Medicare's Coverage of In-Home Care

Medicare covers some in-home care, but not all of it, and the coverage depends on what kind of care you need and why. Medicare Part A covers skilled nursing care and home health aide services when you meet specific conditions — mainly that you are homebound, a doctor has ordered the care, and you are recovering from a hospital or nursing home stay. Medicare does not cover custodial care (help with bathing, dressing, or meals when that is the only reason for the visit) or long-term personal care at home. If you need ongoing help with daily living but are not recovering from an acute illness, Medicare will not pay.

The difference matters because it determines what you will owe. Skilled care under Part A has no copay once you meet the deductible. Home health aide visits tied to skilled care also have no copay. But if Medicare decides your need is custodial rather than skilled, you pay the full cost yourself — there is no partial coverage.

Key Takeaways

  • Medicare Part A covers skilled nursing and home health aide visits only if you are homebound, a doctor orders the care, and you are recovering from a hospital or nursing home stay of at least three days.
  • Medicare does not cover ongoing personal care at home (bathing, dressing, meal prep) unless it is tied to a skilled nursing need like wound care or physical therapy.
  • If Medicare denies coverage, you may be able to appeal the decision, and you have the right to know why the denial happened before you pay out of pocket.
  • Medicaid, not Medicare, is the program that covers long-term in-home personal care for people who meet income and asset limits.
  • Private long-term care insurance and Veterans benefits may cover in-home care if Medicare does not, depending on your situation.

When Medicare Pays for Skilled Nursing at Home

Medicare Part A will cover skilled nursing visits and home health aide visits if all of these conditions are met: you spent at least three consecutive days in a hospital or skilled nursing facility; a doctor ordered home health care; you are homebound (leaving home is a major effort, even with help); and the care is for a condition related to your recent hospital or facility stay.

Skilled nursing means a nurse is doing something that requires a license — wound care, injections, catheter management, physical therapy, occupational therapy, or speech therapy. Home health aides can help with bathing, dressing, toileting, and meals, but only if a nurse is also visiting for a skilled reason. The aide visits are covered as part of the home health plan, not separately.

Coverage is not automatic or permanent. Medicare reviews your case regularly — usually every 60 days — to see whether you still need skilled care. Once your condition improves enough that you no longer need skilled nursing, the visits stop, even if you still need help at home.

What Medicare Does Not Cover at Home

Medicare does not cover custodial care, which is help with activities of daily living when there is no skilled nursing reason for the visit. If you need someone to help you bathe, dress, take medications you can manage yourself, prepare meals, or do light housekeeping, Medicare will not pay — even if you cannot do these things alone and even if you are homebound.

Medicare also does not cover ongoing personal care at home for chronic conditions. If you have arthritis, dementia, or mobility problems and need daily help but are not recovering from a recent hospital stay, Medicare will not cover in-home caregivers. This is true even if your doctor says you need the help.

Homemaker services, meal delivery, transportation, and companionship are not covered. Neither is care provided by family members, even if they are paid and even if a nurse supervises them.

How to Know if Your Care Will Be Covered

Your doctor must order home health care for Medicare to consider covering it. The home health agency then submits the order to Medicare along with medical records showing why skilled care is needed and why you are homebound. Medicare's contractor in your state reviews this paperwork and decides whether to approve it.

You should receive a document called the Notice of Medicare Non-Coverage if Medicare denies the claim or if the home health agency believes Medicare will deny it. This notice must explain why coverage was denied and tell you how to appeal. Read it carefully — you have the right to understand the reason before you pay.

If you disagree with the decision, you can ask the home health agency to appeal on your behalf, or you can file an appeal yourself. The first level of appeal is called reconsideration, and you have 120 days from the date on the notice to request it.

Medicaid Coverage for Long-Term In-Home Care

Medicaid, not Medicare, is the program that covers long-term personal care at home. Medicaid is a joint federal and state program for people with low income and limited assets. Each state runs its own Medicaid program and sets its own rules about what in-home care is covered and how much you can own and earn and still may have access to.

In most states, Medicaid will cover a home health aide or personal care attendant to help with bathing, dressing, toileting, meals, and other daily tasks — but only if you meet the income and asset limits. Some states also offer home and community-based services waivers that let people stay at home instead of moving to a nursing facility, with Medicaid paying for in-home care.

If you think you might may have access to for Medicaid, contact your state Medicaid office or your local Area Agency on Aging. They can tell you the income and asset limits in your state and help you understand what in-home services Medicaid covers there.

Other Sources of Payment for In-Home Care

If Medicare and Medicaid do not cover your in-home care, other options may exist. Veterans benefits cover in-home care for may be able to access veterans and surviving spouses, including Aid and Attendance benefits that can help pay for personal care. The Department of Veterans Affairs has a separate process process.

Long-term care insurance, if you have a policy, may cover in-home care depending on what the policy says. Review your policy documents or call your insurance company to learn what services are covered and what you must pay out of pocket.

Some people pay for in-home care privately, either out of savings or by hiring caregivers directly. Costs vary widely by region and by the type of care needed — from $15 to $30 per hour for basic personal care to $25 to $50 per hour or more for skilled nursing care. Some agencies charge a markup on top of what they pay the caregiver.

What to Ask Your Doctor and Medicare

If you think you need in-home care, ask your doctor whether the care is skilled (requiring a nurse or therapist) or custodial (help with daily living). Ask whether your doctor will order home health care and whether Medicare is likely to cover it based on your situation. Be specific about what help you need and why.

If a home health agency is involved, ask them to explain in writing what Medicare will and will not cover in your case before the visits start. Ask what you will owe if Medicare denies coverage. If you receive a Notice of Medicare Non-Coverage, ask the agency or your doctor to help you understand it and to explain your appeal options.

If you have questions about Medicare's decision, you can call Medicare directly at 1-800-MEDICARE (1-800-633-4227). Have your Medicare number and the date of the denial notice ready.

Frequently Asked Questions

Can I hire my own caregiver and have Medicare pay for it?

No. Medicare only pays home health agencies that are Medicare-certified, not independent caregivers you hire yourself. If you hire someone privately, you pay the full cost. Some people hire caregivers for the hours Medicare does not cover, or for custodial care that Medicare will not cover.

What if I need in-home care but I am not homebound?

Medicare will not cover it. Medicare requires that you be homebound — meaning leaving home is a major effort, even with help. If you can leave home regularly, even with information, Medicare considers you not homebound and will not cover in-home care, even if you need it.

Does Medicare cover in-home care after I leave the hospital?

Medicare may cover it if you spent at least three days in the hospital, a doctor orders home health care, you are homebound, and the care is for a condition related to your hospital stay. Coverage is not automatic — Medicare reviews your medical records and decides. If approved, coverage usually lasts a few weeks to a few months, depending on how quickly you recover.

If Medicare stops paying for my in-home care, can I appeal?

Yes. If Medicare or the home health agency says your care is no longer covered, you have the right to appeal. You must receive a Notice of Medicare Non-Coverage that explains why and tells you how to request reconsideration. You have 120 days from the date on the notice to appeal.

What is the difference between Medicare and Medicaid for in-home care?

Medicare is federal health insurance for people 65 and older and covers skilled nursing and therapy at home only after a hospital stay. Medicaid is a program for people with low income and covers long-term personal care at home in most states. You may may have access to for both, and Medicaid may cover what Medicare does not.