Medicare home health care covers skilled nursing, physical therapy, and medical equipment — but only if a doctor orders it and you meet specific conditions
Medicare Part A and Part B together pay for home health services when a doctor determines you need them after a hospital stay, skilled nursing facility stay, or for a worsening condition at home. The services must be ordered by your doctor, delivered by a Medicare-certified agency, and tied to a medical need — not general help with daily living. You must also be homebound, meaning leaving home requires considerable effort or help, though you can leave for medical appointments or religious services.
Home health is different from home care. Medicare does not pay for a housekeeper, personal care attendant, or someone to help you bathe and dress unless that person is a licensed nurse or therapist providing skilled care as part of your treatment plan. Understanding what falls under Medicare coverage and what you would pay for privately can help you plan ahead and avoid surprise bills.
Key Takeaways
- Medicare covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy ordered by your doctor for a medical reason.
- You must be homebound and the care must follow a hospital stay, skilled nursing facility stay, or be ordered for a worsening condition — routine checkups alone do not may have access to.
- Medicare pays the home health agency directly; you typically pay nothing if the agency is Medicare-certified and the services are covered.
- Home health aides who help with bathing, dressing, and toileting are covered only when a nurse or therapist is also visiting for skilled care.
- Custodial care, housekeeping, meal preparation, and transportation are never covered by Medicare, even if ordered by a doctor.
Skilled Nursing and Therapy Services Medicare Pays For
Skilled nursing visits are the most common home health service Medicare covers. A registered nurse or licensed practical nurse can assess your condition, manage wounds, give injections, monitor vital signs, teach you how to use medical equipment, and adjust medications. These visits are covered when ordered by your doctor for a specific medical reason — for example, wound care after surgery, monitoring for infection, or teaching you to use a new insulin pump.
Physical therapy helps you regain strength and mobility after an injury, stroke, or surgery. An occupational therapist helps you relearn daily tasks like dressing, cooking, and using the bathroom safely. Speech therapy addresses swallowing problems or speech difficulties after a stroke or other condition. All three are covered when your doctor orders them and a therapist documents that you are making progress toward a specific goal.
Home health aides can help with bathing, dressing, toileting, and grooming — but only when a nurse or therapist is also visiting your home for skilled care. If you need only aide services with no skilled nursing or therapy, Medicare does not pay. The aide's visits must be part of your overall treatment plan and supervised by a nurse or therapist.
Medical Equipment and Supplies Medicare Covers at Home
Medicare Part B pays for durable medical equipment (DME) prescribed by your doctor and used in your home. This includes hospital beds, wheelchairs, walkers, canes, oxygen equipment, continuous positive airway pressure (CPAP) machines, and diabetic testing supplies. You typically pay 20 percent of the approved amount after you meet your Part B deductible; Medicare pays 80 percent.
Supplies related to your condition — such as wound dressings, catheter supplies, or ostomy bags — may be covered under Part B or as part of your home health plan. Your home health agency can tell you whether supplies are included in the skilled nursing visits or whether you need to order them separately through a DME supplier.
Equipment that is not medically necessary — such as a chair lift for convenience, a grab bar installed as a safety feature without a medical reason, or a bed rail — is not covered. The equipment must be prescribed by your doctor for a specific medical condition.
Conditions That Must Be Met for Coverage
Your doctor must order home health services, and you must be under the care of a physician who oversees your treatment plan. The home health agency must be Medicare-certified; if it is not, Medicare will not pay, and you could be billed for the full cost. You can check whether an agency is certified by searching the Medicare Care Compare tool on Medicare.gov.
You must be homebound, which means leaving home is medically contraindicated or requires supportive information and considerable and taxing effort. You can leave home for medical appointments, religious services, or adult day care, but you cannot be going to work or running errands regularly. If a nurse visits and finds you are not homebound, the visit may not be covered.
The services must be medically necessary and related to your diagnosis. Routine wellness visits, preventive care, or monitoring without a specific treatment goal are not covered. Your doctor must document that the home health services are needed to treat your condition, not straightforward to monitor it.
What Medicare Home Health Does Not Cover
Custodial care — help with bathing, dressing, toileting, and eating when no skilled nursing or therapy is needed — is not covered by Medicare. If you need only personal care, you must pay privately or through Medicaid if you may have access to. Many seniors pay out of pocket for home care aides or use long-term care insurance for this type of help.
Housekeeping and meal preparation are never covered, even if your doctor says they would help your recovery. Cleaning, laundry, grocery shopping, and cooking are considered custodial, not skilled care. Some area agencies on aging or local nonprofits offer these services at low cost; your social worker or discharge planner can refer you.
Transportation to medical appointments is not covered by Medicare home health, though some agencies may help arrange it. Medications are covered under Part D (prescription drug coverage), not home health. Nutritional supplements and over-the-counter items are not covered. Live-in caregivers are not covered under any Medicare benefit.
How to Start Home Health Services and What to Expect
Home health services usually begin after you leave a hospital or skilled nursing facility. Before discharge, a hospital social worker or discharge planner will ask whether you want home health services. If you say yes, the hospital will refer you to a Medicare-certified agency in your area. You can also request a specific agency if you have a preference, and the hospital should honor that request if the agency is available and certified.
If you are at home and your doctor believes you need home health services, your doctor can order them directly. Call your doctor's office and ask them to place a home health order. The agency will contact you within one business day to schedule an initial assessment visit. During this visit, a nurse will review your medical history, current medications, and what you need help with, then create a treatment plan.
Medicare covers home health services with no copay or coinsurance if the agency is certified and the services are covered. You are responsible for any services that are not covered — for example, if you ask an aide to do housekeeping, you pay for that time out of pocket. Ask the agency upfront which services are covered and which are not.
When Home Health Coverage Ends
Medicare stops paying for home health when your doctor determines you no longer need skilled care, when you no longer meet the homebound requirement, or when you are not making progress toward your treatment goals. The agency must notify you in writing before they discharge you. If you disagree with the discharge decision, you have the right to appeal.
If you are discharged but still need help at home, ask your social worker or nurse about other options: Medicaid home care (if you may have access to), programs through your local area agency on aging, or private pay agencies. Some seniors transition from Medicare-covered skilled care to privately paid home care aides or housekeeping services.
Questions to Ask Your Doctor and Home Health Agency
Before home health services start, ask your doctor: "What specific medical reason are you ordering home health for?" and "How long do you expect I will need these services?" Ask the agency: "Is your agency Medicare-certified?" "Which services are covered by Medicare and which would I pay for?" and "What is your cancellation or discharge policy?"
During your care, ask: "Am I making progress toward my treatment goals?" and "When do you expect my services to end?" If you receive a bill you believe should have been covered, contact the agency first. If the issue is not resolved, you can file a complaint with your state's home health ombudsman or contact Medicare directly at 1-800-MEDICARE.
Frequently Asked Questions
Does Medicare cover home health after I leave the hospital?
Yes, if your doctor orders it and you meet the homebound requirement. Most home health services begin within one to three days of hospital discharge. The hospital discharge planner will arrange this before you leave, or your doctor can order it after you are home.
Do I have to use the home health agency the hospital recommends?
No. You can request a different Medicare-certified agency in your area. Tell the hospital or your doctor which agency you prefer, and they should place the order with that agency instead. Make sure the agency you choose is Medicare-certified.
What if I need help at home but do not meet the homebound requirement?
Medicare home health will not cover you. You can pay privately for home care aides, or you may may have access to for Medicaid home care services if your income and assets are low enough. Contact your local Medicaid office or area agency on aging to learn what programs are available in your state.
Can Medicare home health pay for someone to help me with housekeeping and cooking?
No. Medicare covers only skilled nursing and therapy services. For housekeeping and meal preparation, you would need to pay privately or check whether your local area agency on aging offers these services at reduced cost.
What happens if I disagree with being discharged from home health?
You have the right to appeal. The agency must give you written notice before discharge. You can request a detailed explanation of why they believe you no longer need skilled care, and you can ask for a second opinion from your doctor or another healthcare provider.