Medicare covers some in-home care, but not all of it, and the rules are strict about what counts

Medicare will pay for in-home care only if a doctor orders it for a medical reason, you are homebound, and a Medicare-approved agency provides it. The most common covered services are skilled nursing (wound care, injections, catheter management) and physical or occupational therapy after an injury or hospital stay. Medicare does not pay for help with daily tasks like bathing, dressing, or cooking unless those tasks are part of a skilled service a nurse or therapist is already providing. If you need ongoing personal care without a medical reason, you will pay out of pocket or look to Medicaid, which has different rules.

The two parts of Original Medicare handle in-home care differently. Part A covers it after a hospital stay, with a time limit and copays that start on day 21. Part B covers it without a hospital stay, as long as you are homebound and need skilled care, with no time limit but a 20 percent copay. Neither part covers personal care alone, and both require the care to come from a Medicare-approved agency.

Key Takeaways

  • Medicare Part A covers in-home care only after a hospital or skilled nursing facility stay of at least three days, and only for the first 60 days at home.
  • Medicare Part B covers in-home care ordered by your doctor when you are homebound, but only skilled services like nursing or therapy — not personal care or housekeeping.
  • You must use a Medicare-approved home health agency; care from a private caregiver or unlicensed worker is not covered.
  • Your doctor must document that you are homebound and that skilled care is medically necessary, or Medicare will deny the claim.
  • If you need long-term personal care, Medicaid may cover it in your state, but the rules and income limits differ from Medicare.

What Medicare Part A covers after a hospital stay

If you spent at least three consecutive days in a hospital and then go home, Medicare Part A may cover in-home care for up to 60 days. This is called home health care, and it is part of your hospital discharge plan. The care must be ordered by your doctor and provided by a Medicare-approved agency. Part A covers the full cost of the service with no copay for the first 20 days. From day 21 to day 60, you pay a copay (the amount changes each year) for each visit.

The catch is that Part A only covers skilled services — nursing care, physical therapy, occupational therapy, or speech therapy. If you need only a home health aide to help you bathe or dress, Part A will not pay for that aide unless a nurse is also visiting you for a skilled reason. Once your skilled need ends, the home health benefit ends, even if you still need help at home. Your doctor and the home health agency will work together to decide when you no longer need skilled care, and that is when Medicare stops paying.

What Medicare Part B covers without a hospital stay

If you did not have a may have access to hospital stay, Medicare Part B may still cover in-home care if your doctor orders it and you meet two conditions: you must be homebound (unable to leave home without help or great difficulty), and the care must be skilled (not just personal information). Homebound means you cannot go to a doctor's office or a store without a major effort or help from another person. Your doctor must document this in your medical record for Medicare to approve the claim.

Part B covers the same skilled services as Part A — nursing, physical therapy, occupational therapy, and speech therapy. You pay 20 percent of the Medicare-approved amount after you meet your annual deductible. Unlike Part A, there is no time limit on Part B coverage as long as your doctor continues to order it and you remain homebound. However, if you improve and no longer need skilled care, the benefit stops. Part B is often the route for people who need ongoing therapy or nursing care at home but did not have a recent hospital stay.

What is not covered, and what you pay out of pocket

Medicare does not cover personal care services — bathing, dressing, toileting, meal preparation, or housekeeping — unless a nurse or therapist is in your home for a skilled reason and those tasks are part of that visit. If you need someone to help you bathe every day but do not need nursing or therapy, Medicare will not pay. You would need to hire a private caregiver and pay the full cost yourself, or look into Medicaid if you may have access to in your state. Many people are surprised by this limit, because they assume that help with daily living is what Medicare covers.

Medicare also does not cover care from unlicensed workers or family members, even if they perform skilled tasks. The agency must be Medicare-approved, and the worker must be employed by that agency. If you hire a caregiver directly or use an agency that is not Medicare-approved, you pay the full cost and cannot bill Medicare. Some people hire private caregivers to fill the gaps — for example, a caregiver to help with bathing on days when the nurse is not visiting — and pay out of pocket for that care.

How to know if your in-home care will be covered

Before you leave the hospital or your doctor orders home care, ask whether the plan meets Medicare's rules. Your hospital discharge planner or your doctor's office should tell you whether the care is covered. You can also call Medicare at 1-800-MEDICARE to ask about a specific situation, though they cannot tell you whether your individual case will be approved — only your doctor and the home health agency can do that. It is worth asking these questions before you sign up for care, so you know what to expect.

The home health agency will verify your coverage before they start. They will check your Medicare may be able to access, confirm that your doctor's order is in the system, and tell you what your out-of-pocket cost will be. If the agency says Medicare will not cover the care, ask them why and ask your doctor whether the order can be changed to meet Medicare's rules. Sometimes a small change — like adding a skilled service or clarifying that you are homebound — can make the difference between coverage and no coverage.

What happens when Medicare coverage ends

Medicare coverage for in-home care ends when one of three things happens: your doctor says you no longer need skilled care, you improve enough that you are no longer homebound, or (for Part A) 60 days have passed since you left the hospital. When coverage ends, the home health agency must stop billing Medicare. If you still need care, you will have to pay out of pocket, move to a facility, or look into other programs. This can be a difficult transition, especially if you have grown used to having help at home.

Some people move to Medicaid coverage at this point. Medicaid is a joint federal and state program that covers long-term personal care in the home in many states, but the rules are different from Medicare. Medicaid has income and asset limits, and the definition of homebound is less strict. If you think you might may have access to, ask your doctor's office or the home health agency to refer you to your state Medicaid office or a social worker who can help you understand your options. The transition from Medicare to Medicaid can take time, so it is worth starting the conversation early.

Medicare Advantage and supplemental insurance

If you have a Medicare Advantage plan (Part C), your in-home care coverage may be different from Original Medicare. Some Advantage plans cover personal care services that Original Medicare does not, or they may have different copays or time limits. Check your plan's summary of coverage or call the plan directly to ask what in-home care is covered. This is an important question to ask when you are choosing a plan or reviewing your coverage each year.

If you have a Medigap (supplemental insurance) policy, it does not change what Medicare covers — it only helps pay your share of costs that Medicare already covers. Medigap will not pay for services Medicare does not cover, such as long-term personal care. However, some Medigap plans do cover the copays you owe for the first 20 days of Part A home health care, which can save you money. Check your Medigap policy documents or call your insurance company to see what in-home care costs it will help pay.

Frequently Asked Questions

Can Medicare pay for a live-in caregiver?

No. Medicare only pays for visits from a Medicare-approved agency, not for someone living in your home. If you need 24-hour care, you would need to hire and pay a private caregiver, use Medicaid if you may have access to in your state, or move to a facility like an assisted living home or nursing home.

What if my doctor says I need in-home care but Medicare denies it?

Ask your doctor or the home health agency why Medicare denied the claim. Common reasons are that the care is not skilled, you are not homebound, or the doctor's order was incomplete. Your doctor can resubmit the order with more detail, or you can file an appeal with Medicare. The home health agency can tell you how to appeal and what documents you will need.

Does Medicare pay for in-home care after surgery?

Yes, if you spent at least three days in the hospital before surgery. Medicare Part A will cover skilled in-home care for up to 60 days after discharge. If you had outpatient surgery and went home the same day, you would not may have access to for Part A coverage, but Part B might cover it if your doctor orders it and you are homebound.

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

Only if a nurse or therapist is also visiting you for a skilled reason, and the aide's help is part of that visit. If bathing is your only need, Medicare will not pay. You would need to hire a private caregiver or explore Medicaid coverage in your state.

How do I find a Medicare-approved home health agency?

Your doctor, hospital discharge planner, or social worker can refer you to agencies in your area. You can also search Medicare's official list of certified agencies at Medicare.gov or call 1-800-MEDICARE. Ask the agency to confirm they are Medicare-approved before you sign any paperwork.