Medicare covers home health care only under specific conditions, and the amount it pays depends on the type of service, your medical need, and whether a doctor has ordered it

Medicare Part A (hospital insurance) pays for skilled nursing care and therapy services delivered at home if a doctor orders them, you are homebound, and a Medicare-approved agency provides the care. You pay nothing for these covered services — no copay, no coinsurance. Medicare Part B (medical insurance) covers some home health services under the same conditions, and you typically pay 20 percent of the approved amount after you meet your deductible.

The catch is that Medicare does not pay for custodial care — help with bathing, dressing, meals, or housekeeping — even if you need it daily. It also does not pay for services ordered by someone other than a doctor, or for care from an agency that is not Medicare-approved. Understanding which services Medicare will actually cover, and which ones you will pay for out of pocket, is the first step to planning home care costs.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy at home with no out-of-pocket cost if a doctor orders it, you are homebound, and a Medicare-approved agency provides it.
  • Medicare does not cover custodial care — bathing, dressing, meals, or housekeeping — no matter how much you need it.
  • The amount Medicare pays varies by service type and region, but you can find the exact payment rates on the Centers for Medicare & Medicaid Services website.
  • If you need ongoing custodial care, Medicaid, long-term care insurance, or out-of-pocket payment are your main options.
  • A home health agency must be Medicare-approved for Medicare to pay; you can verify this on Medicare.gov before you sign up.

What Medicare Part A Covers at Home

Part A covers skilled nursing care — wound care, catheter management, medication injection, or monitoring for a medical condition — when ordered by a doctor. It also covers physical therapy, occupational therapy, and speech-language pathology if they are medically necessary and ordered by a doctor. Home health aide services (bathing, dressing, toileting) are covered only when they are part of a skilled nursing or therapy visit — not as standalone custodial care.

You pay nothing for these services under Part A, as long as the agency is Medicare-approved and you meet the homebound requirement. "Homebound" means you cannot leave home without considerable and taxing effort, or a doctor has determined you should not leave. It does not mean you are bedridden or never leave the house; it means leaving requires medical equipment, information, or poses a medical risk.

Part A coverage is not unlimited. Medicare will pay for home health services for as long as they are medically necessary, but if your condition improves and you no longer need skilled care, coverage ends. There is no set number of visits or weeks — it depends on your medical need.

What Medicare Part B Covers at Home

Part B covers some home health services that Part A does not, including certain durable medical equipment (oxygen, wheelchairs, hospital beds), some diagnostic tests ordered by a doctor, and services from independent providers who are not part of a home health agency. You pay 20 percent of the Medicare-approved amount after you meet your annual Part B deductible (which varies by year).

Part B does not cover the same skilled nursing or therapy services that Part A covers — if you are may be able to access for Part A home health, Part A pays first. Part B is relevant mainly if you are not homebound or do not meet Part A's requirements, but still need certain medical equipment or services at home.

How Much Medicare Pays — and What Varies by Region

Medicare does not publish a single dollar amount for home health care. Instead, it pays agencies a bundled rate that covers all skilled nursing, therapy, and home health aide visits for a 60-day episode of care. The rate varies significantly by geographic region, type of diagnosis, and the mix of services needed.

For example, a 60-day episode of skilled nursing and physical therapy in one county might result in a Medicare payment of $3,000 to $5,000 to the agency, while the same services in a different region might be $4,500 to $6,500. The agency bills Medicare, not you — you see no bill if the agency is Medicare-approved and the services are covered.

To find the exact payment rates for your area, visit the Centers for Medicare & Medicaid Services (CMS) website and search for "home health payment rates" or "HH PPS rates" (Home Health Prospective Payment System). You can filter by state and county. These rates change annually, usually in October.

What You Pay Out of Pocket

If services are covered under Part A, you pay nothing — no copay, no coinsurance, no deductible. This applies to the first 60 days of a home health episode, as long as the agency is Medicare-approved and a doctor has ordered the care.

If you need services beyond what Medicare covers — custodial care, homemaking, meal preparation, or ongoing care after your medical need ends — you pay the full cost. Rates for private home care aides or homemakers range widely by region and agency, typically from $20 to $35 per hour for basic custodial care, and higher for specialized services. Some agencies charge a minimum number of hours per visit or per week.

If you have a Medigap or Medicare Advantage plan, check your policy to see whether it covers any home health services beyond what Original Medicare covers. Some plans offer limited coverage for custodial care or extended visits, but this varies widely.

How to Verify a Home Health Agency Is Medicare-Approved

Before you sign up with a home health agency, confirm it is Medicare-approved. Go to Medicare.gov, click "Care Providers," and search for home health agencies by name or location. The search tool will show you whether the agency is certified, any complaints filed against it, and inspection results.

You can also call your local Medicare office or your state's home health hotline (your doctor's office or hospital discharge planner can provide the number). Ask whether the agency is Medicare-approved and whether it accepts Medicare assignment — meaning it agrees to bill Medicare directly and not bill you for covered services.

If an agency is not Medicare-approved, Medicare will not pay for its services, even if a doctor orders them. You would pay the full cost out of pocket.

When Medicaid or Private Pay Becomes Necessary

If you need ongoing custodial care — help with daily living activities — Medicare will not pay. Your options are Medicaid (if you meet income and asset limits), a long-term care insurance policy (if you have one), or out-of-pocket payment.

Medicaid covers home care services in most states, but may be able to access rules vary. Some states cover custodial care generously; others cover it narrowly. You will need to contact your state Medicaid office to learn what is available in your area and whether you meet the income and asset limits.

If you do not have Medicaid and cannot afford private pay, ask your doctor, hospital discharge planner, or local Area Agency on Aging about low-cost or sliding-scale home care programs in your community. Some nonprofits and community health centers offer reduced-cost services based on income.

Frequently Asked Questions

Does Medicare pay for a live-in home health aide?

No. Medicare pays for home health aide services only as part of a skilled nursing or therapy visit. If you need a live-in aide for custodial care, you pay privately or through Medicaid (if may be able to access). Some agencies offer live-in aides on a private-pay basis, typically at a higher hourly rate than part-time visits.

What happens to my home health coverage if I go to the hospital?

If you are admitted to the hospital, your home health episode pauses. When you return home, the episode resumes, and Medicare continues to cover the remaining days (up to 60 total). If you are discharged to a skilled nursing facility instead of home, the home health episode ends.

Can I choose any home health agency, or does Medicare limit my options?

You can choose any Medicare-approved agency. Your doctor may recommend one, but you have the right to select a different agency. Always verify the agency is Medicare-approved before you sign up, and ask whether it accepts Medicare assignment.

Does Medicare pay for home health care after surgery?

Yes, if a doctor orders it and you meet the homebound requirement. Post-surgical wound care, physical therapy, and nursing visits are commonly covered. Coverage continues as long as the services are medically necessary — typically a few weeks to a few months, depending on the surgery and your recovery.

What if I need home health care but I am not homebound?

Medicare will not cover home health services if you do not meet the homebound requirement. You would need to pay privately or explore whether Medicaid covers services in your state. Some community health centers or nonprofits offer low-cost services regardless of homebound status.