Medicare does cover home health care, but only under specific conditions
Medicare Part A and Part B together cover skilled home health services when a doctor orders them and you meet certain requirements. The program pays for nursing visits, physical therapy, occupational therapy, speech therapy, and medical social work — but not for help with daily tasks like bathing, dressing, or cooking unless those services are part of a skilled care plan. You must be homebound (unable to leave home without considerable effort), have a doctor's order for care, and receive services from a Medicare-certified agency. The coverage is free after you meet your Part A deductible, with no copayment for the visits themselves.
Key Takeaways
- Medicare covers skilled nursing and therapy services ordered by a doctor, but not personal care or housekeeping unless tied to a medical treatment plan.
- You must be homebound and have a doctor's written order for home health services before any visits begin.
- Services must come from a Medicare-certified home health agency; Medicare will not pay for independent caregivers or unlicensed providers.
- Coverage is free after your Part A deductible, but the length of coverage depends on your medical need and can end if your condition improves.
What Medicare covers and what it does not
Medicare covers skilled nursing care — wound care, injections, catheter management, and monitoring of medical conditions. It covers physical therapy to regain strength or mobility after surgery or illness, occupational therapy to relearn daily tasks, and speech therapy for swallowing or communication problems. It also covers medical social work to help you understand your condition and find community resources.
Medicare does not cover custodial care — bathing, dressing, toileting, or meal preparation — unless a nurse or therapist is teaching you how to do these tasks as part of recovery from an acute illness or injury. It does not cover housekeeping, yard work, or shopping. It does not cover 24-hour care or live-in companions. If you need only personal care and no skilled services, Medicare will not pay, and you will need to look at Medicaid, private pay, or long-term care insurance.
The homebound requirement and doctor's order
To receive Medicare home health services, you must be homebound — meaning leaving home requires considerable and taxing effort, or is medically contraindicated. You do not have to be bedridden. A person recovering from hip surgery who can walk with a walker but cannot safely navigate stairs or travel to a clinic counts as homebound. Someone with severe arthritis who can leave home but only with great pain and difficulty may also may have access to. The information is made by the home health agency and the doctor, not by Medicare directly.
A doctor must order home health services in writing before the first visit. The doctor states what services are needed, how often, and for how long. The home health agency uses this order to set up your care plan. If your doctor has not ordered home health care, you can ask them to do so — bring up the conversation at your next visit or call their office. If your primary care doctor is unsure whether you may have access to, a home health agency can sometimes help by discussing your situation with the doctor.
How to start home health services
The most common path is through your hospital or rehabilitation facility. If you are being discharged after a hospital stay or skilled nursing facility stay, the discharge planner will discuss home health with you and can arrange a referral to a Medicare-certified agency. You do not have to use the agency they suggest — you can choose any Medicare-certified agency in your area.
If you are not in a hospital or facility, ask your doctor to order home health services. Your doctor can refer you to a specific agency, or you can find one yourself. To confirm an agency is Medicare-certified, search the Medicare Care Compare tool on Medicare.gov or call 1-800-MEDICARE. Once you choose an agency, they will contact your doctor to get the written order, schedule an intake visit, and begin care. The intake usually happens within a few days.
There is no cost to you to start services — no process fee, no enrollment process. The agency handles all the paperwork with Medicare. You will need to show your Medicare card at the first visit.
How long coverage lasts and when it ends
Medicare home health coverage is not a set number of visits. Instead, it continues as long as your doctor certifies that skilled care is medically necessary and you remain homebound. The home health agency reviews your progress every 60 days and the doctor recertifies the need. If you improve and no longer need skilled services, or if you become able to leave home safely, coverage ends.
Some people receive home health for a few weeks after surgery. Others receive it for months if they have a chronic condition that requires ongoing skilled nursing. If your condition worsens and you need 24-hour care or inpatient treatment, you would transition to a hospital or facility instead. If coverage ends but you still need personal care, you would need to pay out of pocket, use Medicaid if you may have access to, or explore other options like adult day programs or assisted living.
What happens if your doctor will not order home health
If your doctor believes home health is not medically necessary, they may decline to order it. This happens when the doctor thinks your condition does not require skilled nursing or therapy, or that you can recover safely without it. You have the right to disagree and ask for a second opinion from another doctor. Some people find that a different doctor — such as a geriatrician or a specialist in their condition — is more willing to order home health.
You can also ask your doctor to explain in writing why they believe home health is not needed. This explanation can be useful if you later want to appeal a Medicare denial or seek care through another program. If cost is a concern for your doctor (though it should not be), remind them that Medicare covers the full cost of skilled home health services, so there is no financial barrier to ordering it.
Medicare Advantage and home health coverage
If you have a Medicare Advantage plan (Part C), your coverage for home health may differ from Original Medicare. Most Medicare Advantage plans cover home health services, but the rules about which agencies you can use, how many visits you get, and what you pay out of pocket vary by plan. Some plans require prior authorization before home health begins. Others limit you to agencies in their network.
Check your Medicare Advantage plan documents or call the plan directly to understand your home health coverage before you need it. If you are thinking about switching plans during open enrollment, home health coverage should be one of the factors you consider, especially if you have a chronic condition or expect to need care soon.
Frequently Asked Questions
Will Medicare pay for a live-in caregiver or 24-hour care at home?
No. Medicare covers skilled nursing and therapy visits, not round-the-clock personal care. If you need 24-hour supervision or information, you would need to pay privately, use Medicaid if you may have access to, or move to an assisted living facility or nursing home where Medicare or Medicaid would cover some costs.
Can I choose which home health agency Medicare sends?
Yes. You can choose any Medicare-certified agency. If your hospital or doctor suggests one, you are not required to use it. Search Medicare Care Compare on Medicare.gov to see which agencies serve your area and compare their ratings and inspection history.
What if I need home health but my doctor says I am not homebound?
The homebound information is made by the home health agency and your doctor together, not by you alone. If you believe you meet the definition — leaving home requires considerable effort or is medically unsafe — ask your doctor to reconsider, or ask the home health agency to discuss it with your doctor. You can also seek a second opinion from another doctor.
Does Medicare pay for physical therapy at home if I just want to stay fit?
No. Medicare covers therapy only when it is ordered by a doctor to treat a specific medical condition or help you recover from an acute illness or injury. Therapy for general fitness or wellness is not covered, even if you are homebound.
What happens to my home health coverage if I go to the hospital?
Your home health services pause while you are in the hospital. When you are discharged, your doctor can restart the home health order if you still need skilled care and remain homebound. The home health agency will contact you to resume visits, usually within a few days of discharge.