Medicare Part A covers home health care, but only under specific conditions
Medicare Part A will pay for home health care if a doctor orders it, you are homebound, and you need skilled nursing or therapy services. Part A does not cover custodial care — help with bathing, dressing, or meals when that is the only service you need. The care must be provided by a Medicare-certified home health agency, and you typically pay nothing out of pocket for covered services.
Home health care under Part A is different from other types of in-home support. It is medical care delivered at home, not general information. If you need help with daily tasks but not medical treatment, Part A will not cover it, and you would need to pay out of pocket or look into other programs like Medicaid.
Key Takeaways
- Part A covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy ordered by your doctor when you are homebound.
- Your doctor must order home health care and determine you are unable to leave home except with difficulty, or the services will not be covered.
- You must receive care from a Medicare-certified home health agency; care from an uncertified provider is not covered by Part A.
- Part A does not cover help with bathing, dressing, meals, or housekeeping unless those services are part of a skilled nursing or therapy visit.
- You pay no copayment or coinsurance for covered home health services, though you may owe a copay for medical equipment like oxygen or a walker.
What Part A actually covers in home health care
Part A covers skilled nursing care — wound care, injections, catheter management, or monitoring of a medical condition. It covers physical therapy to help you regain strength or mobility after surgery or illness. It covers occupational therapy to help you relearn daily tasks, and speech-language pathology if you have swallowing or speech problems.
Part A also covers medical social services and home health aide visits, but only when they are ordered alongside skilled nursing or therapy. A home health aide can help with bathing and dressing, but only if a nurse or therapist is also treating you. Once the skilled services end, the aide visits stop, even if you still need help with personal care.
Durable medical equipment — a hospital bed, wheelchair, walker, or oxygen — may be covered under Part B, not Part A. Your doctor must order it, and you typically pay 20 percent of the approved amount after you meet your Part B deductible.
The homebound requirement and how it works
To receive home health care under Part A, you must be homebound. This does not mean you never leave your house. It means leaving home requires a considerable and taxing effort because of your medical condition. You might be able to leave for a doctor's appointment or religious services with help, but you cannot go to work or run errands on your own.
Your doctor decides whether you meet the homebound requirement when they order home health care. Medicare does not send someone to your home to test this. The home health agency will ask you questions about your mobility and may ask your doctor for clarification, but the information rests with your physician.
If you start going out regularly — to a job, to volunteer, to shop — the home health agency may discharge you because you no longer meet the homebound requirement. Tell your nurse or therapist if your mobility improves so there is no surprise when services end.
How to start home health care through Part A
Your doctor must order home health care. You cannot request it on your own or call a home health agency directly and have Part A pay. Your doctor writes an order that includes the type of care you need, how often you need it, and how long the services should continue.
Once your doctor places the order, you can choose a Medicare-certified home health agency. Your doctor may recommend one, or you can search for agencies in your area on Medicare.gov. Call the agency and tell them your doctor has ordered care. The agency will contact your doctor to confirm the order and schedule your first visit.
The home health agency handles billing to Medicare. You do not submit paperwork or pay upfront. If the agency is in-network with Medicare (which all certified agencies are), you owe nothing for covered services. If the agency later determines that a service was not medically necessary, Medicare may deny payment, but the agency cannot bill you for a denied claim.
What you pay and what you do not
You pay nothing for covered home health services under Part A — no copayment, no coinsurance, no deductible. This is one of the most generous benefits in Medicare. The only cost to you is if the home health agency provides a service that Part A does not cover, and they tell you in advance that you will be responsible for the bill.
If you need durable medical equipment, you may owe a copayment. Part B covers equipment at 80 percent after your deductible, so you pay 20 percent. If you rent equipment like a hospital bed, you pay 20 percent of the rental cost each month for up to 13 months, then the equipment is yours.
If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of the costs you would normally owe. Check your plan documents or call your plan to understand what you pay.
When Part A home health care ends
Home health care under Part A is not permanent. It ends when your doctor determines you no longer need skilled services, when you no longer meet the homebound requirement, or when you have reached your medical goals. There is no set time limit — some people receive home health for a few weeks after surgery, others for several months during recovery from illness.
The home health agency must tell you in writing before they discharge you. If you disagree with the discharge decision, you can ask for a review. Contact your home health agency's patient advocate or call 1-800-MEDICARE to request a peer-to-peer review, where another doctor looks at whether the discharge is appropriate.
If you still need help after home health services end, you may be able to pay out of pocket for a home care aide, or you may be covered under Medicaid if you meet income and asset limits. Some states cover non-medical home care through Medicaid programs for seniors and people with disabilities.
Part A home health versus other types of home care
Home health care under Part A is medical care ordered by a doctor. It is different from home care services you pay for privately, which can include housekeeping, meal preparation, and personal care without a medical component. It is also different from assisted living or adult day programs, which Part A does not cover.
If you need only custodial care — help with bathing, dressing, or meals — Part A will not pay. You would need to pay out of pocket, use long-term care insurance if you have it, or explore whether Medicaid covers home care in your state. Some states have Medicaid waiver programs that cover non-medical home care for seniors, but income and asset limits explore.
Medicare Advantage plans (Part C) must cover at least what Original Medicare covers, so they cover home health care under the same rules as Part A. Some Advantage plans offer additional home care benefits, such as a certain number of non-medical aide hours per month. Check your plan's summary of benefits to see what extra services are included.
Questions to ask your doctor before home health care starts
Ask your doctor what type of care you will receive — skilled nursing, therapy, or both. Ask how often the nurse or therapist will visit and for how long. Ask whether a home health aide will come, and if so, what tasks they will help with. Ask what your role is in the treatment plan and what you should do if your condition changes.
Ask your doctor how they will know when home health care should end and what signs to watch for that mean you are improving. Ask whether you will need any equipment at home and whether Part A will cover it. If you have questions after services start, ask the nurse or therapist — they can contact your doctor if something needs to change.
Frequently Asked Questions
Can I get home health care if I live in an assisted living facility or nursing home?
No. Part A home health care is only for people living in their own home or a family member's home. If you live in a facility that provides meals and housekeeping, you are not homebound, and Part A will not cover home health services. If you need skilled care in a facility, you would be admitted as a resident, not as a home health patient.
What happens if my home health agency is not Medicare-certified?
Medicare will not pay. You must use a Medicare-certified agency. You can search for certified agencies in your area on Medicare.gov or call 1-800-MEDICARE for a list. If an agency tells you they are certified but you are unsure, ask for their Medicare provider number and verify it on the Medicare website.
Can I choose a specific nurse or therapist?
You cannot request a specific person, but you can tell the agency if you have a concern about the person assigned to you. If there is a serious problem — a personality conflict, a safety issue, or a language barrier — ask to speak with the agency's supervisor. The agency should work to resolve the issue or assign someone else.
Do I have to accept home health care if my doctor orders it?
No. You can refuse home health care. If you refuse, tell your doctor and the home health agency in writing. You can change your mind later and ask your doctor to order services again. Refusing services does not affect your Medicare coverage for other benefits.
What if I need home health care but my doctor will not order it?
Talk to your doctor about why they believe you do not need it. If you disagree, you can ask for a second opinion from another doctor. You can also contact your state's Patient Advocate Foundation or call 1-800-MEDICARE to discuss your situation, though Medicare cannot order your doctor to prescribe services.