Medicare's coverage for in-home caregivers is limited and depends on whether you need skilled nursing or personal care
Medicare Part A and Part B cover some in-home care, but not the kind most people think of when they say "caregiver." Medicare will pay for a nurse or therapist to visit your home if a doctor orders it as part of your recovery from an illness or surgery. Medicare does not pay for someone to help you bathe, dress, take medication reminders, or do housework — even if you cannot do these things alone. That kind of personal care is called custodial care, and it is not covered by Original Medicare, Medicare Advantage, or Medigap plans.
Understanding the difference between what Medicare covers and what you pay for yourself is the first step to planning for in-home help. Many people find they need both: skilled care that Medicare covers for a time, and personal care they arrange and pay for separately.
Key Takeaways
- Medicare Part A covers up to 100 days of skilled nursing care at home after a hospital stay of at least three days, with you paying nothing for the first 20 days and a daily copay for days 21 to 100.
- Medicare Part B covers physical therapy, occupational therapy, and speech therapy at home if ordered by your doctor, with you paying 20 percent of the cost after you meet your deductible.
- Medicare does not cover personal care such as bathing, dressing, meal preparation, or medication reminders, no matter how much help you need.
- Medicaid, not Medicare, is the program that pays for long-term custodial care at home in most states, though rules vary widely by location.
- Many people use a combination of Medicare-covered skilled visits and out-of-pocket payment for personal care hours.
What Medicare Part A covers: skilled nursing and rehabilitation at home
Medicare Part A pays for a registered nurse or licensed practical nurse to visit your home and provide skilled nursing care. This includes wound care, injections, catheter management, and monitoring for complications after surgery or hospitalization. Part A also covers physical therapy, occupational therapy, and speech therapy ordered by your doctor as part of your recovery plan.
To be covered, you must meet three conditions: you must have been in a hospital for at least three consecutive days (not counting the day you were discharged), your doctor must order home health care, and the care must be for a condition related to your hospital stay or a condition that developed while you were there. You cannot straightforward decide you want home care — a doctor's order is required.
Medicare Part A covers up to 100 days of home health care per benefit period. You pay nothing for the first 20 days. For days 21 through 100, you pay a copay of about $200 per day, though this amount changes each year. After 100 days, you pay all costs yourself unless you move to a different benefit period (which begins after you have had 60 days with no skilled care).
What Medicare Part B covers: therapy and skilled nursing visits
Medicare Part B covers skilled nursing visits and therapy services ordered by your doctor even if you did not have a recent hospital stay. A nurse can visit to manage a chronic condition, teach you how to give yourself injections, or monitor a wound. A physical therapist can help you regain strength after a fall or stroke. An occupational therapist can work with you on daily tasks like dressing or cooking after an injury.
For Part B services, you pay 20 percent of the cost after you meet your annual deductible (which is $240 in 2024, though this changes yearly). Medicare pays the other 80 percent. The number of visits is not limited by a set number — instead, Medicare requires that the care be medically necessary and that you be homebound or unable to leave home without considerable effort.
Part B does not cover routine check-ins or visits purely for personal care. A nurse cannot visit just to remind you to take your pills or to help you bathe, even if you live alone and have no one to help you.
Personal care and custodial care: what you pay for yourself
Personal care — help with bathing, dressing, grooming, toileting, eating, and medication reminders — is not covered by Medicare. Neither is housekeeping, meal preparation, laundry, or shopping. This is called custodial care because it is care for your daily living needs, not treatment for a medical condition. Many people need this kind of help and pay for it out of pocket, through long-term care insurance, or through Medicaid.
The cost of hiring a caregiver varies widely by location and the number of hours you need. In some areas, home care aides cost $20 to $30 per hour; in others, the cost is $40 to $50 or more per hour. If you need 24-hour care, the cost can be thousands of dollars per month. Some people hire caregivers directly; others use a home care agency, which costs more but handles payroll and background checks.
If you have a Medicare Advantage plan, check your plan documents to see whether it offers any coverage for personal care or non-medical support services. Some plans do offer limited benefits for things like meal delivery or transportation, but these vary by plan and are not may provide.
Medicaid coverage for in-home care in your state
Medicaid, the joint federal-state program for people with low income, is the main source of payment for long-term in-home personal care in the United States. Unlike Medicare, Medicaid can pay for a caregiver to help you bathe, dress, eat, and manage your home. However, Medicaid rules vary significantly by state, and not all states offer the same in-home care programs.
Some states have programs called Home and Community-Based Services (HCBS) waivers that let Medicaid pay for in-home care as an alternative to nursing home placement. Other states have programs specifically for older adults or people with disabilities. To find out what your state offers, contact your state Medicaid office or call 211 (a free referral service) and ask about in-home care programs for your situation.
If you think you might be Medicaid-may be able to access based on income and assets, your state Medicaid office can tell you what programs exist and what the rules are. Some people are covered by both Medicare and Medicaid (called "dual may be able to access"), and in those cases, Medicaid often pays for the personal care that Medicare does not cover.
How to arrange Medicare-covered home health care
If your doctor believes you need skilled nursing or therapy at home, ask them to write an order for home health care. Your doctor will specify what type of care you need (nursing, physical therapy, occupational therapy, or speech therapy) and how often the visits should occur. Your doctor will also need to document that you are homebound or have a medical reason you cannot leave home.
Once your doctor places the order, Medicare will arrange for a home health agency to contact you and schedule your first visit. You do not choose the agency — Medicare assigns one based on your location and the services you need. The agency will send a nurse or therapist to your home to assess your needs and create a care plan. This first visit is called the initial assessment.
Home health visits are typically scheduled during business hours on weekdays. If you need care at night or on weekends, you will need to arrange and pay for that separately. Keep track of your visits and any changes in your condition, and let your doctor know if you feel you need more or fewer visits than you are receiving.
Combining Medicare coverage with out-of-pocket care
Many people use Medicare-covered skilled care for a limited time — perhaps a few weeks after surgery or hospitalization — and then hire a personal care aide for the ongoing help they need. For example, a person recovering from hip surgery might have Medicare-covered physical therapy twice a week for eight weeks, and also hire a caregiver for three hours a day to help with bathing and dressing. The therapy is covered; the personal care is paid out of pocket.
If you are planning to hire a caregiver, start looking before you need one. Ask your doctor, hospital discharge planner, or local Area Agency on Aging for referrals to home care agencies or independent caregivers. Check references and make sure the person is bonded and insured. If you hire someone directly (not through an agency), you become their employer and are responsible for payroll taxes and workers' compensation insurance.
Some people use a combination of family caregiving and paid help. A family member might handle medication reminders and meal preparation, while a paid caregiver comes in for bathing and heavy housework. This arrangement can be more affordable than full-time paid care and allows family members to stay involved without burning out.
Frequently Asked Questions
Will Medicare pay for a caregiver to help me at home if I am not recovering from a hospital stay?
Medicare Part B can pay for skilled nursing visits or therapy if your doctor orders it and you are homebound, but only for medical care — not for personal care like bathing or dressing. If you need help with daily living tasks, you will need to pay out of pocket or explore Medicaid options in your state.
What happens when my 100 days of Medicare home health care run out?
After 100 days in a benefit period, Medicare stops paying. If you still need skilled care, you can start a new benefit period if you have had 60 days without any skilled care. If you need ongoing personal care, you will need to pay for it yourself, use long-term care insurance if you have it, or explore Medicaid.
Can I choose which home health agency provides my care?
No. Medicare assigns a home health agency based on your location and the services you need. However, you can ask to switch agencies if you are unhappy with the service. Contact your doctor or call Medicare at 1-800-MEDICARE to request a change.
Does Medicare Advantage cover in-home personal care?
Original Medicare rules explore to all Medicare Advantage plans for skilled nursing and therapy. Some Medicare Advantage plans offer additional benefits like meal delivery or transportation, but these vary by plan. Check your plan documents or call your plan to ask what in-home support services, if any, are included.
How do I know if I am homebound for Medicare purposes?
You are considered homebound if leaving home requires considerable effort due to a medical condition, or if your doctor has ordered you to stay home. You do not have to be completely unable to leave — occasional trips to a doctor's office or religious service do not disqualify you. Your home health nurse will assess whether you meet this requirement during your first visit.