Medicare does cover home health care, but only under specific conditions
Medicare Part A and Part B together cover home health services when a doctor determines you are homebound and need skilled care. "Skilled care" means nursing, physical therapy, occupational therapy, speech therapy, or social work — not help with daily tasks like bathing or cooking. Medicare pays the home health agency directly; you pay nothing if the agency is Medicare-certified and you meet the requirements.
The catch is that Medicare will not pay for custodial care, which is help with activities of daily living when you do not need skilled medical services. If you need someone to help you bathe, dress, or take medications you can manage yourself, Medicare does not cover that. Many people discover this gap only after a hospital stay, when they assume all home care is covered.
Key Takeaways
- Medicare covers skilled nursing, physical therapy, occupational therapy, speech therapy, and social work visits at home, but only if a doctor orders them and you are homebound.
- You must be under the care of a doctor who certifies that home care is medically necessary, and the home health agency must be Medicare-certified.
- Medicare does not cover custodial care — help with bathing, dressing, meals, or housekeeping — even if you live alone and cannot do these tasks yourself.
- After a hospital or skilled nursing facility stay of at least three days, Medicare Part A covers home health visits with no copay; otherwise, Part B covers 80 percent after you meet your deductible.
What counts as skilled care that Medicare will pay for
Skilled nursing visits include wound care, injections, catheter management, medication monitoring, and assessment of new or worsening symptoms. A nurse might visit to check your blood pressure after a heart attack, change a surgical dressing, or teach you how to use a new medication. These visits must be ordered by your doctor and documented as medically necessary.
Physical therapy covers exercises and treatment to restore movement after surgery, stroke, or injury. Occupational therapy helps you relearn daily tasks — like dressing or cooking — when illness or injury has made them difficult. Speech therapy addresses swallowing problems or speech loss after stroke. Social work visits focus on discharge planning and connecting you to community resources, not ongoing counseling.
All of these services must be ordered by your doctor, and the home health agency must submit documentation to Medicare showing why you need them. If Medicare denies a claim, it is usually because the agency did not prove the care was skilled or that you were homebound.
The homebound requirement and how it works
To receive home health services, Medicare requires that you be homebound — meaning you cannot leave home without considerable and taxing effort, or leaving home is medically contraindicated. You do not have to be bedridden. Homebound means you cannot safely or reasonably go to an outpatient clinic for therapy or monitoring.
If you can leave home to go to a doctor's office, a dialysis center, or an adult day program, Medicare may deny home health coverage. The home health agency assesses whether you meet this standard when you are admitted. If you later start leaving home regularly, the agency may discharge you from the program.
Occasional absences — a trip to the doctor, a family event — do not automatically disqualify you. But if you are well enough to attend outpatient therapy or leave home several times a week, Medicare will likely stop paying.
How Medicare payment works after hospitalization versus other situations
The payment rules differ depending on whether you are coming home from a hospital or skilled nursing facility stay.
| Situation | Coverage | Your Cost |
|---|---|---|
| After a hospital or skilled nursing stay of 3+ days, ordered by your doctor | Part A covers home health with no copay for up to 60 days | Nothing (after any hospital deductible already paid) |
| Home health ordered by your doctor without a recent hospital stay | Part B covers 80% after you meet your annual deductible | 20% coinsurance per visit, plus any deductible |
| Custodial care (bathing, dressing, meals, housekeeping) | Not covered by Medicare | You pay the full cost out of pocket |
After a may have access to hospital or nursing facility stay, Part A covers home health visits at no cost to you for up to 60 days. The home health agency bills Medicare directly. If you need home health without a recent hospital stay, Part B covers 80 percent of the cost after you meet your $226 annual deductible (2024 amount; this changes yearly). You pay 20 percent coinsurance per visit.
What to do if Medicare denies home health coverage
If your home health agency tells you Medicare has denied coverage or plans to discharge you, ask the agency for a written explanation. Medicare must send you a notice called a Notice of Non-Coverage before services end. This notice explains why coverage is ending and tells you how to appeal.
You have the right to request a Detailed Explanation of Non-Coverage (DENC) within 24 hours of receiving the notice. A DENC gives you more information about the denial and your appeal options. You can then file a formal appeal, which starts with a review by the home health agency's utilization review contractor.
Many denials are reversed on appeal, especially if your condition has changed or if the agency did not submit complete medical documentation the first time. Contact your local State Health Insurance information Program (SHIP) for free help understanding the denial and filing an appeal. You can find your state's SHIP at shiptacenter.org or by calling 1-877-839-2675.
Supplemental insurance and Medicaid coverage for custodial care
Because Medicare does not cover custodial care, many people turn to other sources. If you have a Medigap policy (supplemental insurance), check your plan documents — some Medigap plans cover a limited number of home health visits for custodial care, but most do not. Call your Medigap insurer to ask what home care services, if any, your plan covers.
If you have both Medicare and Medicaid, your state's Medicaid program may cover custodial home care. Medicaid rules vary widely by state. Some states cover in-home personal care services; others cover them only for people in nursing homes. Contact your state Medicaid office or call your local Area Agency on Aging to learn what your state covers.
If you do not have Medicaid and cannot afford private home care, ask the home health agency's social worker about community programs, senior centers, or volunteer services in your area. Some nonprofits offer reduced-cost or free help with household tasks for low-income seniors.
Questions to ask your doctor before home health services start
Before your doctor orders home health, ask these questions to make sure Medicare will cover it:
- What specific skilled services am I being referred for, and how long do you expect I will need them?
- Will you document in my medical record that I am homebound and cannot leave home without considerable effort?
- Is this order based on a recent hospital or nursing facility stay, or am I starting home health without that?
- If Medicare denies this, what is the plan — will you order outpatient therapy instead, or will I need to pay privately?
Once the home health agency is assigned, ask them to confirm that they are Medicare-certified and to explain what Medicare will and will not cover in your case. Ask whether they expect Medicare to cover the full course of care or whether you may reach a point where you pay out of pocket.
Frequently Asked Questions
Does Medicare cover a home health aide to help me bathe and dress?
No. Medicare does not cover custodial care, which includes bathing, dressing, grooming, and toileting. If you need only these services and no skilled nursing or therapy, Medicare will not pay. You would need to pay privately, use Medicaid if you may have access to, or find community resources.
What if I need both skilled care and help with daily living?
Medicare will pay for the skilled services — such as nursing or physical therapy — but not for the custodial help. Some home health agencies employ both skilled nurses and aides; you may be able to hire the aide privately while Medicare covers the nurse's visits. Ask the agency about this option.
Can I get home health services if I have not been in the hospital?
Yes, if your doctor orders skilled care and certifies that you are homebound. However, Medicare Part B will cover only 80 percent after you meet your deductible, so you will have a copay. After a hospital or nursing facility stay, Part A covers home health at no cost.
How long does Medicare cover home health?
There is no set limit. Medicare covers home health as long as your doctor orders it, you remain homebound, and you need skilled services. However, Medicare reviews your case regularly. If you improve and no longer need skilled care, or if you become able to leave home, coverage will end.
What happens if the home health agency is not Medicare-certified?
Medicare will not pay. Always confirm that the agency is Medicare-certified before services begin. You can check an agency's certification status on Medicare.gov or by calling 1-800-MEDICARE. If an agency is not certified, you would pay the full cost yourself.