Medicare does cover home health care, but only under specific conditions
Medicare Part A and Part B together cover home health services when a doctor orders them and you meet the program's requirements. The key condition: you must be homebound, meaning leaving home is medically difficult or impossible without help. Medicare will not pay for general housekeeping, meal preparation, or personal care unless it is tied to a skilled service like physical therapy or wound care.
Home health coverage is different from home care agencies you hire privately. Medicare pays only for visits from nurses, therapists, and aides when they are performing skilled tasks — not for companionship, bathing, or help with daily activities unless a nurse or therapist is also in the home for a medical reason.
Key Takeaways
- Medicare covers home health only if a doctor orders it, you are homebound, and the care involves skilled nursing or therapy.
- Part A covers the full cost of home health visits with no copay when ordered by your doctor and provided by a Medicare-certified agency.
- You must use a Medicare-certified home health agency; private agencies or individual caregivers are not covered.
- Home health coverage ends when you no longer need skilled care or when your doctor determines you can leave home safely.
What counts as skilled care under Medicare
Skilled care means a nurse or therapist must perform the task because it requires professional training. Examples include wound dressing changes, catheter care, medication management, physical therapy after surgery, speech therapy, and occupational therapy. A nurse checking your blood pressure or adjusting your insulin is skilled care. A home health aide helping you bathe is not — unless a nurse is also in the home that day for a skilled reason.
The distinction matters because Medicare will not pay for unskilled personal care on its own. If you need help with bathing, dressing, or toileting but do not need nursing or therapy, Medicare does not cover it. You would need to pay out of pocket, use Medicaid if you may have access to, or arrange private care.
How to start home health through Medicare
Your doctor must order home health care and document that you are homebound. You cannot request it yourself or go directly to an agency. Your doctor fills out a home health referral form and sends it to a Medicare-certified agency. You can ask your doctor which agencies they work with, or you can call your local hospital discharge planner — they maintain lists of certified agencies in your area.
Once the referral reaches the agency, a nurse visits your home to assess your needs and create a care plan. This initial visit is covered by Medicare. The nurse then schedules follow-up visits based on what your doctor ordered. The whole process from referral to first skilled visit usually takes three to seven days.
What Medicare Part A and Part B each cover
Part A covers home health visits with no copay when the care is ordered by your doctor and provided by a Medicare-certified agency. This includes skilled nursing visits, physical therapy, occupational therapy, and speech therapy. Part A also covers medical equipment like oxygen, wheelchairs, and hospital beds if your doctor orders them as part of your home health plan.
Part B covers home health services if Part A has ended or does not explore to your situation. Under Part B, you pay 20 percent of the Medicare-approved amount for each visit after you have met your annual deductible. Most people with Part A coverage do not need to use Part B for home health, but it is available if your situation changes.
When Medicare stops paying for home health
Medicare coverage ends when your doctor determines you no longer need skilled care or when you are no longer homebound. If you improve enough to leave home safely or to manage your condition without nursing or therapy, the agency will discharge you. Your doctor can also end the order if your condition stabilizes.
Some people move from home health to outpatient therapy or to a skilled nursing facility. Others transition to private care or family support. The home health agency should tell you in advance when coverage is ending and discuss what comes next. If you disagree with the discharge decision, you can request a review through Medicare.
Common reasons Medicare denies home health coverage
The most common reason for denial is that the person is not homebound. Medicare defines homebound strictly: you must have a medical condition that makes leaving home difficult, and leaving must require supportive information or be medically contraindicated. If you can leave home with help from a cane or walker, or if you leave regularly for appointments or errands, Medicare may say you are not homebound.
Another reason is that the care ordered is not skilled. If your doctor orders home health only for bathing or meal preparation, Medicare will deny it because those are not skilled services. The order must include skilled nursing, therapy, or both. A third reason is using an agency that is not Medicare-certified. Always confirm the agency is certified before the first visit.
Supplemental and advantage plans and home health coverage
If you have a Medigap (supplemental) plan, it does not change what Medicare covers for home health — it only helps pay your copays and deductibles. Since Medicare Part A home health has no copay, Medigap does not add much value for this service.
If you have a Medicare Advantage plan, coverage rules may differ. Some Advantage plans cover additional home health services that Original Medicare does not, such as non-skilled personal care or homemaking services. Check your plan's summary of coverage or call the plan to ask what home health services are included. Advantage plans can also restrict which agencies you can use.
Frequently Asked Questions
Can I choose which home health agency Medicare sends?
Your doctor chooses the agency when they write the referral, but you can request a different Medicare-certified agency. Call your doctor's office and ask them to send the referral to the agency you prefer. If your doctor is not familiar with that agency, ask the agency to contact your doctor directly to confirm they work together.
Does Medicare pay for a live-in caregiver?
No. Medicare does not cover live-in caregivers or 24-hour care. It covers specific skilled visits ordered by your doctor. If you need round-the-clock care, you would need to pay privately, use Medicaid if you may have access to, or arrange family support alongside Medicare-covered visits.
What if I need home health but I am not homebound?
Medicare will not cover it. You would need to pay out of pocket for a private home care agency, use Medicaid if you may have access to, or explore outpatient therapy at a clinic or hospital. Some people use a combination: Medicare-covered skilled visits plus privately paid personal care.
How long does Medicare home health coverage last?
There is no set time limit. Coverage continues as long as your doctor orders it and you remain homebound and need skilled care. Some people receive home health for weeks, others for months. Your doctor and the agency review your progress regularly and adjust the plan or end coverage when you improve.
Do I need prior authorization from Medicare before home health starts?
No. Your doctor's order is sufficient. The Medicare-certified agency handles all paperwork with Medicare. You do not need to contact Medicare yourself or get approval in advance. The agency will verify your coverage when you enroll.