Medicare Part B covers some home health care, but not all of it — and the rules are strict about what counts
Medicare Part B pays for home health care only when you meet three conditions at the same time: your doctor orders it, you are homebound (meaning leaving home is medically difficult), and a Medicare-approved home health agency provides it. Part B does not cover custodial care — help with bathing, dressing, or meals when that is the only thing you need. It covers skilled nursing visits, physical therapy, occupational therapy, and speech-language pathology. If you need only personal care or housekeeping, Medicare Part B will not pay.
The key word is skilled. A nurse checking your wound, adjusting medication, or teaching you to use medical equipment counts. A home aide helping you shower does not, unless the aide is there as part of a skilled nursing plan — for example, helping you bathe after surgery while a nurse monitors your recovery. Once you no longer need skilled care, Part B coverage stops, even if you still need help at home.
Key Takeaways
- Medicare Part B covers skilled nursing, physical therapy, occupational therapy, and speech therapy at home only when a doctor orders it and you cannot leave home without medical difficulty.
- Part B does not cover personal care, housekeeping, or meal preparation unless they are part of a skilled nursing plan ordered by your doctor.
- You pay nothing for home health care covered by Part B if the agency is Medicare-approved and you meet the homebound requirement.
- Coverage typically lasts as long as you need skilled care; once you improve enough to leave home or no longer need skilled services, Part B stops paying.
- If you need ongoing personal care after skilled care ends, you may need to pay out of pocket or explore Medicaid or long-term care insurance.
When Part B pays for home health visits
Your doctor must write an order for home health care and state that you are homebound. Homebound does not mean you never leave your house — it means leaving requires considerable and taxing effort, or your condition makes it medically inadvisable. Someone recovering from hip surgery, managing severe heart failure, or unable to walk without information would may have access to. Someone who can drive to a doctor's appointment or go to the grocery store with help typically would not.
Once your doctor orders home health, Medicare Part B covers the cost of visits from a Medicare-approved agency. You pay nothing for the visits themselves. The agency bills Medicare directly. If the agency is not Medicare-approved, Part B will not pay, so always ask the agency whether Medicare covers them before the first visit.
Part B covers these services when ordered by your doctor: skilled nursing (wound care, medication management, monitoring vital signs), physical therapy (regaining strength and mobility after injury or surgery), occupational therapy (relearning daily tasks), and speech-language pathology (swallowing problems, speech recovery after stroke). It also covers medical equipment and supplies the nurse or therapist orders — oxygen, wound dressings, diabetic supplies — as long as they are medically necessary.
What Part B does not cover at home
Personal care — bathing, dressing, grooming, toileting — is not covered by Part B unless a nurse is there as part of a skilled nursing plan. A home health aide can help you bathe, but only if a nurse is actively treating you for a skilled condition and the aide's help is part of that treatment. Once the skilled nursing ends, the aide cannot continue on Part B's dime.
Housekeeping, meal preparation, laundry, and shopping are never covered by Part B, even if you are homebound. Companionship and supervision are not covered. If you live alone and need someone to check on you daily, Part B will not pay for that service. Medications you take at home are covered under Part D (prescription drug coverage), not Part B home health.
If your only need is help with daily living — you are homebound but do not need skilled nursing or therapy — Part B will not pay. You would need to explore other options: Medicaid (if you meet income and asset limits), a long-term care insurance policy, or out-of-pocket payment to a private home care agency.
How long Part B covers home health care
There is no set time limit. Part B covers home health as long as your doctor orders it and you remain homebound and need skilled care. Some people receive home health for a few weeks after surgery; others receive it for months if they have a chronic condition requiring ongoing skilled nursing.
Your home health agency must recertify your need every 60 days. A doctor or nurse practitioner reviews whether you still meet the homebound requirement and still need skilled services. If you improve enough to leave home or no longer need skilled care, the certification ends and Part B stops paying. This can happen suddenly — for example, once your wound heals and no longer needs professional dressing changes, skilled nursing ends.
If you disagree with the decision to end coverage, you can request a reconsideration. The home health agency can tell you how to file that request, or you can contact Medicare directly at 1-800-MEDICARE.
The difference between Part B home health and Part A home health
Medicare Part A also covers home health care, but only in specific situations. Part A pays for home health if you were hospitalized for at least three consecutive days and then discharged to home. Part A coverage typically lasts up to 60 days after discharge. Part B, by contrast, covers home health without requiring a hospital stay — your doctor can order it directly from home.
If you may have access to for Part A home health, Part A pays first. Once Part A coverage ends, Part B can take over if you still need skilled care and remain homebound. The two programs work together, not against each other. Your home health agency handles the transition and bills the correct program.
What you pay for Part B home health care
If the home health agency is Medicare-approved and you meet all the requirements, you pay nothing for the skilled nursing and therapy visits themselves. Part B covers 100 percent of the cost. You do not pay a copay or coinsurance for home health services.
You may pay for other things: if your doctor orders medical equipment (a walker, hospital bed, oxygen concentrator), you typically pay 20 percent of the cost after you meet your Part B deductible. If you need personal care or housekeeping that Part B does not cover, you pay the full cost out of pocket or through another program.
If you have a Medigap or Medicare Advantage plan, check your plan documents to see whether it covers services Part B does not — some plans offer a small benefit for personal care or housekeeping, though this varies widely.
How to start Part B home health care
Talk to your doctor. Tell them you need help at home and ask whether they think you are homebound and need skilled nursing or therapy. If your doctor agrees, they will write an order for home health care and send it to a Medicare-approved agency. You can ask your doctor which agencies they work with, or you can search for one yourself on Medicare.gov — go to the Care Compare tool and select "Home Health Agencies" to find approved providers in your area.
Once you choose an agency, they will contact your doctor to confirm the order and schedule the first visit. The agency will also verify that you are homebound and meet Medicare's requirements. If you do not meet the homebound requirement, the agency will tell you before the first visit, and Part B will not pay.
If you are leaving the hospital, the hospital discharge planner can arrange home health for you before you go home. This is often the fastest route because the hospital coordinates with the agency and your doctor.
Frequently Asked Questions
Can I choose any home health agency, or does it have to be Medicare-approved?
It must be Medicare-approved for Part B to pay. You can choose from any approved agency in your area. Medicare.gov's Care Compare tool lists all approved agencies near you. If you choose an agency that is not approved, you will pay the full cost yourself.
What happens if I improve and no longer need home health care?
Your doctor or the home health agency will discharge you from services. Part B stops paying once skilled care ends. If you still need personal care or housekeeping, you will need to pay out of pocket, explore Medicaid, or check whether a long-term care insurance policy covers it.
Does Part B cover home health care if I live in an assisted living facility or nursing home?
No. Part B home health is only for people living in their own home or a family member's home. If you live in a facility, the facility is responsible for providing care, and Medicare covers it under different rules.
Can I get home health care without a hospital stay?
Yes. Part B covers home health ordered by your doctor without any hospital stay. Part A requires a three-day hospital stay first, but Part B does not. Your doctor can order Part B home health directly if you are homebound and need skilled care.
What if my doctor says I am not homebound but I still need help at home?
Part B will not pay. You would need to explore other options: Medicaid (if you meet income limits), a long-term care insurance policy, or paying a private home care agency out of pocket. Some communities also offer low-cost or sliding-scale home care programs through aging services agencies.