Medicare covers some rehabilitation services at home, but only under specific conditions and not for all types of care

Medicare Part A covers inpatient rehabilitation in a hospital or skilled nursing facility. Medicare Part B covers some outpatient rehabilitation services, including physical therapy, occupational therapy, and speech-language pathology — but the rules about where those services happen matter. If a therapist comes to your home, Medicare Part B will pay for it only if you are homebound or if your doctor orders it as part of a treatment plan. Medicare does not pay for general home care, personal information, or custodial care, even if you need help with daily tasks after an injury or surgery.

The key distinction is between skilled care (which Medicare may cover) and custodial care (which it will not). Skilled care means a licensed professional — a physical therapist, nurse, or occupational therapist — is performing a service that requires their training. Custodial care means help with bathing, dressing, eating, or toileting. If you need only custodial care at home, Medicare will not pay, even if a family member or aide provides it.

Key Takeaways

  • Medicare Part B covers physical therapy, occupational therapy, and speech therapy at home if your doctor orders it and you meet homebound requirements or have a may have access to condition.
  • You must be homebound or have a medical reason your doctor documents for home-based therapy to be covered; therapy in an outpatient clinic is covered differently.
  • Medicare will not pay for custodial care, personal information, or help with daily living tasks, even if provided at home by a professional caregiver.
  • If you need rehabilitation after hospitalization, Medicare Part A may cover a skilled nursing facility stay first; home therapy may follow once you are discharged.
  • Your out-of-pocket costs depend on whether you have met your Part B deductible and whether the provider is in-network; costs vary by region and provider.

What Medicare Part B covers for home rehabilitation

Medicare Part B covers three main types of therapy at home: physical therapy, occupational therapy, and speech-language pathology. A doctor must order the therapy and document that it is medically necessary. The therapist must be employed by or contracted with a Medicare-approved home health agency or be a private practice provider enrolled in Medicare.

For home-based therapy to be covered, you typically must be homebound — meaning you cannot leave your home without considerable difficulty or the help of another person, and leaving is medically contraindicated. Some conditions that may may have access to include recent surgery, a broken bone, stroke recovery, or severe arthritis. Your doctor's order must state why home-based therapy is necessary rather than outpatient therapy at a clinic.

Medicare Part B pays 80 percent of the approved amount after you meet your annual deductible (which is $240 in 2024, though this changes yearly). You pay the remaining 20 percent. If the provider is not in-network or does not accept Medicare assignment, your costs may be higher.

Home health rehabilitation versus outpatient therapy

Home health rehabilitation is different from outpatient therapy, and Medicare covers them under different rules. Home health is a full service that includes nursing, therapy, and sometimes aide services, all coordinated by a home health agency. It is covered under Medicare Part A if you are homebound and your doctor orders it after a hospital stay or may have access to event. Home health is typically short-term — a few weeks to a few months.

Outpatient therapy means you go to a clinic, hospital, or therapist's office for treatment. Medicare Part B covers outpatient therapy without a homebound requirement, though you pay 20 percent of the approved amount after your deductible. Many people choose outpatient therapy because it does not require proving you are homebound, but it requires you to be able to travel.

If you receive home health services, therapy is usually included as part of the package. Once home health ends, you may transition to outpatient therapy if you are able to travel, or your doctor may order continued in-home therapy through a private therapist if you remain homebound.

What Medicare does not cover at home

Medicare will not pay for custodial care, which is the largest category of home care need for older adults. Custodial care includes bathing, dressing, grooming, toileting, eating, and transferring in and out of bed. Even if a licensed aide or nurse provides these services, Medicare does not cover them because they do not require the skill level of a licensed professional.

Medicare also does not cover general homemaking services, meal preparation, shopping, transportation, or companionship. It does not cover 24-hour care, live-in aides, or ongoing personal information. If you need these services, you must pay out of pocket, use Medicaid (if you may have access to), or purchase long-term care insurance.

Skilled nursing care at home — such as wound care, catheter management, or medication administration — is covered under Medicare Part A as part of home health, but only if ordered after a may have access to hospital or skilled nursing facility stay. Routine check-ups or monitoring without a skilled procedure are not covered.

How to arrange Medicare-covered home rehabilitation

Start by talking to your doctor. Tell them you need rehabilitation and prefer home-based services if possible. Your doctor will write an order for home health or home-based therapy and send it to a Medicare-approved home health agency or therapist. You cannot arrange home health on your own; it must be ordered by a physician.

If your doctor orders home health, the agency will contact you to schedule an initial assessment. The agency will verify your Medicare coverage, explain your out-of-pocket costs, and arrange the schedule. If your doctor orders therapy only (not full home health), you can work with the agency or a private therapist to schedule sessions.

Ask your doctor or the agency which provider is in-network for your Medicare plan. If you have a Medicare Advantage plan (Part C) instead of Original Medicare, the rules and covered providers may differ; check your plan documents or call your plan's customer service line.

Out-of-pocket costs for home rehabilitation

Costs vary depending on your Medicare coverage and the type of service. Under Medicare Part A home health, you typically pay nothing for the home health services themselves, but you may have a copay for each therapy visit (usually $0 to $50 per visit, depending on your plan). Under Medicare Part B, you pay 20 percent of the approved amount after your deductible.

If you have a Medigap (supplemental insurance) policy, it may cover some or all of your Part B coinsurance. If you have a Medicare Advantage plan, your costs depend on your specific plan — some cover home therapy with a copay, others with coinsurance, and some may have limits on the number of visits.

Private therapists who do not accept Medicare assignment may charge more than the Medicare-approved amount. Always ask whether a provider accepts Medicare assignment before scheduling, and request an estimate of your out-of-pocket cost.

When Medicare home rehabilitation ends

Home health services are temporary. Medicare covers them as long as your doctor certifies that skilled care is medically necessary and you remain homebound. Once you improve enough to leave home or no longer need skilled services, home health ends. This typically happens within two to eight weeks, though it can be longer for some conditions.

When home health ends, you have options. If you still need therapy but can travel, you can move to outpatient therapy at a clinic. If you still need therapy and remain homebound, your doctor can order continued in-home therapy through a private therapist, and Medicare Part B will cover it if the therapist is enrolled in Medicare. If you need ongoing custodial care or personal information, you will need to pay out of pocket or explore Medicaid.

Ask your home health team about the discharge plan before services end. They should help you understand what comes next and how to arrange any follow-up care.

Frequently Asked Questions

Do I have to be homebound to get home therapy covered by Medicare?

For Medicare Part A home health services, yes — you must be homebound. For Medicare Part B therapy ordered by your doctor, homebound status is the typical requirement, but some conditions (like recent surgery with medical restrictions) may may have access to without strict homebound status. Your doctor will determine whether home-based therapy is medically necessary in your situation.

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

Medicare will not pay for an aide to help with bathing, dressing, or other personal care tasks. It covers skilled nursing or therapy only. If you need personal care help, you must pay out of pocket, use Medicaid if you may have access to, or arrange private care through an agency.

What if I need rehabilitation at home but was not hospitalized first?

Medicare Part A home health typically requires a hospital or skilled nursing facility stay first. However, your doctor can order Medicare Part B therapy (physical therapy, occupational therapy, or speech therapy) at home if you are homebound and the therapy is medically necessary, even without a prior hospitalization. The rules are different for Part A and Part B.

Can I choose which home health agency Medicare uses?

Your doctor chooses the home health agency when they write the order. You can request a different Medicare-approved agency, and the doctor can change the order, but you cannot use a non-Medicare-approved agency and have Medicare pay for it. Ask your doctor which agencies serve your area and accept Medicare.

How long does Medicare cover home rehabilitation?

There is no set time limit, but coverage depends on medical necessity. Your doctor must recertify every 60 days that skilled care is still needed. Once you no longer need skilled services or are no longer homebound, coverage ends. Most home health episodes last two to eight weeks, but some last longer depending on your condition.