain why home health is medically necessary and what specific skilled services you will receive. You can also contact a Medicare-approved home health agency directly; they can often tell you within a few minutes whether your situation is likely to be covered.
Frequently Asked Questions
Can I choose which home health agency Medicare sends?
Yes. Your doctor can refer you to a specific Medicare-approved agency, or you can search for agencies in your area on the Medicare website and contact them directly. Medicare does not assign you to an agency; you choose which one you want to work with, as long as it is Medicare-certified.
What happens if I improve and no longer need skilled care?
Your doctor will not recertify your need for home health, and Medicare coverage will end. If you still want nursing visits or help at home, you would need to pay out of pocket or explore whether Medicaid or another program covers the care you need.
Does Medicare cover a home health aide if I need help with bathing and dressing?
Only if a nurse is also visiting you for a skilled reason. Once the skilled nursing visits end, the aide visits stop too. If you need ongoing help with daily activities, you would need to pay privately or check whether your state's Medicaid program covers in-home support services.
Can I receive home health services if I live in an assisted living facility?
Yes, if you meet all other requirements — homebound status, a doctor's order, and a medical need for skilled care. However, some assisted living facilities have their own staff, so confirm with the facility and the home health agency that they can coordinate care in your setting.
What if my home health agency says Medicare will not cover my visits?
Ask the agency to explain in writing why they believe the visits are not covered. You can also contact Medicare directly at 1-800-MEDICARE to ask about your specific situation, or request a detailed explanation from your doctor about why the care is medically necessary.