Medicare does not pay for a caregiver to help you with daily living tasks, but it may cover skilled nursing or therapy that includes some personal care
Medicare Part A and Part B do not cover a home health aide or personal care attendant who helps you bathe, dress, eat, or take medications. If you need that kind of help, you pay out of pocket, use Medicaid (if you meet income limits), or look into long-term care insurance or Veterans benefits if you served.
What Medicare does cover is skilled home health care — a nurse, physical therapist, or occupational therapist who comes to your home to treat a medical condition. If a skilled nurse or therapist is visiting you, Medicare may also cover a home health aide to help with bathing or dressing as part of that skilled care plan. The aide is covered only while you are receiving skilled services, and only for tasks related to your treatment.
Key Takeaways
- Medicare does not pay for a caregiver to help with cooking, cleaning, bathing, or dressing unless a doctor orders skilled home health care first.
- If you receive skilled nursing or therapy at home, Medicare may cover a home health aide for personal care tasks that support your treatment.
- Medicaid covers personal care attendants in most states, but you must meet income and asset limits that vary by state.
- Veterans may be able to use VA benefits or Aid and Attendance to pay for caregiving, which is separate from Medicare.
- Long-term care insurance, if you bought it before you needed care, may cover some or all of your caregiver costs.
When Medicare covers a home health aide
A home health aide can be covered by Medicare Part A or Part B only if a doctor orders home health services for a medical reason. The aide must be part of a plan of care that includes a skilled service — usually a nurse visit, physical therapy, occupational therapy, or speech therapy. The aide helps with personal care tasks that are tied to your treatment, such as bathing after surgery or helping you move safely if you are recovering from a fall.
To get this coverage, your doctor must order home health care, and a home health agency must assess you and create a care plan. Medicare will cover the aide's visits as long as you are homebound (meaning you cannot leave home without help or it would be medically unsafe) and you are still receiving skilled services. Once the skilled services end, the aide visits end too, even if you still need help with daily tasks.
The number of aide visits is not set in advance. It depends on what your care plan says you need. Some people receive aide visits several times a week; others receive them once a week or less often. Your doctor and the home health agency decide together.
What you pay for home health aide services
If Medicare covers your home health aide as part of a skilled care plan, you typically pay nothing for the aide visits themselves. You may have a copay for each visit under Part B, but many people with Part B do not pay a copay for home health services. Check your plan documents or call your Medicare plan to confirm.
If you need a caregiver for tasks that are not part of a skilled care plan — help with cooking, cleaning, shopping, or personal care when you are not receiving treatment — Medicare does not pay, and you pay the full cost out of pocket. Rates for private caregivers vary widely by region and the caregiver's training, but typically range from $15 to $30 per hour or more in urban areas.
Medicaid coverage for personal care attendants
Medicaid, the joint federal-state insurance program for people with low income, covers personal care attendants in most states. This is different from Medicare and does not require a doctor's order for skilled care. Medicaid will pay a caregiver to help you with bathing, dressing, eating, toileting, and other daily living tasks.
To use Medicaid for caregiving, you must meet your state's income and asset limits. These limits vary significantly — some states allow higher income, others are very restrictive. You can contact your state Medicaid office or use the Medicaid.gov website to find your state's rules. If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid typically pays for the personal care attendant.
Some states offer Medicaid waiver programs that let you stay at home with a caregiver instead of moving to a nursing home. These programs have waiting lists in many states, sometimes years long. Your state Medicaid office can tell you whether a waiver program exists in your state and how to get on the list.
Veterans benefits for caregiving
If you served in the military, you may be able to use VA benefits to pay for a caregiver. The VA offers two main programs: the Aid and Attendance benefit, which is a monthly payment you can use to hire a caregiver, and the Program of Comprehensive information for Family Caregivers, which provides training and support to a family member who is your primary caregiver.
The Aid and Attendance benefit is a monthly stipend added to your VA pension if you need help with daily living tasks. The amount varies based on your service history and whether you are married, but it is meant to help cover caregiver costs. You do not have to use it for a professional caregiver — you can use it to pay a family member or a hired aide.
To explore VA benefits, contact the VA at 1-800-827-1000 or visit your local VA office. The VA can tell you which programs you may be able to use and what documents you need.
Long-term care insurance and other payment options
If you bought a long-term care insurance policy before you needed care, it may cover some or all of your caregiver costs. These policies vary widely — some cover home care, some cover nursing home care, and some cover both. Check your policy documents to see what services are covered and what you must pay out of pocket.
If you do not have long-term care insurance and do not meet Medicaid or VA income limits, you will need to pay for a caregiver yourself. Some people use savings, ask family members to help, or hire a caregiver part-time to reduce costs. Others move closer to family or explore shared housing arrangements.
Some employers offer long-term care insurance as a benefit, and some states have started programs that let workers set aside money for future care costs. Ask your employer's benefits office whether either option is available to you.
How to request home health services from Medicare
If you think you need skilled home health care (which may include a home health aide), ask your doctor. Your doctor will need to order home health services and document that you are homebound and need skilled care. The doctor sends the order to a home health agency.
You can choose which home health agency provides your care, as long as it is Medicare-certified. Your doctor can recommend agencies, or you can search for Medicare-certified agencies in your area on Medicare.gov. Once you choose an agency, they will contact you to schedule an assessment visit.
During the assessment, a nurse or therapist will review your medical history, current medications, and what help you need. They will create a care plan that lists the skilled services (nursing, therapy) and any aide visits. The plan goes to your doctor for approval. Once approved, your care can begin.
Questions to ask your doctor and Medicare
Before you assume Medicare will not help, ask your doctor these questions: "Do I need skilled home health care?" "Would physical therapy, occupational therapy, or nursing visits help my recovery?" "If I receive skilled care, would a home health aide help me?" These questions help your doctor decide whether to order home health services.
If your doctor orders home health care, ask the home health agency: "How many aide visits will Medicare cover?" "Will I have a copay?" "How long will services last?" "What happens when skilled services end?" These questions help you understand what to expect and when your coverage will stop.
If you are denied home health services, you have the right to appeal. Ask your doctor or the home health agency for information about the appeal process.
Frequently Asked Questions
Can I hire my own caregiver and have Medicare pay them?
No. Medicare only pays a home health aide through a Medicare-certified home health agency, and only as part of a skilled care plan ordered by your doctor. You cannot hire a private caregiver and bill Medicare. If you hire a caregiver on your own, you pay them directly.
What if I need help but my doctor says I do not need skilled care?
If you do not meet Medicare's homebound requirement or do not need skilled services, Medicare will not cover a caregiver. You can explore Medicaid (if you meet income limits), Veterans benefits (if you served), or long-term care insurance. Otherwise, you pay out of pocket or ask family members to help.
Does Medicare cover a caregiver after I leave the hospital?
Medicare may cover home health services, including a home health aide, if your doctor orders them and you meet the homebound requirement. This is true whether you are recovering from a hospital stay or an illness at home. The coverage depends on your doctor's order, not on where you were before.
How long does Medicare cover a home health aide?
There is no set time limit. Coverage lasts as long as your doctor says you need skilled care and you remain homebound. Once your skilled services end — for example, when physical therapy is complete — aide visits end too. Your doctor and the home health agency review your progress regularly and adjust the plan as needed.
Can I use Medicare and Medicaid together to pay for a caregiver?
If you have both Medicare and Medicaid, Medicaid typically covers personal care attendants for daily living tasks, while Medicare covers a home health aide only as part of skilled care. Contact your state Medicaid office to learn what personal care services Medicaid will cover in your situation.