Medicare covers some home care services, but not all of them, and the rules depend on whether you need skilled nursing or just help with daily tasks.

Medicare Part A pays for skilled home health care — nursing visits, physical therapy, occupational therapy, and speech therapy — when a doctor orders it and you meet specific conditions. You must be homebound or have difficulty leaving home, have a medical reason for the care, and be under a doctor's active care. Medicare does not pay for help with bathing, dressing, meals, or housekeeping unless those services are part of a skilled nursing visit.

If you need help with daily living tasks but not skilled care, Medicare does not cover it. Many seniors pay out of pocket for this type of care, or they turn to Medicaid (which varies by state), long-term care insurance, or family members. Understanding the difference between what Medicare covers and what you will pay for yourself is the first step in planning home care.

Key Takeaways

  • Medicare Part A covers skilled nursing, physical therapy, and speech therapy at home when ordered by a doctor and you are homebound or have a medical reason for the care.
  • Medicare does not cover non-skilled help with bathing, dressing, meals, or housekeeping, even if you live alone and cannot do these tasks yourself.
  • You must be under a doctor's active care and the home health agency must be Medicare-approved for Medicare to pay.
  • Medicaid, long-term care insurance, and out-of-pocket payment are the main ways seniors cover non-skilled home care that Medicare does not pay for.
  • Your doctor's order and medical records determine what Medicare will cover, so be clear with your doctor about what help you need at home.

What Medicare Part A Covers for Home Care

Medicare Part A covers skilled home health services when a doctor orders them and you meet the conditions. Skilled services include nursing care (wound care, medication management, catheter care), physical therapy, occupational therapy, and speech-language pathology. The home health agency must be Medicare-approved, and a nurse or therapist must visit your home to provide the care.

You do not pay a copay for skilled home health services covered by Medicare Part A, but you may have to pay a copay for any equipment the agency provides, such as a walker or hospital bed. If you need home health care after a hospital stay of at least three days, Medicare is more likely to cover it. The agency will bill Medicare directly, and you should receive a notice explaining what is covered.

The care must be ordered by your doctor and documented as medically necessary. Your doctor will write an order, and the home health agency will submit it to Medicare for approval. If Medicare denies the order, the agency must tell you in writing and explain why.

What Medicare Does Not Cover at Home

Medicare Part A does not pay for non-skilled personal care — help with bathing, dressing, grooming, toileting, or eating — unless a nurse is in your home for a skilled reason and provides that help as part of the skilled visit. It also does not cover housekeeping, meal preparation, laundry, or shopping, even if you cannot do these tasks yourself.

This is one of the biggest gaps in Medicare coverage. Many seniors need help with daily living but do not need skilled nursing, and Medicare will not pay for that help. If you live alone and cannot bathe or dress yourself, Medicare does not cover a home aide to help you. You will have to find another way to pay for this care.

How to Know If You may have access to for Medicare Home Health Care

You may have access to for Medicare home health care if you meet all of these conditions: your doctor orders it, you are homebound (meaning you cannot leave home without help or it is medically contraindicated), you have a medical reason for the care, and you are under your doctor's active care. Homebound does not mean you never leave your home — it means leaving is difficult or unsafe without help.

Your doctor must write an order for home health care and state the medical reason. Common reasons include recovery from surgery, wound care, physical therapy after a fall, management of a chronic condition like heart failure, or monitoring after a hospital stay. The home health agency will review your doctor's order and your medical records to decide whether Medicare will cover the care.

If you are not homebound or your condition does not require skilled care, Medicare will not cover home health services. You can still hire a home care aide privately, but you will pay the full cost yourself.

How to Arrange Medicare-Covered Home Care

Start by talking to your doctor about whether you need home health care. Tell your doctor what tasks you are having trouble with at home — walking, bathing, managing medications, wound care — and ask whether home health services would help. Your doctor can write an order for home health care and send it to a Medicare-approved agency.

You can choose which Medicare-approved home health agency provides your care. Ask your doctor for a recommendation, or search for agencies in your area on Medicare.gov. Call the agency and tell them your doctor has ordered home health care. The agency will contact your doctor to get the order and your medical records, then schedule your first visit.

The agency will send a nurse to your home to assess your needs and create a care plan. This visit is covered by Medicare. After that, the agency will schedule regular visits based on what your doctor ordered. You should receive a written notice explaining what services are covered and what you may have to pay.

What You Pay for Home Health Care

If Medicare covers your home health care, you do not pay a copay for the nursing or therapy visits themselves. However, you may have to pay a copay for medical equipment the agency provides, such as a wheelchair, walker, or hospital bed. The copay is usually 20 percent of the cost of the equipment.

If you have a supplemental insurance plan (Medigap) or Medicare Advantage, your out-of-pocket costs may be lower. Check your plan documents or call your insurance company to find out what home health services are covered and what you will pay.

If Medicare denies coverage for home health care, the agency must tell you in writing before they stop providing care. You have the right to appeal the denial. If you disagree with the decision, you can ask for a review.

Alternatives When Medicare Does Not Cover Home Care

Medicaid covers non-skilled personal care in many states, but rules vary widely. Some states cover home care aides for seniors who may have access to based on income and assets. Contact your state Medicaid office to learn what is available where you live.

Long-term care insurance covers home care if you bought a policy before you needed care. The policy will specify what services are covered and how much you receive per day. If you have this insurance, contact your insurance company to file a claim.

Out-of-pocket payment is how most seniors pay for non-skilled home care. Home care aides cost between $20 and $30 per hour on average, though prices vary by location and the agency. You can hire an aide through an agency, which handles taxes and background checks, or hire someone privately.

Family and friends provide unpaid care for many seniors. If family members help you with bathing, dressing, or meals, that is not covered by Medicare, but it is a real option many people use.

Questions to Ask Your Doctor About Home Care

Before you leave your doctor's office, ask these questions: Do I need home health care? What specific services do I need? How often should I receive visits? How long will I need this care? Will Medicare cover it? What should I do if I need help with tasks Medicare does not cover, like bathing or meals?

Write down your doctor's answers so you have them when you call a home health agency. If your doctor is unsure whether Medicare will cover your care, ask the doctor to write the order anyway and let the agency and Medicare decide. The agency can tell you whether Medicare will cover it before care begins.

Frequently Asked Questions

Will Medicare pay for a home aide to help me bathe and dress?

No, Medicare does not cover non-skilled personal care like bathing or dressing. If you need this help, you will have to pay for it yourself, use Medicaid if your state covers it, or rely on family members. A home health aide can help with these tasks, but you will pay the full cost out of pocket.

Do I have to go to a nursing home if Medicare does not cover home care?

No. You can hire a home care aide privately, use Medicaid if you may have access to, or ask family members to help. Many seniors stay at home and pay for non-skilled care themselves. Talk to your doctor and a social worker about what options fit your situation and budget.

What happens if Medicare stops covering my home health care?

The home health agency must tell you in writing before they stop visits. You have the right to appeal the decision if you disagree. You can also ask your doctor to write a new order if your condition changes. If Medicare will not cover it, you can hire a home care aide privately or explore other payment options.

Can I choose which home health agency provides my care?

Yes. You can ask your doctor for a recommendation or search Medicare.gov for agencies in your area. Call the agency and tell them your doctor has ordered home health care. You are not required to use the first agency that contacts you.

Does Medicare Advantage cover home health care differently than Original Medicare?

Medicare Advantage plans must cover the same home health services as Original Medicare, but your out-of-pocket costs may differ. Check your plan documents or call your plan to find out what home health services are covered and what you will pay.