Medicare covers home health care when a doctor says you need skilled nursing or therapy at home and you meet specific conditions

Medicare Part A or Part B will pay for home health care if four things are true at the same time: a doctor has ordered it, you need skilled care (not just help with daily tasks), you are homebound or have a hard time leaving home, and a Medicare-approved home health agency provides the care. You do not pay a copay for most home health services under Part A, though Part B services may have a 20% coinsurance. The key is that Medicare pays for the skilled care itself — the nurse visits, physical therapy, wound care — not for a home aide to help you bathe or cook unless that aide is part of a skilled care plan.

Home health care is different from hiring a caregiver on your own. Medicare will only pay an agency it has approved, and that agency is responsible for coordinating your care and reporting to Medicare. If you hire someone privately, Medicare will not pay, even if that person is a licensed nurse.

Key Takeaways

  • Your doctor must order home health care and state in writing that you are homebound or have severe difficulty leaving home.
  • Medicare covers skilled nursing, physical therapy, occupational therapy, and speech therapy at home, but not custodial care or housekeeping alone.
  • You must use a Medicare-approved home health agency; Medicare will not pay if you hire a caregiver on your own.
  • Home health care is usually free under Part A after a hospital or skilled nursing facility stay, but Part B services have a 20% coinsurance.
  • Your doctor and the home health agency will decide how often you are visited and for how long, based on your medical needs.

The four conditions Medicare requires

First, a doctor must order home health care and document that you need it. This can be your primary care doctor, a specialist, or a hospital discharge planner. The order goes into your medical record and is sent to the home health agency. Without a written doctor's order, Medicare will not pay.

Second, you must need skilled care. This means nursing care that requires a licensed nurse — wound dressing, catheter care, medication management, or monitoring after surgery — or therapy from a physical therapist, occupational therapist, or speech-language pathologist. Help with bathing, dressing, or meals alone does not count as skilled care, even if you cannot do these things yourself. The skilled care is what Medicare is paying for; any other help is extra.

Third, you must be homebound. This does not mean you never leave your house. It means leaving home takes considerable and taxing effort because of an illness or injury, or you need supportive information to leave. A person recovering from a stroke who can leave only with a walker and someone's help, or someone with severe arthritis who cannot walk to a car without pain, is homebound. Someone who goes to the grocery store twice a week is not.

Fourth, the care must come from a Medicare-approved home health agency. You cannot hire a nurse or therapist privately and have Medicare pay. The agency is responsible for coordinating your care and reporting to Medicare. You can choose which approved agency you use, but it must be on Medicare's list.

What Medicare pays for and what it does not

Medicare Part A covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy at home after you have been in a hospital or skilled nursing facility for at least three days. There is no copay for these services. Part A also covers medical equipment like oxygen, walkers, and hospital beds, and supplies like wound dressings. This coverage is free as long as you remain homebound and need skilled care.

Medicare Part B covers the same skilled services if you have not had a hospital stay, but you pay 20% coinsurance after you meet your Part B deductible. Part B also covers some home health aide visits if they are part of a skilled care plan — for example, a home health aide might help you bathe on days when the nurse is not there, but only because the nurse is managing your wound care. The aide's visit is covered only because skilled nursing is also happening.

Medicare does not pay for custodial care — help with activities of daily living when no skilled care is involved. It does not pay for housekeeping, meal preparation, grocery shopping, or transportation. It does not pay for a live-in caregiver or 24-hour care. If you need these services, you pay out of pocket, use Medicaid if you are on both programs, or look into long-term care insurance or local senior services.

How to start the process with your doctor

Talk to your doctor about whether home health care makes sense for your situation. Be specific about what is hard for you to do — walking, bathing, managing medications, physical therapy after surgery. Your doctor will decide whether you meet the homebound requirement and whether you need skilled care. If your doctor agrees, they will write an order for home health care and send it to an agency.

If you are leaving a hospital or skilled nursing facility, the discharge planner will often arrange home health care before you go home. They will ask which Medicare-approved agencies are in your area and may give you a choice of two or three. If you are at home and your doctor thinks you need home health care, ask your doctor which agencies they work with or call your local Area Agency on Aging to find agencies near you. You have the right to choose the agency.

Once your doctor sends the order to the agency, a nurse from that agency will call you to schedule an initial assessment. During this visit, the nurse will review your medical history, check your home setup, and decide what skilled services you need and how often. The nurse will also explain what Medicare covers and what you may owe. This assessment is free and is covered by Medicare.

What happens during home health visits

A nurse or therapist will visit your home on a schedule your doctor and the agency set — this might be two or three times a week, or it might be daily for a short time after surgery. The visits are usually 30 minutes to an hour. During a nursing visit, the nurse might change a wound dressing, check your blood pressure and blood sugar, teach you how to take medications, or monitor how you are recovering from an illness. The nurse will also watch for signs that your condition is getting worse.

Physical therapy visits focus on strength, balance, and mobility — helping you walk safely, use stairs, or regain function after a stroke. Occupational therapy helps you manage daily tasks like dressing, cooking, or using the bathroom safely. Speech therapy addresses swallowing or communication problems. The therapist will also teach you exercises to do at home on days they are not there, and will report your progress to your doctor.

The home health agency is responsible for coordinating all your care. If the nurse thinks you also need physical therapy, the agency will arrange that. If something changes — you fall, you develop a new symptom, or you are not improving — the nurse reports this to your doctor, who may adjust your care plan or order additional services.

How long Medicare pays for home health care

There is no set time limit. Medicare will pay as long as your doctor says you need skilled care and you remain homebound. Some people need home health for a few weeks after surgery; others need it for months if they are recovering from a stroke or managing a chronic illness. Your doctor and the home health agency review your progress regularly and adjust the plan based on how you are doing.

If you improve and no longer need skilled care, or if you are no longer homebound, the agency will discharge you. If you need help after that — someone to help with bathing or cooking — you will need to pay for that privately or look into other programs like Medicaid waiver services, Veterans benefits, or programs through your local Area Agency on Aging. Ask the home health agency about these options before you are discharged.

What to ask your doctor and the home health agency

Before home health care starts, ask your doctor: "Do I meet Medicare's homebound requirement?" and "How long do you think I will need home health care?" Ask the home health agency: "Which services does Medicare cover for me, and which will I pay for?" "How often will I be visited?" "What should I do if I have a problem between visits?" and "How will you communicate with my doctor about my progress?"

Also ask whether the agency accepts your Medicare plan. If you are on a Medicare Advantage plan, some agencies may not be in your plan's network, or you may have different copays or prior authorization requirements. Confirm this before the first visit so there are no surprises about what you will owe.

When to contact your doctor or the agency

Call your doctor or the home health nurse right away if you develop a fever, have chest pain or shortness of breath, fall, or notice a wound is getting worse instead of better. Call if you are confused, very dizzy, or cannot take your medications. These are signs that your condition may be changing and your care plan may need to adjust.

If you have questions about what Medicare is paying or what you owe, call the home health agency's billing department. If you think Medicare should be paying for a service and the agency says it will not, you can ask the agency to submit a request to Medicare for review. You also have the right to appeal if you disagree with a decision about coverage.

Frequently Asked Questions

Can I choose which home health agency Medicare sends me to?

Yes. If you are in a hospital or skilled nursing facility, the discharge planner will give you a choice of Medicare-approved agencies in your area. If your doctor orders home health care while you are at home, ask your doctor which agencies they recommend, or call your local Area Agency on Aging for a list. You can pick the agency you want.

What if I live alone and need help with bathing but do not need nursing care?

Medicare does not cover help with bathing alone. You would need to pay privately for a home aide, or you may be able to get help through Medicaid if you are on both programs, or through a state or local program for seniors. Ask your doctor or your Area Agency on Aging about other options in your area.

Do I have to stay in my house all the time to be homebound?

No. Homebound means leaving home takes considerable effort because of your medical condition. You can go to a doctor's appointment or to church if someone helps you and it is difficult. The key is that you cannot leave regularly or independently because of your illness or injury.

Will Medicare pay for home health care if I have not been in a hospital?

Yes, Medicare Part B will pay if your doctor orders it and you meet the other requirements. You will pay 20% coinsurance after your deductible. Part A is free only if you have had a may have access to hospital or skilled nursing facility stay within the past 60 days.

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

Your doctor and the home health agency will discharge you when you no longer need skilled care or are no longer homebound. If you still need help at home — with bathing, meals, or housekeeping — you will need to pay privately or explore other programs like Medicaid, Veterans benefits, or local senior services.