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

Medicare Part A covers skilled nursing care and physical therapy delivered in your home, but only if a doctor orders it after a hospital stay of at least three days. Medicare Part B covers some home health services — mainly skilled nursing, physical therapy, occupational therapy, and speech therapy — without requiring a hospital stay first, as long as your doctor orders them and you are homebound or mostly homebound. Neither part covers custodial care, which is help with bathing, dressing, toileting, and meals when skilled medical care is not involved.

The distinction matters because it determines what you pay and how long coverage lasts. If Medicare covers your home care, you typically pay nothing for the service itself — Medicare pays the home health agency directly. If what you need is not covered, you pay the full cost out of pocket, or you look to Medicaid (which does cover custodial care in many states) or private long-term care insurance.

Key Takeaways

  • Medicare Part A covers skilled home care after a may have access to hospital stay; Part B covers it without a hospital stay if your doctor orders it and you are homebound.
  • Custodial care — help with bathing, dressing, and meals — is not covered by Medicare, even if you need it daily.
  • Your doctor must order home care and document that it is medically necessary for Medicare to pay; you cannot arrange it on your own.
  • Medicaid covers custodial care in most states and may cover skilled care too, but income and asset limits explore and they vary by state.
  • If you need ongoing personal care, private pay, Medicaid, or a long-term care insurance policy are usually your only options.

What Medicare Part A Covers After a Hospital Stay

If you spend three or more consecutive days in a hospital and are then discharged to home care, Medicare Part A covers skilled nursing visits and therapy (physical, occupational, or speech) for up to 60 days. The home health agency must be Medicare-certified, and your doctor must order the care and state that it is medically necessary. You pay nothing for these services — Medicare pays the agency directly.

The three-day hospital stay is a hard rule. Observation stays (where you are in the hospital but not formally admitted) do not count. If you were in the hospital for observation only, you do not meet the requirement, and Part A will not cover home care afterward. This is a common source of confusion and frustration, so ask the hospital before discharge whether your stay counts as an inpatient admission.

Part A coverage ends when your skilled care needs end — typically when you have recovered enough to manage on your own or when your condition stabilizes and no further improvement is expected. Your home health agency and doctor determine this, not you. Once coverage stops, you pay out of pocket if you want to continue receiving care.

What Medicare Part B Covers Without a Hospital Stay

Medicare Part B covers skilled home health services even if you did not have a hospital stay, as long as your doctor orders the care, documents that it is medically necessary, and certifies that you are homebound or mostly homebound. Homebound means you cannot leave home without considerable difficulty or the help of another person, or leaving home would be medically contraindicated. You do not have to be bedridden.

Part B covers skilled nursing (wound care, medication management, catheter care), physical therapy, occupational therapy, and speech therapy. It does not cover routine check-ins, medication reminders, or companionship. Your doctor must recertify the need for care every 60 days. You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible; Medicare pays the rest.

Part B home care can continue as long as your doctor certifies the need and you remain homebound. Unlike Part A, there is no set time limit. However, if you improve and are no longer homebound, coverage stops.

What Medicare Does Not Cover

Medicare does not cover custodial care — the day-to-day personal information that many people need most. This includes help with bathing, dressing, grooming, toileting, eating, and getting in and out of bed. It also does not cover housekeeping, meal preparation, laundry, or shopping, even if you cannot do these things safely on your own.

Medicare also does not cover 24-hour care, live-in caregivers, or ongoing supervision. If you need someone present all day and night, Medicare will not pay for it. Additionally, Medicare does not cover home care ordered by anyone other than a doctor — not by a nurse, social worker, or family member, even if they believe you need it.

Respite care (temporary relief for a family caregiver) is not covered by Medicare. Neither is care that is primarily for convenience or comfort rather than medical necessity. If your doctor does not order it and document a medical reason, Medicare will not pay.

How to Get Medicare Home Care Started

The process begins with your doctor. You or a family member must ask your doctor to order home health care and explain why you need it. Your doctor will write an order and send it to a Medicare-certified home health agency. You can choose which agency, or your doctor can recommend one. The agency will contact you to schedule an initial assessment.

During the assessment, a nurse will visit your home, review your medical history, and confirm that you meet Medicare's requirements — that you are homebound (if using Part B) and that the care ordered is medically necessary. If you meet the requirements, the agency will begin providing services. If you do not, the agency will tell you, and you will need to pay out of pocket or explore other options.

You will receive a document called the Home Health Advance Beneficiary Notice (ABN) if the agency believes Medicare may not cover the care. This notice tells you that you may be responsible for the cost. Read it carefully. If you disagree that the care is not covered, you can ask the agency to submit the claim to Medicare anyway, and Medicare will make the final decision.

Medicaid Coverage for Home Care in Your State

If Medicare does not cover the care you need, Medicaid may. Medicaid is a joint federal and state program, and each state sets its own rules about what home care it covers and who is may be able to access. Most states cover custodial care through Medicaid, but some limit it to people in nursing homes or assisted living facilities. A few states offer home and community-based services waivers that allow Medicaid to pay for in-home custodial care even if you could afford a facility.

Medicaid may be able to access depends on income and assets, and the limits vary by state. Some states use the federal poverty level; others set higher limits. Some count only your income; others count your spouse's income too. To find out what your state covers and whether you may be may be able to access, contact your state Medicaid office or call 211 and ask for a Medicaid referral.

If you are already on Medicare and have limited income, you may also be may be able to access for Medicaid at the same time — a situation called "dual may be able to access." In that case, Medicaid may cover services Medicare does not, including custodial care and some costs Medicare does not pay.

Private Pay and Long-Term Care Insurance

If you do not meet Medicare or Medicaid requirements, or if you need care that neither program covers, you can pay out of pocket. The cost of in-home care varies widely by region and type of care. A home health aide (who provides custodial care) may cost between $20 and $30 per hour in rural areas and $25 to $40 per hour in cities, though prices are higher in some places. Skilled nursing is typically more expensive.

If you purchased a long-term care insurance policy before you needed care, it may cover some or all of the cost of home care, depending on the policy. Review your policy documents or call your insurance company to understand what is covered, what the daily or monthly benefit is, and whether there are waiting periods before coverage begins.

Some people also use a combination of approaches: Medicare or Medicaid covers the skilled care, and they pay out of pocket for the custodial care and housekeeping they also need. This is common and often the most practical solution.

Frequently Asked Questions

Does Medicare cover a home health aide to help me bathe and dress?

No. Medicare covers skilled nursing and therapy, not custodial care like bathing and dressing. If a home health aide visits, it is only to help with a skilled task — for example, to help you practice exercises a physical therapist taught you. You would pay out of pocket for an aide to help with personal care, or you would need to be on Medicaid in a state that covers it.

My doctor says I need home care but I was not in the hospital. Will Medicare pay?

Medicare Part B may, if your doctor documents that you are homebound and the care is medically necessary. You do not need a hospital stay for Part B. Your doctor must order it and recertify every 60 days. Part A requires a three-day hospital stay, but Part B does not.

What if my home health agency says Medicare will not cover my care?

Ask the agency to give you a Home Health Advance Beneficiary Notice. This document explains why they believe Medicare will not pay and tells you that you may owe the cost. You can ask them to submit the claim to Medicare anyway, and Medicare will decide. You can also ask your doctor to clarify the medical necessity in writing.

Can I hire my own caregiver and have Medicare pay them?

No. Medicare only pays agencies that are Medicare-certified. You cannot hire an independent caregiver and bill Medicare. If you hire someone privately, you pay them directly out of pocket.

If I am on Medicaid, does it cover home care that Medicare does not?

In most states, yes — Medicaid covers custodial care that Medicare does not. But Medicaid rules vary by state, and you must meet your state's income and asset limits. Contact your state Medicaid office or call 211 to learn what your state covers and whether you may be may be able to access.