Medicare does not pay for routine in-home caregiving, but it does cover some care-related services under specific conditions

Medicare will not pay a family member or hired caregiver to help you with daily tasks like bathing, dressing, cooking, or cleaning. Those services fall under custodial care, which Medicare does not cover. However, Medicare does pay for skilled nursing care and home health aide services when a doctor orders them as part of medical treatment — and those services can include help with personal care tasks as part of that treatment plan.

The difference matters because it determines what you pay and who can provide the care. If you need help because of a medical condition and a doctor has ordered home health services, Medicare may cover a nurse or aide to come to your home. If you need help because you cannot manage daily life on your own, you pay for that yourself or through Medicaid (a different program), long-term care insurance, or out of pocket.

Key Takeaways

  • Medicare covers skilled nursing and home health aide services only when ordered by a doctor as part of treatment for a medical condition, not for general daily help.
  • You must be homebound or have severe mobility limits, have received inpatient hospital care for at least three days, and be under a doctor's care plan for Medicare to cover home health services.
  • Medicaid (not Medicare) covers long-term custodial care in many states, but income and asset limits explore and vary by state.
  • If you do not meet Medicare's conditions, you can pay for caregiving out of pocket, use long-term care insurance if you have it, or explore Medicaid in your state.
  • A social worker or discharge planner at your hospital can tell you whether your situation qualifies for Medicare-covered home health and help arrange it.

When Medicare covers home health services

Medicare will pay for a nurse, physical therapist, or home health aide to visit your home if all of these are true: a doctor has ordered the services as part of a treatment plan; you are homebound or have severe difficulty leaving home; you have been an inpatient in a hospital for at least three consecutive days within the past 60 days; and you are still under a doctor's care. The services must be related to the condition that put you in the hospital or that your doctor is actively treating.

Common situations where Medicare covers home health include recovery from surgery, management of a wound that needs nursing care, physical therapy after a stroke or broken bone, and monitoring of conditions like heart failure or diabetes when skilled assessment is needed. A home health aide can help with bathing, dressing, and toileting as part of these services, but only because the aide is supporting the skilled care — not because you need help with those tasks alone.

Medicare covers the full cost of skilled nursing visits and home health aide visits with no copay, as long as the services are ordered by your doctor and provided by a Medicare-certified home health agency. Physical therapy, occupational therapy, and speech therapy visits are also covered. The agency must be certified by Medicare, so ask your hospital discharge planner or doctor to arrange services through an approved provider.

What Medicare does not cover

Medicare does not pay for someone to help you with activities of daily living — bathing, dressing, grooming, toileting, eating — unless that help is part of a skilled nursing plan. It does not pay for housekeeping, meal preparation, laundry, shopping, or transportation. It does not pay for a caregiver to stay with you for safety or companionship, even if you live alone and cannot manage alone.

Medicare also does not cover custodial care in assisted living facilities, memory care units, or nursing homes unless you are receiving skilled nursing or rehabilitation services. Once you no longer need skilled care, Medicare stops paying, even if you remain in the facility. Many people then turn to Medicaid, which does cover long-term custodial care in nursing homes and some assisted living settings, but only if your income and assets fall below your state's limits.

Medicaid coverage for caregiving and long-term care

Medicaid is a joint federal and state program that does cover custodial care and long-term services, including in-home caregiving, assisted living, and nursing home care. Unlike Medicare, Medicaid is based on income and assets, not on age or work history. Each state sets its own income limits, asset limits, and rules about what services it covers.

Some states offer Medicaid waiver programs that allow you to receive long-term care services at home instead of in a facility, which can include a paid caregiver. Other states cover in-home care through their standard Medicaid program. To find out what your state covers, contact your state Medicaid office or call 211 to be connected to a local benefits counselor who can explain your state's rules.

Medicaid has strict asset limits — in most states, you cannot have more than $2,000 in countable assets (though rules vary and some assets, like your home, do not count). If you have more than the limit, you may need to spend down assets before Medicaid will cover care. This is a complex area, and it is worth talking to an elder law attorney or a certified financial planner who specializes in Medicaid planning if you think you may need long-term care.

Paying for caregiving out of pocket

If you do not meet Medicare's conditions and do not may have access to for Medicaid, you can hire a caregiver privately and pay out of pocket. You can hire someone directly, use a home care agency, or ask family members to provide care (though family members cannot bill Medicare or Medicaid for that care). Costs vary widely depending on where you live, the caregiver's experience, and whether you need full-time or part-time help.

If you have long-term care insurance, check your policy to see what in-home caregiving it covers. Some policies cover a portion of the cost of a hired caregiver; others cover only facility-based care. Review your policy documents or call your insurance company to understand what you are may have access to to.

Some employers and unions offer long-term care insurance as a benefit, and some states have started offering state-run long-term care insurance programs. If you are considering buying long-term care insurance, it is typically less expensive the younger and healthier you are when you buy it.

How to arrange Medicare-covered home health services

If you are in the hospital or a rehabilitation facility, ask your discharge planner or social worker whether you meet the conditions for Medicare-covered home health. They can assess your situation and, if you may have access to, arrange services before you leave. If you are at home and your doctor thinks you need home health services, ask your doctor to order them. Your doctor will write an order, and you or your doctor can contact a Medicare-certified home health agency to begin services.

To find a Medicare-certified home health agency in your area, visit Medicare.gov and use the Care Compare tool, or call Medicare at 1-800-MEDICARE. You can choose which agency provides your care, and you have the right to change agencies if you are not satisfied. The agency will send a nurse to assess your needs, create a care plan with your doctor, and arrange visits.

Questions to ask your doctor or discharge planner

Before you leave the hospital or when you are discussing home care with your doctor, ask these questions: Do I meet Medicare's conditions for home health services? If so, what services will Medicare cover and for how long? Will I have any out-of-pocket costs? How often will a nurse or aide visit? What should I do if I need care after Medicare stops covering it? If I do not may have access to for Medicare, what other options are available to me?

If your doctor says you do not may have access to for Medicare-covered home health, ask why and whether the situation might change. Also ask whether your state's Medicaid program covers in-home care and how to learn about you may have access to. A social worker can often help you explore these options and connect you with local resources.

Frequently Asked Questions

Can Medicare pay a family member to be my caregiver?

No. Medicare does not pay family members for caregiving, even if they provide skilled nursing or personal care. If a family member is a licensed nurse and your doctor orders skilled nursing care, Medicare will pay a home health agency to send that nurse — but not if the nurse is a family member. Some state Medicaid programs do pay family members to provide care under waiver programs, so check with your state Medicaid office.

What if I need help but do not may have access to for Medicare home health?

You can hire a caregiver privately and pay out of pocket, use long-term care insurance if you have it, or explore whether you may have access to for Medicaid in your state. A social worker or benefits counselor can help you understand your options. Call 211 to reach a local counselor.

How long does Medicare cover home health services?

Medicare covers home health services as long as your doctor orders them and you continue to meet the conditions — you are homebound, under a doctor's care, and receiving skilled services. Once you no longer need skilled care, coverage stops. 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.

Does Medicare cover assisted living or memory care?

Medicare does not cover the cost of living in an assisted living facility or memory care unit. It covers only skilled nursing or rehabilitation services if you receive them in that setting. Medicaid covers long-term care in these settings in some states, but only if your income and assets meet your state's limits.

What is the difference between Medicare and Medicaid for caregiving?

Medicare is a federal program based on age and work history; it covers skilled medical services but not custodial care. Medicaid is a joint federal-state program based on income and assets; it covers long-term custodial care, including in-home caregiving and facility care, in most states. You may may have access to for both programs at the same time.