Medicare covers some in-home care, but not all of it, and the amount varies by the type of care you need

Medicare pays for skilled nursing care and physical, occupational, or speech therapy delivered in your home — but only if a doctor orders it, you meet specific conditions, and you use a Medicare-approved provider. Medicare does not pay for custodial care (help with bathing, dressing, or meals) or for ongoing personal information. What you pay depends on whether you are on Original Medicare or a Medicare Advantage plan, and whether the care is considered part of a home health episode or a different service.

The most important thing to understand upfront: Medicare's definition of "home care" is narrower than what many people think. If you need someone to help you get dressed or prepare meals, Medicare will not cover that. If you need skilled nursing — like wound care, catheter management, or monitoring after surgery — Medicare may cover it, but only under strict conditions.

Key Takeaways

  • Medicare covers skilled nursing and therapy services in your home only when ordered by a doctor and provided by a Medicare-approved home health agency.
  • You pay nothing for covered home health services if you meet the homebound requirement and your doctor certifies medical necessity, but you may pay a copay for certain supplies or equipment.
  • Medicare does not cover custodial care — help with bathing, dressing, eating, or housekeeping — even if you need it daily.
  • Home health coverage requires that you be homebound or have severe difficulty leaving home, and that you receive care from a certified agency, not a private caregiver you hire yourself.
  • If you need ongoing personal care, you may need to pay out of pocket, use Medicaid (if you may have access to), or explore long-term care insurance options.

What Medicare Covers Under Home Health Services

Medicare covers skilled nursing visits — a nurse performing medical tasks like wound dressing, injections, catheter care, or monitoring vital signs after hospitalization or for a chronic condition. It also covers therapy services: physical therapy to regain mobility, occupational therapy to relearn daily tasks, and speech therapy for swallowing or communication problems. These services must be ordered by your doctor and delivered by a Medicare-approved home health agency.

Medicare also covers medical equipment and supplies used during home health visits — things like wound dressings, catheters, or oxygen equipment. You typically pay 20 percent of the approved amount for durable medical equipment (like a walker or hospital bed), but the equipment must be deemed medically necessary and prescribed by your doctor.

Home health aide visits — a trained aide helping you with bathing, dressing, or toileting — are covered only if they occur alongside skilled nursing or therapy visits. The aide cannot be the only service; skilled care must be the primary reason for the home health episode.

What Medicare Does Not Cover

Medicare does not pay for custodial care — personal information with activities of daily living like bathing, dressing, eating, toileting, or grooming. It does not cover housekeeping, meal preparation, laundry, or shopping, even if you cannot do these tasks yourself. It does not cover 24-hour care or live-in caregivers. It does not cover care from a family member or a private caregiver you hire on your own.

Medicare also does not cover ongoing care once you no longer need skilled services. If you recover from surgery and no longer require nursing or therapy, home health coverage ends, even if you still need help with daily tasks. This is the gap that catches many people: they assume Medicare will cover long-term personal care, and it does not.

What You Pay for Covered Home Health Services

If you are on Original Medicare and you meet all the conditions for home health coverage, you pay nothing for the skilled nursing and therapy visits themselves. You do not pay a copay or coinsurance for home health services covered under Part A (Hospital Insurance). However, you may pay 20 percent coinsurance for durable medical equipment prescribed during your care.

If you are on a Medicare Advantage plan, your costs depend on your specific plan. Some plans cover home health with no copay; others charge a copay per visit (typically $0 to $50). Check your plan documents or call the plan to learn your exact costs before you need the service.

You are responsible for any services Medicare does not cover — custodial care, ongoing personal information, or care from a private caregiver. These costs come entirely out of your pocket unless you have a separate long-term care insurance policy or you may have access to for Medicaid.

The Homebound Requirement and How It Works

To receive Medicare-covered home health services, you must be homebound — meaning you have a medical condition that makes it difficult or impossible to leave home without help. You do not have to be bedridden. You might be homebound because you use a wheelchair, have severe arthritis that makes walking painful, or are recovering from surgery and your doctor has ordered bed rest. The key is that leaving home requires a supportive person or significant effort.

Your doctor must certify that you are homebound and that skilled care is medically necessary. The home health agency will verify this before they start visits. If you are able to leave home regularly — to go to appointments, shopping, or social activities — you may no longer meet the homebound requirement, and Medicare will stop covering your home health services.

How to Start Home Health Services Through Medicare

Your doctor must order home health services and refer you to a Medicare-approved home health agency. You cannot start home health on your own; it always begins with a doctor's order. Your doctor will specify what type of care you need — skilled nursing, physical therapy, or both — and how often you should receive it.

Once your doctor places the order, contact a Medicare-approved home health agency in your area. You can search for agencies on Medicare.gov or ask your doctor for a recommendation. The agency will schedule an initial assessment visit to confirm your medical needs and set up a care plan. The agency bills Medicare directly for covered services; you do not submit claims yourself.

Home health episodes typically last 60 days. At the end of that period, your doctor and the agency will reassess whether you still need skilled care. If you do, a new episode can begin. If you no longer need skilled services, coverage ends.

When You Need Care Medicare Does Not Cover

If you need ongoing personal care — someone to help you bathe, dress, and prepare meals — but you do not may have access to for Medicare home health services, you have several options. You can pay out of pocket for a private caregiver or home care agency. Costs vary widely by location and the number of hours needed, but can range from $15 to $30 per hour for basic personal care.

If your income and assets are low enough, Medicaid may cover personal care services in your home. Medicaid is a joint federal-state program, and coverage varies by state. Some states offer robust home and community-based services; others offer less. Contact your state Medicaid office to learn what is available where you live.

Long-term care insurance, if you have a policy, may cover in-home personal care. Review your policy to see what services and what daily amount it covers. Some policies pay a fixed daily benefit; others reimburse actual costs up to a limit.

Medicare Advantage Plans and Home Health Coverage

Medicare Advantage plans must cover at least the same home health services that Original Medicare covers — skilled nursing and therapy — but they may have different rules about copays, the number of visits, or which agencies you can use. Some plans limit you to in-network agencies; others allow any Medicare-approved agency.

Before you need home health services, review your Medicare Advantage plan's summary of benefits or call the plan to understand your out-of-pocket costs. Ask specifically about copays per visit, any limits on the number of visits, and whether you can use any Medicare-approved agency or only in-network providers. This information will help you plan and avoid surprises.

Frequently Asked Questions

Does Medicare cover a live-in caregiver or 24-hour care at home?

No. Medicare does not cover live-in caregivers or round-the-clock personal care. It covers skilled nursing and therapy visits ordered by a doctor, but not continuous custodial care. If you need 24-hour information, you would need to pay privately, use Medicaid if you may have access to, or explore long-term care insurance.

What if I need help with bathing and dressing but not nursing care?

Medicare does not cover personal care alone. If you need only help with bathing, dressing, or meals and do not need skilled nursing or therapy, Medicare will not pay for it. You would need to pay out of pocket, explore Medicaid in your state, or use long-term care insurance if you have it.

Can I hire my own caregiver and have Medicare pay for it?

No. Medicare only pays home health agencies that are Medicare-approved. You cannot hire a private caregiver and bill Medicare. If you use a private caregiver, you pay them directly out of pocket.

How long does Medicare cover home health services?

Home health episodes last 60 days. If your doctor determines you still need skilled care after 60 days, a new episode can begin. Coverage continues as long as you are homebound and need skilled nursing or therapy ordered by your doctor. Once you no longer need skilled services, coverage ends.

Will Medicare cover home health if I live in an assisted living facility or nursing home?

Generally, no. If you live in a facility that provides care, Medicare assumes that facility is responsible for your care. However, there are exceptions — for example, if you need specialized therapy that the facility cannot provide. Ask your facility and your doctor whether Medicare home health services are possible in your situation.