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 will pay for skilled home health care — nursing visits, physical therapy, occupational therapy, and speech therapy delivered at home — if a doctor orders it, you are homebound or mostly homebound, and you meet specific medical conditions. Medicare does not pay for custodial care or personal care — help with bathing, dressing, toileting, or housekeeping — even if you need it badly. The difference matters because skilled care is medically necessary treatment; personal care is support with daily living. If you need both, Medicare covers the skilled part and you pay out of pocket for the rest, or Medicaid covers it if you may have access to.

The coverage also depends on where you receive care. If you are in a hospital or skilled nursing facility first, Medicare may cover home health visits for a limited time after discharge. If you go straight home without a hospital stay, the rules are stricter. Understanding which services are covered and which are not helps you plan what to pay for and when to look for other funding sources.

Key Takeaways

  • Medicare Part A covers skilled home health care — nursing, therapy, and medical equipment — when ordered by a doctor and delivered by a Medicare-certified agency.
  • You must be homebound or mostly homebound, meaning leaving home is difficult and requires help or medical risk.
  • Medicare does not cover personal care like bathing, dressing, or housekeeping, even if you live alone and cannot do these tasks.
  • If you need both skilled care and personal care, you may need to pay privately for personal care or look into Medicaid coverage in your state.
  • Home health coverage is temporary — it lasts as long as the skilled need exists, typically weeks to a few months, not indefinitely.

What Medicare Part A Covers at Home

Medicare Part A covers skilled nursing visits, which include wound care, catheter management, injections, and monitoring of medical conditions. A nurse visits your home to perform or teach these tasks. Physical therapy, occupational therapy, and speech-language pathology are also covered when ordered by your doctor and delivered by a Medicare-certified home health agency.

Medicare also pays for medical equipment and supplies — hospital beds, wheelchairs, walkers, oxygen, diabetic supplies, and wound dressings — when prescribed by your doctor and rented or purchased through a Medicare-approved supplier. Home health aides may visit to help with personal hygiene and activities of daily living, but only if a nurse is also providing skilled care in the home. The aide's visits must be tied to the skilled nursing plan; they cannot be the only service you receive.

You do not pay a copay or coinsurance for home health services covered by Part A. However, you are responsible for 20 percent of the cost of durable medical equipment after you meet your Part B deductible.

The Homebound Requirement

To receive Medicare home health care, you must be homebound or mostly homebound. This means leaving your home is difficult, requires help, or poses a medical risk. You do not have to be completely unable to leave — you can attend medical appointments or go to religious services occasionally — but your primary residence must be your home, and leaving it must require significant effort or information.

A doctor must certify that you are homebound when ordering home health care. The certification is part of the home health plan of care. If you are able to leave home regularly without help or medical risk, Medicare will not cover home health services, even if you have a serious medical condition.

What Medicare Does Not Cover

Medicare does not pay for custodial care or personal care — help with bathing, dressing, grooming, toileting, eating, or transferring in and out of bed. These are activities of daily living, not medical treatment. If personal care is the only service you need, Medicare will not cover it. If you need both skilled care and personal care, Medicare pays only for the skilled part.

Housekeeping, meal preparation, laundry, and shopping are also not covered. Neither is respite care — temporary care to give your family caregiver a break. Homemaker services, yard work, and home modifications are not covered either. If you live alone and need help with these tasks, you will need to pay privately, hire someone independently, or look into Medicaid or local aging services in your state.

Ongoing personal care — for example, a home health aide who visits five days a week indefinitely to help you bathe and dress — is not a Medicare benefit. If you need long-term personal care support, Medicaid may cover it in your state through a home and community-based services waiver, but rules vary widely by state.

How to Start Home Health Care Through Medicare

Your doctor must order home health care and refer you to a Medicare-certified home health agency. You cannot refer yourself. The doctor writes an order that includes your diagnosis, the skilled services you need, how often you need them, and certification that you are homebound. The home health agency then contacts you to schedule an initial assessment.

When the agency visits, a nurse will evaluate your medical condition, create a plan of care, and arrange for the specific services — nursing, therapy, or aide visits — that Medicare will cover. The agency bills Medicare directly. You do not submit a claim yourself. The agency must be Medicare-certified; if it is not, Medicare will not pay.

If you are leaving a hospital or skilled nursing facility, the discharge planner will often help arrange home health care before you go home. If you are at home and your doctor thinks you need home health services, ask your doctor to place the referral with a Medicare-certified agency in your area. You can ask for a specific agency by name, or your doctor can choose one.

How Long Medicare Covers Home Health Care

Medicare covers home health care for as long as you have a skilled medical need and are homebound. This is not indefinite. Coverage typically lasts weeks to a few months, depending on your condition and recovery. Once you no longer need skilled care — for example, your wound has healed, your therapy goals are met, or your condition has stabilized — the home health services end.

Your home health agency will reassess your progress regularly. If you improve and no longer need skilled services, the agency will discharge you from home health care. If your condition changes and you need more care, the agency can increase visits or add services within the plan of care. If you need ongoing personal care after skilled services end, you will need to arrange and pay for that separately or look into Medicaid or local programs.

Medicare Advantage and Home Health Coverage

If you have a Medicare Advantage plan (Part C), home health coverage works differently than Original Medicare. Medicare Advantage plans must cover the same home health services that Original Medicare covers, but they may have different rules about which agencies you can use, how many visits you get, or what you pay out of pocket.

Some Medicare Advantage plans cover additional services that Original Medicare does not — such as some personal care or homemaker services — as a supplemental benefit. Check your plan's coverage documents or call your plan to find out what home health services are covered and whether there are limits on visits or copays. If you are thinking about switching plans, home health coverage is an important factor to compare.

Paying for Personal Care and Long-Term Support

If you need personal care — bathing, dressing, toileting, or meal preparation — Medicare will not pay. You have several options. You can hire and pay a home care worker privately, which costs between $20 and $30 per hour on average, though rates vary by location and agency. You can ask family members to help. You can look into Medicaid, which covers personal care in most states through home and community-based services waivers, though may be able to access rules are strict and vary by state.

Some states offer programs for older adults and people with disabilities that help pay for personal care or housekeeping services. Contact your local Area Agency on Aging to learn what programs are available in your state. Long-term care insurance, if you have it, may also cover personal care at home. Veterans may be covered through the VA Aid and Attendance benefit. Exploring these options before you urgently need care gives you time to understand costs and plan.

Frequently Asked Questions

Can I get home health care if I have never been in a hospital?

Yes, but the rules are stricter. Your doctor must order home health care, certify that you are homebound, and document a skilled medical need. You do not have to have a recent hospital or nursing facility stay. However, if you do come from a hospital or skilled nursing facility, Medicare is more likely to approve home health services because the medical need is clearly documented.

What if I need help with bathing but I am also recovering from surgery?

Medicare will cover nursing care related to your surgery recovery — wound care, monitoring, or medication management — and a home health aide can help with bathing as part of the skilled care plan. Once your surgical recovery is complete and you no longer need skilled nursing, the aide visits will stop. If you still need help with bathing after that, you will need to pay privately or look into Medicaid.

Does Medicare pay for a live-in caregiver?

No. Medicare does not cover live-in caregivers or ongoing personal care. If you need 24-hour care, you will need to pay privately, hire someone independently, or explore Medicaid coverage in your state. Some people combine Medicare-covered home health visits with privately paid personal care to meet their needs.

Can I choose which home health agency provides my care?

Yes. Your doctor can refer you to a specific Medicare-certified agency, or you can ask your doctor to refer you to an agency you choose. If you have a Medicare Advantage plan, check whether the agency is in your plan's network. You can also change agencies if you are unhappy with the service, though you will need your doctor to place a new referral.

What happens if I improve and no longer need home health care?

The home health agency will discharge you from services. If you still need personal care or support at home, you will need to arrange and pay for it privately, or look into Medicaid or local aging services programs. Your doctor can always place a new home health referral later if your condition changes and you develop a new skilled medical need.