Medicare covers skilled nursing care, physical therapy, and occupational therapy when you receive them at home — but only if a doctor orders the care and you meet specific conditions.
Home health coverage through Medicare Part A (hospital insurance) pays for services delivered by nurses, therapists, and home health aides after you have been in a hospital or skilled nursing facility. The care must be ordered by your doctor, you must be homebound or have severe difficulty leaving home, and the services must be medically necessary. Medicare does not cover custodial care — help with bathing, dressing, or meals when that is the only service you need.
The amount Medicare pays depends on which services you receive and how often. You typically pay nothing for covered home health services, though you may owe a copay for certain equipment or supplies. The program covers up to 60 days of care in most cases, though that can extend if your condition requires it.
Key Takeaways
- Medicare Part A covers skilled nursing, physical therapy, occupational therapy, and speech therapy at home when ordered by your doctor after a hospital or nursing facility stay.
- You must be homebound or have severe difficulty leaving home, and a doctor must certify that the care is medically necessary for your condition.
- Custodial care — bathing, dressing, meal preparation, or housekeeping — is not covered by Medicare, even if delivered at home.
- You pay nothing for covered services, though you may owe a copay for medical equipment, and coverage typically lasts up to 60 days.
- A home health agency must be Medicare-certified, and your doctor must order the services before care begins.
What Services Medicare Covers at Home
Medicare Part A pays for skilled nursing care — wound care, injections, catheter management, and monitoring of your condition by a registered nurse. It covers physical therapy to help you regain strength and mobility after surgery or illness, occupational therapy to help you manage daily activities, and speech-language pathology when you have swallowing or speech problems. The program also covers home health aide services — personal care tasks like bathing and dressing — but only when a nurse or therapist is also treating you for a medical condition.
Medicare covers medical equipment and supplies ordered by your doctor: hospital beds, wheelchairs, walkers, oxygen, and wound care supplies. It pays for some of these items in full and requires a copay for others, depending on the equipment type. The agency must rent or sell only equipment that is medically necessary for your condition.
Services must be ordered by your doctor before the home health agency begins care. Your doctor certifies that you need the services and how often you should receive them. The agency submits this order to Medicare along with your medical history and reason for homebound status.
Who Qualifies for Medicare Home Health Coverage
You must meet three conditions for Medicare to cover home health. First, you must be homebound — unable to leave home without considerable and taxing effort, or leaving home only for medical appointments or religious services. Second, a doctor must order the care and certify it is medically necessary. Third, you must receive the care from a Medicare-certified home health agency.
Most people who receive home health coverage have recently left a hospital or skilled nursing facility. Medicare covers home health after a three-day hospital stay for the same condition, or after a skilled nursing facility stay. You do not have to have had a hospital stay to receive home health, but your doctor must document that you are homebound and that skilled care is necessary.
If you live in a nursing home or assisted living facility, you are not homebound for Medicare purposes, and Medicare will not cover home health services. If you are in a hospital or nursing facility now, ask your discharge planner whether you will meet the homebound requirement before you go home.
What Medicare Does Not Cover at Home
Medicare does not cover custodial care — personal care services when they are the only service you need. This includes bathing, dressing, grooming, toileting, meal preparation, and housekeeping. If you need only these services and no skilled nursing or therapy, Medicare will not pay, even if a home health aide provides them.
Medicare does not cover 24-hour care at home, live-in aides, or companions. It does not pay for homemaking services, yard work, or home repairs. It does not cover services from family members, even if they are paid. It does not cover over-the-counter medications, vitamins, or supplies not ordered by your doctor as medically necessary.
If you need only custodial care, you may be able to pay out of pocket, use Medicaid (if you may have access to), or explore long-term care insurance. Some Medicare Advantage plans offer additional home care benefits beyond Original Medicare, so check your plan documents or call your plan to ask what is covered.
How Long Medicare Covers Home Health
Medicare covers home health services for up to 60 days in a benefit period. A benefit period begins the day you start home health and ends 60 days later. If you still need care after 60 days, your doctor can request an extension, and Medicare will review whether the care remains medically necessary.
Some people receive home health for only a few weeks — for example, after surgery or a fall. Others need ongoing care for chronic conditions and may receive services for several months or longer if their doctor continues to order it and Medicare approves the extension. The number of visits per week varies based on your condition and your doctor's orders.
Your home health agency will tell you how many visits are approved and when your 60-day period ends. If you approach the end of your coverage and still need care, ask your doctor or the agency about requesting an extension before your current period runs out.
How to Start Home Health Services Through Medicare
Your doctor must order home health services and send the order to a Medicare-certified agency. If you are leaving a hospital or nursing facility, the discharge planner will help arrange this. If you are at home and your doctor thinks you need home health, ask your doctor to write the order and specify which agency you prefer, or ask for a referral to a local agency.
Once your doctor sends the order, the home health agency will contact you to schedule an initial assessment. A nurse will visit your home to review your medical history, current medications, and what you need help with. The nurse will also confirm that you are homebound and that the services ordered match your needs. This visit usually takes 60 to 90 minutes.
After the assessment, the agency will submit your information to Medicare for approval. This typically takes a few days. Once approved, the agency will schedule your first therapy or nursing visit. You will receive a summary of what Medicare covers, what you owe, and how often services will be provided.
What You Pay for Home Health Services
You pay nothing for covered home health services under Medicare Part A — no copay, no coinsurance, and no deductible. This is true whether you receive skilled nursing, therapy, or home health aide services. However, you may owe a copay for certain medical equipment: 20% of the approved amount for items like wheelchairs, walkers, or oxygen equipment.
If you have a Medigap policy (supplemental insurance), it may cover some or all of the equipment copays. If you have a Medicare Advantage plan, your costs may differ — some plans cover more home health services than Original Medicare, and some charge copays for visits. Check your plan documents or call your plan to understand your costs before services begin.
If you cannot afford the copay for equipment, ask the home health agency or your doctor whether the equipment is truly necessary or whether a lower-cost alternative exists. Some agencies have financial information programs for patients who cannot pay.
Frequently Asked Questions
Can Medicare cover home health if I have not been in a hospital?
Yes, but your doctor must document that you are homebound and that skilled nursing or therapy is medically necessary. Medicare does not require a hospital stay, though most people who receive home health have recently left one. Your doctor's order and certification are what matter most.
Does Medicare cover a live-in aide or 24-hour care at home?
No. Medicare covers home health aide services only when a nurse or therapist is also treating you, and only for the hours ordered by your doctor. It does not pay for live-in aides, overnight care, or companions. If you need 24-hour care, you may need to explore private pay, Medicaid, or long-term care facilities.
What happens if I leave home for a doctor's appointment while receiving home health?
You can leave home for medical appointments or religious services and still be considered homebound. Leaving for other reasons — shopping, visiting friends, or running errands — may disqualify you. Tell your home health agency about any trips so they can adjust your schedule if needed.
Can I choose which home health agency provides my care?
Yes. Your doctor can order services from any Medicare-certified agency you choose. If you do not have a preference, your doctor or hospital discharge planner can recommend one. You can also call your local Area Agency on Aging or your state health department to find certified agencies in your area.
What if my condition improves and I no longer need home health?
Tell your home health agency or your doctor. The agency will discharge you from services, and Medicare will stop paying. If your condition worsens later and you need home health again, your doctor can order it again, and a new 60-day benefit period will begin.