Medicare covers some home care services, but not all of them, and the rules depend on whether you need skilled nursing or personal care
Medicare Part A and Part B together pay for skilled home health care — nursing visits, physical therapy, occupational therapy, and speech therapy delivered at home by a Medicare-certified agency. Medicare does not pay for custodial care — help with bathing, dressing, toileting, and meals — unless it is part of a skilled service a nurse or therapist is already providing. If you need only personal care and no skilled services, Medicare will not cover it, and you will need to pay out of pocket or look into Medicaid.
The difference matters because it determines your costs and what you can actually get paid for. A nurse changing a wound dressing is skilled care. A home health aide helping you bathe is custodial care. If a nurse visits to check your wound and the aide comes on the same day to help you bathe, Medicare pays for the nurse but not the aide.
Key Takeaways
- Medicare Part A covers skilled home health care when you are homebound and a doctor orders it, with no copay for the service itself, though you may pay a small copay per visit for certain supplies.
- Skilled care includes nursing, physical therapy, occupational therapy, and speech therapy, but not personal care like bathing or dressing unless a therapist is teaching you how to do it yourself.
- You must be homebound — unable to leave home without considerable effort or help — and the care must be ordered by your doctor and provided by a Medicare-certified agency.
- If you need only personal care or custodial help, Medicare does not cover it; Medicaid may cover it in your state, or you pay privately or hire someone independently.
- Medicare Advantage plans (Part C) may cover additional services like transportation or meal delivery, so check your plan documents to see what your specific plan includes.
What Medicare Part A Covers at Home
Medicare Part A pays for skilled home health services when three conditions are met: your doctor must order the care, you must be homebound, and the care must come from a Medicare-certified agency. Homebound means you cannot leave your home without considerable effort or help — not that you never leave, but that leaving requires information or creates a medical risk. If you can get to a doctor's office or grocery store on your own, you may not meet the homebound requirement.
The services Medicare covers include skilled nursing (wound care, medication management, monitoring after hospitalization), physical therapy (regaining strength and mobility after surgery or stroke), occupational therapy (relearning daily tasks), and speech therapy (swallowing or speech problems). A home health aide can come with these services, but only to help with the skilled task — for example, the aide might help you bathe before the physical therapist arrives, but only because the therapist needs you clean to assess your skin or mobility. The aide's time is not billed separately to Medicare.
You pay nothing for the skilled services themselves under Part A. You may owe a small copay — usually $0 to $20 per visit — for certain medical supplies like wound dressings or diabetic testing supplies, depending on your plan. If you need equipment like a walker or hospital bed, Medicare Part B may cover it as durable medical equipment, subject to the Part B deductible and 20% coinsurance.
When Medicare Part B Covers Home Services
Medicare Part B covers home health services in situations where Part A does not explore — usually when you are not homebound or when you do not may have access to for Part A coverage. Part B also covers certain services that Part A does not, such as mental health counseling at home (up to 42 visits per year) and some preventive services like flu shots or blood pressure checks during a home visit.
If you have both Part A and Part B, Part A is primary for home health services, meaning it pays first. You would use Part B only if Part A coverage has ended or does not explore. Part B coverage of home services is less common than Part A, and the rules are narrower, so ask your doctor or the home health agency which part of Medicare will cover your care.
What Medicare Does Not Cover at Home
Medicare does not pay for custodial care — the day-to-day help that makes living at home possible for many seniors. This includes bathing, dressing, toileting, meal preparation, housekeeping, laundry, and grocery shopping. It also does not cover 24-hour care, live-in companions, or ongoing personal care aides unless they are part of a skilled nursing visit.
Medicare also does not cover services that are not medically necessary, such as physical therapy for general fitness or occupational therapy to help you organize your home. It does not cover services from family members or people who are not employed by a Medicare-certified agency, even if a nurse supervises them. If you hire someone privately and pay them yourself, Medicare will not reimburse you.
Homemaker services — cleaning, laundry, meal prep — are not covered, even if you are homebound and receiving skilled care. Some home health agencies offer these services for an additional private fee, but Medicare will not pay for them.
How to Start Medicare Home Health Care
Your doctor must order home health care and document that you are homebound and need skilled services. You cannot order it yourself. Talk to your doctor about whether home care makes sense for your situation — after hospitalization, after a fall, or if you have a chronic condition that requires ongoing monitoring or therapy.
Once your doctor writes the order, they will send it to a Medicare-certified home health agency. You can ask your doctor which agencies they work with, or you can search for agencies in your area on Medicare.gov under "Care Compare." When the agency calls to schedule your first visit, ask them to confirm that they are Medicare-certified and which services Medicare will cover in your case.
The agency will send a nurse to assess your needs and create a care plan. This visit is covered by Medicare. The nurse will explain what services are covered, what you will pay, and how often the therapists or nurses will visit. If you disagree with the plan or think you need more visits, you can ask your doctor to request additional services, and the agency will submit the request to Medicare for review.
Medicare Advantage Plans and Home Care Coverage
If you have a Medicare Advantage plan (Part C), your coverage of home health services is the same as Original Medicare — skilled care is covered, custodial care is not. However, many Advantage plans offer additional benefits that Original Medicare does not, such as transportation to medical appointments, meal delivery, or in-home safety assessments. These vary by plan and by year.
Check your plan's Summary of Benefits or call the plan directly to ask what home services are covered beyond the standard Medicare benefits. Some plans cover a certain number of non-medical home support visits per year, which can help with light housekeeping or meal prep. Others do not. Knowing what your specific plan covers can help you plan for the services you will need to pay for privately.
Paying for Custodial Care and Personal information
If you need personal care or custodial help that Medicare does not cover, you have several options. Medicaid covers custodial care and personal care aides in most states, but you must meet income and asset limits that vary by state. Some states cover these services through a home and community-based waiver program, which may have a waiting list. Contact your state Medicaid office to learn what is available in your area.
You can also pay privately for home care services. Home care agencies that are not Medicare-certified can provide personal care, housekeeping, and companionship. Costs vary widely by region and by the type of care — typically $20 to $35 per hour for personal care aides and $15 to $25 per hour for housekeeping. Some people hire caregivers independently, which may be less expensive but requires you to handle payroll taxes and employment responsibilities.
Long-term care insurance, if you have it, may cover custodial care at home. Check your policy to see what services and daily amounts are covered. If you do not have insurance and cannot afford private care, ask the home health agency social worker about community resources, senior centers, or volunteer programs that may help.
Questions to Ask Your Doctor and Home Health Agency
Before home care begins, ask your doctor: "Will Medicare cover the home care you are ordering?" and "How long do you expect I will need these services?" This helps you understand whether coverage is temporary (after hospitalization) or ongoing (for a chronic condition). Ask whether the care plan includes a goal — for example, regaining strength to walk safely — because Medicare expects home health to have an end point, not to continue indefinitely.
When the home health agency calls, ask: "Is your agency Medicare-certified?" "Which services will Medicare pay for?" "What will I pay out of pocket?" and "How often will nurses or therapists visit?" Ask for a written copy of your care plan and the agency's contact information for questions or concerns. If you feel the number of visits is not enough, ask how to request more visits through your doctor.
Frequently Asked Questions
Will Medicare pay for a home health aide to help me bathe and dress every day?
No, not unless a nurse or therapist is also visiting to provide skilled care. If a nurse is checking your wound or a therapist is working with you, an aide can help with personal care on those days. For daily personal care without skilled services, you would need to pay privately or explore Medicaid coverage in your state.
What happens when my home health care ends?
Medicare home health care ends when your doctor determines you no longer need skilled services or when you no longer meet the homebound requirement. The agency must give you notice before discharge. If you still need help at home, ask the social worker about community resources, adult day programs, or how to transition to private pay care.
Can I choose which home health agency Medicare sends?
Yes. Your doctor can send the order to any Medicare-certified agency you choose. You can search for agencies on Medicare.gov or ask your doctor which ones they recommend. If you are unhappy with an agency, you can ask your doctor to switch to a different one.
Does Medicare pay for home care if I live in assisted living or a nursing home?
No. Medicare home health care is for people living in their own homes. If you live in a facility, the facility is responsible for providing care, and Medicare pays the facility directly, not a separate home health agency.
Will Medicare pay for someone to help me with housekeeping or yard work?
No. Medicare does not cover housekeeping, yard work, or other non-medical services. Some home care agencies offer these services for a private fee, or you can hire someone independently and pay them yourself.