Medicare covers home health care, but only under specific conditions

Medicare Part A and Part B together cover skilled home health services when you meet four requirements: a doctor must order the care, you must be homebound, the care must be medically necessary, and you must use a Medicare-certified agency. The coverage is substantial — Medicare pays the full cost of skilled nursing visits, physical therapy, occupational therapy, speech therapy, and medical social work. What Medicare does not cover is custodial care (help with bathing, dressing, or toileting when that is the only need), homemaker services, or care that is not medically necessary.

The distinction between skilled care and custodial care is the hinge on which coverage turns. Skilled care means a nurse or therapist must perform the task because it requires their training — wound dressing, medication management, catheter care, or therapy after surgery. Custodial care is help with activities of daily living that does not require a medical professional. If you need only custodial care, Medicare will not pay, and you will need to look at Medicaid, private pay, or long-term care insurance instead.

Key Takeaways

  • Medicare covers skilled home health services at no cost to you when ordered by a doctor, but only if you are homebound and the care is medically necessary.
  • Skilled care — nursing, therapy, medical social work — is covered; custodial care like bathing or dressing help is not, even if you need it daily.
  • You must use a Medicare-certified home health agency, and your doctor must recertify your need every 60 days or the coverage stops.
  • If you need only custodial care or care beyond what Medicare covers, Medicaid, private insurance, or out-of-pocket payment are your options.

What counts as skilled care under Medicare

Skilled nursing visits cover wound care, injections, catheter management, medication teaching, and monitoring of conditions like heart failure or diabetes. A nurse assesses your condition, adjusts your care plan, and documents changes that affect your treatment. Physical therapy covers exercises and techniques to restore function after stroke, surgery, or injury. Occupational therapy helps you relearn daily tasks — dressing, cooking, using the bathroom — when illness or injury has made them difficult. Speech therapy addresses swallowing problems or speech loss after stroke.

Medical social work is less visible but often essential: a social worker helps you navigate resources, arrange equipment, plan for discharge, and address barriers to recovery. All of these services must be ordered by your doctor and must have a clear medical reason tied to a recent hospitalization, acute illness, or change in condition. If you have been stable for months and straightforward need ongoing help, Medicare will not cover it, even if the help is medically sound.

The homebound requirement and what it means

You must be homebound — meaning leaving home requires considerable and taxing effort, or is medically contraindicated. You do not have to be bedridden. You can leave home for medical appointments, religious services, or adult day care, and still be homebound. What matters is that leaving home is not routine and that you need care at home because of your condition.

If you are able to go to a doctor's office, a therapy clinic, or a senior center regularly, Medicare may decide you are not homebound and will deny coverage. This is a common point of dispute. If your claim is denied on homebound grounds, you can appeal and provide evidence — a letter from your doctor, a description of the effort required, documentation of falls or near-falls when you try to leave.

How the certification and recertification process works

Your doctor must sign a home health certification form (called a HCFA 485) that states the medical reason for care, the type of services needed, and the expected duration. This certification is good for 60 days. At the end of 60 days, your doctor must recertify — sign another form saying you still need care and still meet the homebound requirement. If your doctor does not recertify, your coverage stops when ready, even if you still need the care.

The home health agency is responsible for obtaining the recertification, but you should ask about it yourself around day 55. If your doctor is slow to respond or if your condition has improved and your doctor believes you no longer need care, the agency will discharge you. You can appeal a discharge if you believe you still need care, but the burden is on you to show medical necessity.

What you pay and what the agency bills Medicare

When you receive care from a Medicare-certified agency, you pay nothing for the skilled services themselves. Medicare Part A covers the first 60 days of home health care after a hospital stay of at least 3 days. After 60 days, Part B takes over and covers ongoing skilled care with no time limit, as long as your doctor recertifies every 60 days. There is no copay, coinsurance, or deductible for home health services covered by Medicare.

The agency bills Medicare directly. You should receive an Explanation of Benefits (EOB) from Medicare showing what was billed and what Medicare paid. If you see charges on your bill that are not covered — for instance, a homemaker visit or a medication that is not on Medicare's list — ask the agency why you are being billed and whether the service is truly not covered or whether it was billed in error.

When Medicare does not cover home care and what to do instead

If you need only custodial care — help with bathing, dressing, grooming, toileting, or meal preparation — Medicare will not pay. If you need care but are not homebound, Medicare will not pay. If your doctor will not recertify, coverage ends. In these situations, you have three main routes: Medicaid (if you meet income and asset limits), private long-term care insurance (if you have a policy), or private pay.

Medicaid covers custodial care in the home in most states, but the rules vary widely. Some states cover it generously; others cover it only for people in nursing homes. You will need to contact your state Medicaid office to learn what is available. If you have a long-term care insurance policy, check the terms — many policies cover home care, including custodial care, once you meet the elimination period (usually 90 days of care at your own expense). If you have neither Medicaid nor insurance, you will pay out of pocket or look for community programs, senior centers, or volunteer services that may offer reduced-cost help.

How to start the process and what documents you need

Start by talking to your doctor. Tell them you need help at home and ask whether they believe you need skilled care. If they agree, ask them to order home health services and to sign the certification form. You do not need to find an agency first — your doctor can recommend one, or you can call Medicare at 1-800-MEDICARE and ask for a list of certified agencies in your area.

Once you have chosen an agency, they will handle most of the paperwork. You will need to provide your Medicare card, proof of identity, and a list of current medications. The agency will obtain the doctor's signature on the certification form. The first visit usually happens within a few days. If you are coming home from a hospital, the hospital discharge planner can arrange the referral and often coordinates with the agency before you leave.

Common reasons Medicare denies home health coverage

The most common denials are for lack of homebound status, lack of medical necessity, and failure to recertify. A second common reason is that the care ordered is custodial, not skilled — for example, a doctor orders "help with activities of daily living" without specifying a skilled component. A third is that the condition is chronic and stable, not acute or improving. Medicare expects home health to be temporary and goal-oriented: you receive care to recover from an event or to stabilize a new condition, not to manage a long-standing disability indefinitely.

If your claim is denied, you will receive a Notice of Medicare Non-Coverage (NOMNC) from the agency. This notice explains the reason and tells you how to appeal. You have the right to appeal within 120 days. Many denials are overturned on appeal if you can show that the care is truly skilled and medically necessary, or that you are homebound. If you are unsure whether you have grounds to appeal, contact your State Health Insurance information Program (SHIP) — they offer free help with Medicare appeals.

Frequently Asked Questions

Does Medicare cover home health after I leave the hospital?

Yes, if your doctor orders it and you meet the homebound and medical necessity requirements. Medicare Part A covers the first 60 days after a hospital stay of at least 3 days. After 60 days, Part B covers ongoing care with no time limit, as long as your doctor recertifies every 60 days.

What if I need help with bathing and dressing but no nursing care?

Medicare does not cover custodial care like bathing or dressing. You would need to look at Medicaid (if you may have access to), a long-term care insurance policy, or private pay. Some communities offer low-cost or volunteer services for seniors who need help with activities of daily living.

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

Yes. You can ask your doctor to recommend an agency, call Medicare at 1-800-MEDICARE for a list of certified agencies in your area, or ask the hospital discharge planner for options. The agency must be Medicare-certified, but you have the right to choose among certified providers.

What happens if my doctor stops recertifying my home health care?

Your coverage stops when ready when the 60-day certification expires without a new one. If you believe you still need care, you can appeal the discharge or ask your doctor why they will not recertify. If your condition has genuinely improved, the discharge may be appropriate, but you have the right to request a review.

Do I have to pay anything out of pocket for home health services?

No. Skilled home health services covered by Medicare have no copay, coinsurance, or deductible. If the agency bills you for a service, ask why — it may be a service Medicare does not cover, or it may be a billing error.