Medicare covers some in-home care, but not all of it, and the coverage depends on whether you need skilled nursing or personal care

Medicare will pay for in-home skilled nursing — a nurse or therapist coming to your house to treat a medical condition — but only if a doctor orders it and you meet specific conditions. Medicare does not pay for help with daily tasks like bathing, dressing, or housekeeping, even if you need that help. Understanding which services Medicare covers and which you pay for yourself is the first step to planning care at home.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy at home only after a hospital or skilled nursing facility stay of at least three days, and only for the condition you were treated for.
  • Medicare Part B covers some home health services ordered by your doctor if you are homebound, but the services must be medical in nature — not personal care or housekeeping.
  • Medicare does not cover custodial care, which is help with bathing, dressing, eating, or toileting, no matter how much you need it.
  • If you need ongoing personal care at home, you will likely pay out of pocket, use Medicaid if you may have access to, or purchase long-term care insurance.
  • Your doctor must order home health services and certify that you are homebound for Medicare to cover any in-home care.

What Medicare Part A covers at home after a hospital stay

If you spend at least three consecutive days in a hospital and are then discharged to home, Medicare Part A will cover skilled nursing visits and therapy for up to 60 days. The care must be for the condition you were hospitalized for, and a doctor must order it. A nurse or physical therapist will come to your home to provide the treatment.

This coverage ends when your doctor decides you no longer need skilled care, or after 60 days, whichever comes first. If you improve and then your condition worsens again, you may be able to restart coverage, but only if you meet the three-day hospital stay requirement again. Part A pays the full cost of these visits after you meet your Part A deductible.

What Medicare Part B covers for ongoing home care

Medicare Part B covers home health services even if you did not have a recent hospital stay, as long as your doctor orders the care and certifies that you are homebound. "Homebound" means leaving your home is difficult or medically inadvisable — you do not have to be bedridden. Part B covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy ordered by your doctor.

Part B also covers medical equipment and supplies your doctor prescribes, such as oxygen, wound care supplies, or a walker. You pay 20 percent of the cost after you meet your Part B deductible; Medicare pays 80 percent. The number of visits is not set in advance — your doctor and the home health agency determine how many visits you need based on your condition.

What Medicare does not cover at home

Custodial care — help with bathing, dressing, eating, toileting, or other personal activities — is not covered by Medicare, even if you need it every day. This is true whether you live alone or with family. Medicare also does not cover housekeeping, meal preparation, laundry, or shopping, even when these tasks are difficult for you.

Companion care and non-medical supervision are not covered. If you need someone to stay with you for safety or to remind you to take medications, Medicare will not pay for that service. Many seniors pay for this care privately, hire a home care aide through an agency, or rely on family members.

How to arrange Medicare-covered home care

Your doctor must order home health services and submit an order to a Medicare-certified home health agency. You do not choose the agency yourself in most cases — your doctor or hospital discharge planner will refer you to one. The agency will send a nurse to assess your needs and create a care plan.

Before the first visit, ask the agency for an estimate of how many visits you will receive and what services are included. Ask whether the agency is Medicare-certified and whether all staff members are employees of the agency or contractors. Request an itemized list of what Medicare will cover and what you will be responsible for paying.

When you need personal care that Medicare does not cover

If you need help with bathing, dressing, or other personal care, you have several options. You can hire a home care aide privately — costs vary widely by region but typically range from $20 to $30 per hour for non-medical aides. Some agencies handle hiring and payroll; others connect you with independent aides and you manage the employment yourself.

If your income and assets are low enough, Medicaid may cover personal care services in your home. Medicaid rules vary by state, so contact your state Medicaid office to learn what is covered where you live. Some people purchase long-term care insurance before they need care, which can help pay for in-home personal care later.

Questions to ask your doctor before home care begins

Ask your doctor how long you will need home health services and what the goals of treatment are. Ask whether the services ordered are covered by Medicare Part A or Part B, and what you will owe out of pocket. Request a written order that specifies the type of care, the frequency of visits, and the diagnosis being treated.

Ask your doctor to explain what "homebound" means in your situation and whether you will be able to leave home for appointments or activities. Ask whether the home health agency can provide the specific services you need or whether you will need to arrange additional care elsewhere. If your condition changes, ask how to contact your doctor to adjust the care plan.

Frequently Asked Questions

Does Medicare cover a live-in caregiver?

No. Medicare does not cover the cost of someone living in your home to provide care, whether that person is a family member or a paid aide. If you need 24-hour care, you would need to pay for it privately or explore whether Medicaid covers personal care in your state.

What if I need home care but was not hospitalized?

Medicare Part B can cover home health services without a prior hospital stay, as long as your doctor orders the care and certifies that you are homebound. The services must be skilled nursing or therapy — not personal care or housekeeping. Contact your doctor to discuss whether home health services are appropriate for your condition.

Can I choose which home health agency provides my care?

Your doctor or hospital discharge planner typically refers you to a specific agency, but you can request a different Medicare-certified agency. Call your local Medicare office or visit Medicare.gov to find certified agencies in your area. You have the right to know which agency will provide your care before the first visit.

Will I have to pay anything for Medicare-covered home health visits?

If your care is covered under Medicare Part A after a hospital stay, you pay nothing for the home health visits after you meet your Part A deductible. If your care is covered under Part B, you pay 20 percent of the cost after your Part B deductible; Medicare pays 80 percent. You may also owe copayments for medical equipment or supplies.

What happens if I improve and no longer need home care?

Your doctor will discharge you from home health services when you no longer need skilled nursing or therapy. If your condition worsens later and you need care again, your doctor can order new services. If you had a hospital stay, you would need another three-day stay to restart Part A coverage; Part B coverage can restart without a hospital stay if your doctor orders it.