Medicare does not pay a family member or friend to be your caregiver, but it does cover some in-home care services under specific conditions
If you need help at home because of illness or injury, Medicare may cover skilled nursing care or home health aide services — but only through a Medicare-approved agency, and only if a doctor orders the care as part of a treatment plan. Medicare will not pay a spouse, adult child, or other family member directly for caregiving work, even if they provide the same services a paid aide would.
What Medicare will pay for depends on what kind of care you need and whether you meet specific requirements. If you need help with bathing, dressing, or toileting because of a medical condition, a home health aide employed by an agency can provide that care at no cost to you (after you meet your Part B deductible). If you need skilled care — wound care, physical therapy, medication management — a nurse or therapist can visit your home. But the care must be ordered by your doctor, and you must be homebound or mostly homebound to receive it.
Key Takeaways
- Medicare covers home health aide services and skilled nursing through a Medicare-approved agency, not through family members you hire yourself.
- Your doctor must order the care and document that you are homebound or mostly homebound for Medicare to pay.
- You pay nothing for covered home health services after you meet your Part B deductible, but the agency must be Medicare-certified.
- If you need non-medical help — housekeeping, meal prep, companionship — Medicare does not cover it, but Medicaid or local aging programs may.
- If a family member is your primary caregiver, you may be able to pay them through a Medicaid waiver program in your state, but rules vary widely.
What Medicare Home Health Services Include
Medicare Part A covers home health services if you are homebound and a doctor orders the care. "Homebound" means you cannot leave home without considerable effort or help, or leaving would be medically inadvisable. The services covered include skilled nursing (wound care, catheter management, medication teaching), physical therapy, occupational therapy, speech therapy, and home health aide services for personal care.
A home health aide can help you bathe, dress, use the toilet, eat, and move around your home. They can also help with light housekeeping related to your care — for example, washing the clothes you wear or cleaning the bathroom you use. What they cannot do is provide general housekeeping, cook full meals, or provide companionship or supervision alone. The aide works under a nurse's supervision and only for the hours the care plan specifies.
The agency sends the aide to your home; you do not hire the aide directly. Medicare pays the agency, and you pay nothing if the agency is Medicare-certified and the services are covered. If you use an aide from an agency that is not Medicare-certified, Medicare will not pay, and you will owe the full cost.
How to Start Home Health Services Through Medicare
Your doctor must order home health services and document that you are homebound. You cannot request home health on your own — the order must come from your physician, nurse practitioner, or physician assistant who is treating you. The doctor will write an order and send it to a Medicare-approved home health agency.
To find a Medicare-approved agency in your area, call 1-800-MEDICARE or visit Medicare.gov and search "home health agencies." You can also ask your doctor for a referral. When you contact an agency, tell them your doctor has ordered care and ask them to contact your doctor to get the order. The agency will schedule an intake visit, during which a nurse will assess your needs and create a care plan.
Medicare will cover the services as long as your doctor continues to order them and you remain homebound. The agency must recertify your need for care every 60 days. If your condition improves and you no longer meet the homebound requirement, Medicare coverage will end.
What Medicare Does Not Cover for Caregiving
Medicare does not pay for non-skilled personal care — help with activities of daily living that do not require a trained nurse or therapist. This includes bathing and dressing help if you need it only because of age or disability, not because of a specific medical condition requiring skilled assessment. Medicare also does not cover housekeeping, meal preparation, grocery shopping, laundry, or companionship.
Medicare does not cover care provided by a family member, even if that family member is trained or experienced. If your adult child or spouse is your primary caregiver, Medicare will not reimburse them for the hours they spend helping you. Some states offer Medicaid waiver programs that do pay family members to provide care, but these are separate from Medicare and have different rules and income limits.
If you need help with non-medical tasks or want to pay a family member, you have other options: Medicaid (if you meet income and asset limits), your state's aging and disability services program, Veterans benefits (if you are a veteran), or private pay. Your local Area Agency on Aging can tell you what programs are available in your state.
Medicaid Waivers: Paying Family Caregivers
Some states offer Medicaid Home and Community-Based Services (HCBS) waivers that allow you to hire a family member as a paid caregiver. These programs are Medicaid, not Medicare, and they have strict income and asset limits. If you may have access to for Medicaid and your state offers a waiver program, you may be able to pay a spouse, adult child, or other family member for caregiving work.
The rules vary by state. Some states allow you to hire any family member; others exclude spouses or require that the family member not live with you. Some states set a wage rate; others allow you to negotiate. You will need to go through a hiring and employment process, including background checks and tax withholding. Contact your state Medicaid office or your local Area Agency on Aging to learn whether your state has a waiver program and what the requirements are.
Waiting lists for waiver programs are common and can be long. Some states prioritize people with the highest care needs or those at risk of nursing home placement. If you are interested in a waiver program, ask to be added to the waiting list even if you do not currently need it, because the list can take years to move through.
Finding and Paying for Care When Medicare Does Not Cover It
If you need caregiving help that Medicare does not cover, you have several paths. Medicaid covers personal care services in most states if you meet income and asset limits; call your state Medicaid office to learn what is available. Your state or local Area Agency on Aging can connect you to programs that help pay for in-home care, meal delivery, transportation, or other services. Call the Eldercare Locator at 1-800-677-1116 to find your local agency.
If you are a veteran or surviving spouse of a veteran, the Department of Veterans Affairs offers Aid and Attendance benefits that can help pay for in-home care. Contact your VA regional office or call 1-800-827-1000. If you have long-term care insurance, review your policy to see what in-home care it covers and how much it will pay.
If none of these programs are available or you do not meet the requirements, you can hire a caregiver privately and pay out of pocket. Agencies that provide caregivers charge an hourly rate (which varies by region and the caregiver's qualifications) and handle employment taxes and insurance. Individual caregivers found through referrals or online platforms are usually less expensive but require you to handle employment and tax responsibilities yourself.
Questions to Ask Your Doctor and Home Health Agency
Before home health services begin, ask your doctor how long the care is expected to last and whether it is temporary (while you recover from surgery or illness) or ongoing. Ask the home health agency whether they are Medicare-certified, what services are included in your care plan, how often the aide will visit, and whether there are any costs to you beyond your Part B deductible.
Ask the agency how to report problems or request changes to your care plan, and ask for the name and phone number of the nurse supervisor. If you have questions about what Medicare covers, call 1-800-MEDICARE and ask to speak with a representative. You can also ask your doctor's office to clarify what services they have ordered and why.
Frequently Asked Questions
Can I pay my daughter to be my caregiver using Medicare?
No. Medicare does not pay family members for caregiving. However, your state's Medicaid program may offer a waiver that allows you to pay a family member if you meet income and asset limits. Contact your state Medicaid office or local Area Agency on Aging to learn whether this option is available where you live.
What if I need help but my doctor says I am not homebound?
Medicare home health services require that you be homebound. If you can leave home safely, Medicare will not cover in-home care. You may be able to get help through Medicaid, your state's aging program, or by paying privately. Your Area Agency on Aging can tell you what other programs might help.
Do I have to use the home health agency my doctor recommends?
No. Your doctor orders the care, but you can choose which Medicare-certified agency provides it. Ask your doctor for a list of agencies in your area, or call 1-800-MEDICARE to find one. Make sure any agency you choose is Medicare-certified before you agree to services.
Will Medicare pay for a live-in caregiver?
Medicare will not pay for a live-in caregiver, whether family or hired. Medicare home health services are provided for specific hours based on your care plan. If you need 24-hour care, you would need to pay privately, use Medicaid (if you may have access to), or explore other state or local programs.
What happens to my home health services if I go to the hospital?
Your home health services will pause while you are in the hospital. When you return home, your doctor can restart the services if you still meet the homebound requirement and need skilled care. Contact your home health agency to let them know you have been hospitalized so they can coordinate with your hospital discharge planner.