Medicare covers home health care, but only under specific conditions

Medicare Part A and Part B together cover home health care when a doctor orders it for a medical reason and you meet certain requirements. The care must be skilled nursing or therapy — things like wound care, physical therapy, or medication management — not help with daily tasks like bathing or cooking. You must be homebound or have a hard time leaving home, and you must be under the care of a Medicare-approved home health agency. If these conditions are met, Medicare pays the full cost of the covered services with no copay or deductible.

The catch is that Medicare does not cover custodial care — help with activities of daily living — even if you need it badly. If you need someone to help you bathe, dress, or prepare meals but do not need skilled medical care, Medicare will not pay for it. Many people discover this gap only after a hospital stay, when they assume all home care is covered.

Key Takeaways

  • Medicare covers skilled nursing care and therapy services ordered by a doctor through a Medicare-approved home health agency, with no copay or deductible.
  • You must be homebound or have difficulty leaving home, and a doctor must determine the care is medically necessary.
  • Medicare does not cover custodial care — help with bathing, dressing, meals, or housekeeping — even if you live alone and need it.
  • Home health services are usually covered under Part A if you recently left a hospital or skilled nursing facility, or under Part B if you are receiving ongoing care at home.
  • You will need to work with a Medicare-approved agency; care from an unapproved provider is not covered.

What counts as skilled care that Medicare will pay for

Skilled care means services that require a nurse, physical therapist, occupational therapist, or speech-language pathologist. Examples include changing sterile wound dressings, managing a catheter, giving injections, physical therapy after a stroke or surgery, occupational therapy to regain function, and speech therapy after a swallowing problem. Skilled nursing also includes teaching you or a family member how to manage a medical condition — for instance, how to use an insulin pump or recognize signs of heart failure.

The service itself has to be something that requires training and judgment, not just routine help. A nurse checking your blood pressure and adjusting your blood pressure medication is skilled care. A home health aide helping you take a shower is not, even if the aide works for a skilled nursing agency. Medicare will cover the aide's visit only if the nurse is also there that day for a skilled service, and only for the time the aide spends helping with the skilled task — not for general personal care.

When Medicare Part A covers home health care

Part A covers home health care when you are discharged from a hospital or skilled nursing facility and your doctor orders home health services. This is called post-acute care. You must have been an inpatient in the hospital for at least three consecutive days (not counting the day you were discharged) or in a skilled nursing facility for at least three days before coming home. The home health care must start within 60 days of leaving the facility.

Under Part A, Medicare covers the full cost of the home health services — nursing visits, therapy, and home health aide services — with no copay or deductible. This coverage continues as long as your doctor says the skilled care is medically necessary. Once you no longer need skilled care, the coverage stops, even if you still need help at home.

When Medicare Part B covers home health care

Part B covers home health care when you are not coming directly from a hospital or facility but your doctor still orders it because you are homebound and need skilled services. You do not need a three-day hospital stay to may have access to under Part B. Your doctor straightforward has to document that you are homebound — meaning you cannot leave home without help, or leaving home causes you significant pain or exhaustion — and that skilled care is medically necessary.

Under Part B, Medicare covers the skilled nursing and therapy services but not the home health aide visits unless a nurse or therapist is also visiting that same day for a skilled service. You pay 20 percent of the Medicare-approved amount for each service after you meet your Part B deductible. If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower.

What you have to do to get home health care covered

Your doctor must order home health services and document that they are medically necessary. You cannot arrange home health on your own and expect Medicare to pay; the order has to come from your physician. Your doctor will send the order to a Medicare-approved home health agency, which will contact you to set up an initial assessment visit.

During the assessment, a nurse will evaluate your medical condition, your home setup, and what skilled care you need. The agency will create a plan of care that lists the services, how often you will receive them, and for how long. Medicare requires the agency to recertify your need for care every 60 days. If your condition improves and you no longer need skilled care, the services will stop.

You are responsible for telling your doctor and the home health agency about any changes in your condition or your ability to manage at home. If you move, change doctors, or stop needing the services, let the agency know right away so they can update your records.

The difference between Medicare-approved and non-approved agencies

Medicare only pays for home health services from agencies that are Medicare-certified. You can check whether an agency is certified by searching the Medicare Care Compare tool on Medicare.gov or by calling 1-800-MEDICARE. If an agency is not certified, Medicare will not pay for its services, even if the care is skilled and your doctor ordered it.

Some agencies are certified for certain types of care but not others. For example, an agency might be certified to provide skilled nursing and physical therapy but not occupational therapy. Before you start services, ask the agency which services are covered under your Medicare plan and which are not. If the agency recommends services that are not covered, you have the right to refuse them or to pay out of pocket if you choose.

What happens when home health care ends

Home health services end when your doctor determines you no longer need skilled care, when you move to a facility like a nursing home, or when you stop making progress toward your goals. Medicare does not cover ongoing custodial care at home, so if you need help with daily tasks after skilled services end, you will have to pay for it yourself, use Medicaid if you may have access to, or rely on family and friends.

Some people transition from home health care to adult day programs, senior centers, or community services that help with meals, transportation, and social activities. Your doctor, social worker, or the home health agency can help you find these resources. If you have a Medicare Advantage plan, it may offer additional services like meal delivery or transportation that are not covered by Original Medicare.

Frequently Asked Questions

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

Only if a nurse or therapist is also visiting that same day for a skilled service. Medicare does not cover custodial care — help with bathing, dressing, meals, or housekeeping — on its own. If you need only personal care and no skilled nursing or therapy, you will have to pay out of pocket, use Medicaid if you may have access to, or arrange care through a private agency.

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

Medicare requires that you be homebound or have a hard time leaving home for home health services to be covered. If you can leave home without difficulty, Medicare will not cover home health care even if your doctor thinks it would be helpful. You could pay out of pocket or ask your doctor whether outpatient therapy at a clinic or hospital would work instead.

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

Yes. Your doctor will give you an order for home health care, but you can choose any Medicare-certified agency to provide it. Ask your doctor, hospital discharge planner, or social worker for names of agencies in your area. You can also search Medicare Care Compare on Medicare.gov. Once you choose an agency, it will contact you to schedule the first visit.

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

It depends on the type of facility and the services. If you live in your own apartment within an assisted living community, Medicare may cover home health services ordered by your doctor. If you live in a shared room or the facility provides most of your care, Medicare may not. Ask the facility administrator and your doctor whether your situation qualifies.

What if I disagree with my home health agency about when services should end?

You have the right to ask for a second opinion from your doctor. If your doctor agrees that you still need skilled care, the agency must continue services or you can switch to another Medicare-certified agency. If your doctor agrees with the agency that you no longer need skilled care, Medicare will not pay for further services, but you can pay out of pocket if you choose to continue.