Medicare covers home health care, but only under specific conditions

Medicare Part A covers skilled home health care when a doctor orders it, you are homebound, and a Medicare-approved agency provides the care. You pay nothing for the visits themselves — no copay, no coinsurance — as long as the care meets Medicare's rules. However, Medicare does not cover custodial care (help with bathing, dressing, or toileting alone), meal delivery, or housekeeping. If you need those services, you pay out of pocket or look into Medicaid, which has different rules.

The key word is skilled care. This means a nurse, physical therapist, occupational therapist, or speech therapist must provide the service, or a home health aide must work under a therapist's or nurse's plan. A visit to check your blood pressure, teach you to use a new medication, or help you regain strength after surgery counts. A visit to help you shower because you are frail does not, even if you live alone.

Key Takeaways

  • Medicare Part A pays the full cost of skilled home health visits when a doctor orders them, you cannot leave home without help, and a Medicare-approved agency sends the worker.
  • You must be homebound — meaning leaving home takes considerable effort and is medically contraindicated, not straightforward that you prefer to stay home.
  • Medicare does not cover help with bathing, dressing, meals, or housekeeping unless those tasks are part of a skilled therapy plan.
  • If Medicare stops paying, you can appeal the decision, and your agency must tell you in writing before the last covered visit.
  • Medicaid may cover custodial care in your state, but the rules and income limits differ from Medicare.

When Medicare pays for home health care

Medicare Part A covers home health care only when all four of these conditions are met. First, a doctor must order it and sign an order saying you need skilled care. Second, you must be homebound — meaning you cannot leave home without help, or leaving would risk your health. Third, the care must be skilled: wound care, physical therapy, medication management, catheter care, or similar services that require training. Fourth, a Medicare-approved home health agency must provide the care.

Being homebound does not mean you never leave the house. It means leaving requires considerable effort, help from another person, or medical equipment, and that leaving would be medically inadvisable. A person who uses a walker and can walk to the mailbox but cannot safely travel to a doctor's office may be homebound. A person who stays home because they are depressed or afraid is not homebound under Medicare's definition, even if they rarely go out.

The doctor's order is the starting point. If your doctor thinks you need home health care, ask them to write the order and send it to a Medicare-approved agency. The agency will contact you to schedule an intake visit. At that visit, a nurse will assess whether you meet Medicare's homebound requirement and whether the care ordered is skilled care. If Medicare later denies the claim, the agency must tell you in writing before your last covered visit, and you have the right to appeal.

What services Medicare covers at home

Medicare covers visits from a registered nurse (RN) or licensed practical nurse (LPN) for wound care, injections, catheter management, medication teaching, and monitoring of your condition. It covers physical therapy to help you regain strength or mobility after surgery or illness. It covers occupational therapy to help you relearn daily tasks, and speech therapy if you have swallowing or speech problems. It covers home health aide visits, but only when a nurse or therapist has created a plan of care and the aide is carrying out that plan — not straightforward helping with personal care.

Medicare also covers medical equipment and supplies ordered by your doctor as part of home health care: oxygen, wound dressings, catheters, and similar items. The agency bills Medicare directly for these, and you pay nothing. If the agency charges you for covered supplies, report it to Medicare.

Services Medicare does not cover include housekeeping (cleaning, laundry, yard work), meal preparation or delivery, shopping, transportation, or help with bathing and dressing unless those tasks are part of a skilled therapy plan. For example, if a physical therapist is teaching you to bathe safely after a stroke, that teaching visit is covered. If a home health aide is straightforward helping you bathe because you are frail, it is not.

How long Medicare pays and what happens when it stops

There is no set limit on how long Medicare will pay for home health care. As long as your doctor orders it, you remain homebound, and the care is skilled, Medicare continues to cover it. However, the agency must recertify your need every 60 days. At each recertification, a nurse reviews whether you still meet the homebound requirement and whether the skilled care is still necessary.

If your condition improves and you no longer need skilled care, or if you are no longer homebound, Medicare will stop paying. The agency must notify you in writing at least two days before your last covered visit. If you disagree with the decision, you can appeal. The appeal process starts with the agency's supervisor, then moves to Medicare's contractor for your state, and can eventually reach an administrative law judge.

If you run out of Medicare coverage or need services Medicare does not cover, ask the agency about private pay rates. Some agencies offer services on a private-pay basis at an hourly rate. Medicaid may also cover home care in your state, though the rules differ from Medicare — Medicaid often covers custodial care and has different income limits.

Your costs under Medicare home health care

If you have Medicare Part A and meet all the conditions for home health care, you pay nothing for the skilled nursing visits, therapy visits, or home health aide visits. You also pay nothing for medical equipment and supplies ordered as part of your home health plan. This is true even if you have not met your Part A deductible for the year.

However, if you need services that are not covered — such as housekeeping, meal delivery, or custodial care — you pay the full cost out of pocket. Some agencies offer these services privately, and you can ask for a price quote. If you have a Medigap or Medicare Advantage plan, check your plan documents to see whether it covers any non-Medicare services.

How to start home health care through Medicare

The process begins with your doctor. If you are recovering from surgery, hospitalization, or illness and think you need help at home, ask your doctor whether home health care is appropriate. Your doctor will write an order and send it to a Medicare-approved agency, or you can ask for a list of agencies in your area and contact one directly. The agency will verify that your doctor has written an order before scheduling your first visit.

To find a Medicare-approved home health agency, visit Medicare.gov and use the "Care Compare" tool, or call 1-800-MEDICARE to ask for agencies near you. When you contact an agency, ask whether it is Medicare-approved and whether it accepts Medicare assignment (meaning it bills Medicare directly and you pay nothing for covered services).

At your intake visit, bring your Medicare card and any insurance cards you have. The nurse will ask about your medical history, current medications, and what help you need. Be honest about what you can and cannot do — this determines whether you meet the homebound requirement. The agency will then submit your information to Medicare for approval. Once approved, your visits begin.

What to do if Medicare denies home health care

If Medicare denies your claim or stops paying before you think it should, you have the right to appeal. The agency must give you written notice at least two days before your last covered visit, and that notice must explain why Medicare is stopping payment and how to appeal.

The first step is to ask the agency to reconsider. If the agency agrees that the denial was wrong, it can resubmit the claim to Medicare. If you disagree with the agency's response, you can file a formal appeal with Medicare's contractor for your state. Call the agency and ask for the name and phone number of the contractor, or call 1-800-MEDICARE to find out how to appeal in your state.

You have 120 days from the date on the denial notice to file an appeal. During the appeal, Medicare may continue to pay for your care while the case is being reviewed, depending on your state and the reason for the denial. Ask the agency or Medicare whether your care is covered during the appeal.

Frequently Asked Questions

Can I choose which home health agency Medicare sends?

Yes. Medicare does not assign you to an agency. Your doctor can recommend one, or you can search Medicare.gov's Care Compare tool and call agencies directly. Ask whether the agency is Medicare-approved and accepts Medicare assignment. You can change agencies at any time if you are unhappy with the service.

What if I need help at home but I am not homebound?

Medicare will not pay. However, you may be able to pay privately for a home health aide or housekeeper. Some agencies offer private-pay services at an hourly rate. Medicaid may also cover home care in your state if you meet income and asset limits — call your state Medicaid office to ask.

Does Medicare cover home health care after I leave the hospital?

Yes, if your doctor orders it and you meet the homebound requirement. You do not have to spend a certain number of nights in the hospital first. However, if you were hospitalized and then go to a skilled nursing facility, Medicare Part A covers the facility stay first, and home health care begins after you are discharged from the facility.

Will Medicare pay if my family member is helping me instead of an agency?

No. Medicare only pays when a Medicare-approved agency provides the care. Family members can help, but Medicare will not reimburse them. If you cannot afford an agency and have no family help, ask your doctor or social worker about Medicaid or local programs that may help.

What happens if I improve and no longer need home health care?

Your doctor or the agency can discharge you from home health care. Medicare will stop paying once you are discharged. If you improve but then get worse again, your doctor can order home health care again, and Medicare will cover it if you meet the requirements.