Medicare covers skilled nursing care, physical therapy, and occupational therapy at home if a doctor orders it and you meet specific conditions

Medicare Part A and Part B together cover home health services, but only when a doctor determines you need them for a medical reason — not for general help around the house. The services must be ordered by your doctor, you must be homebound (meaning leaving home is difficult without help), and you must need skilled care rather than just information with daily tasks. When these conditions are met, Medicare pays the full cost of covered services with no copay or deductible.

The key difference between what Medicare covers and what it does not comes down to the word "skilled." A nurse checking your wound or a therapist teaching you to walk again after surgery counts as skilled care. Someone helping you bathe or cook does not, even if you need that help badly. Understanding this line matters because it determines whether Medicare pays or you pay out of pocket.

Key Takeaways

  • Medicare covers skilled nursing, physical therapy, occupational therapy, speech therapy, and medical social work ordered by your doctor when you are homebound.
  • Your doctor must order home health services and document that you need skilled care for a medical condition, not just help with daily living.
  • A home health agency must be Medicare-certified, and you can change agencies if you are unhappy with the care.
  • Medicare does not cover non-skilled help like bathing, cooking, or housekeeping, even if you cannot do these tasks yourself.
  • Home health services are covered under Part A if you recently left a hospital or skilled nursing facility, or under Part B if you have not.

Which services Medicare covers at home

Skilled nursing care is the most common covered service. This includes wound care, injections, catheter management, monitoring for complications after surgery or illness, and teaching you how to manage a medical condition. A nurse assessing your condition and adjusting your care plan also counts as skilled nursing.

Physical therapy covers treatment to help you regain strength, balance, and mobility after an injury, surgery, or stroke. A physical therapist designs exercises for your specific condition and monitors your progress. Occupational therapy helps you relearn daily tasks like dressing, cooking, or using the bathroom after an illness or injury. Speech-language pathology addresses swallowing problems, speech difficulties, or cognitive issues after a stroke or other condition.

Medical social work is covered when a social worker helps you understand your condition, find community resources, or work through emotional or social problems related to your illness. Home health aide services are covered only when ordered by your doctor and only for tasks that are part of your skilled care plan — for example, helping you bathe after surgery while a nurse monitors your healing wound. The aide's work must be tied directly to your medical treatment.

Medicare also covers medical equipment and supplies ordered by your doctor: hospital beds, wheelchairs, walkers, oxygen, wound dressings, and diabetic supplies. The equipment must be medically necessary, and you typically pay 20 percent of the approved amount after your Part B deductible.

What Medicare does not cover at home

Medicare does not cover non-skilled personal care, even when you genuinely need it. Help with bathing, dressing, grooming, toileting, and eating is not covered unless it is part of a skilled nursing visit — for instance, a nurse helping you bathe while checking your surgical incision. Once the skilled need ends, the personal care stops being covered, even if you still cannot do it alone.

Housekeeping, meal preparation, laundry, and shopping are not covered. Neither is general supervision or monitoring of someone with dementia or a chronic condition, unless that monitoring is part of a skilled assessment or treatment plan. Homemaker services, yard work, and home modifications like ramps or grab bars are also not covered by Medicare, though some state Medicaid programs or local aging agencies may help with these.

Continuous care — having someone in your home all day or all night — is not a Medicare home health benefit. If you need that level of care, you would pay privately or look into assisted living or nursing home placement.

How to get home health services started

Your doctor must order home health services and document in your medical record why you need them. You cannot request home health on your own; the order must come from your physician, nurse practitioner, or physician assistant. When your doctor places the order, they specify what services you need and how often.

Your doctor will refer you to a Medicare-certified home health agency. You have the right to choose which agency provides your care, and you can change agencies if you are unhappy. To find Medicare-certified agencies in your area, use the Medicare Care Compare tool at Medicare.gov or call 1-800-MEDICARE. When an agency contacts you, ask whether they are Medicare-certified and whether they accept your insurance.

A nurse from the agency will visit your home to assess your condition and create a care plan. This initial visit is covered by Medicare. The nurse will explain what services you will receive, how often, and for how long. You will sign consent forms and provide information about your medical history and current medications.

How Medicare pays for home health services

If you have been in a hospital or skilled nursing facility within the past 60 days and are admitted to home health within a certain timeframe, Medicare Part A covers your home health services with no copay. This is called a "home health episode," and Part A pays the agency a fixed amount per episode regardless of how many visits you receive.

If you have not recently been in a hospital or skilled nursing facility, Medicare Part B covers home health services. You pay 20 percent of the Medicare-approved amount for each visit after you meet your Part B deductible. The amount varies depending on the type of service — a nursing visit costs differently than a therapy visit.

Home health agencies bill Medicare directly. You should receive an Explanation of Benefits (EOB) from Medicare showing what was billed and what Medicare paid. If you have a Medigap or Medicare Advantage plan, that plan may cover some or all of your out-of-pocket costs.

When home health services end

Home health services continue as long as your doctor determines they are medically necessary and you remain homebound. Your care plan is reviewed regularly, and the agency must document your progress. If you improve enough that you no longer need skilled care, or if you are no longer homebound, Medicare coverage ends.

You will receive notice before services stop, and your doctor can order services again if your condition changes. If you disagree with the decision to end services, you have the right to appeal. The home health agency must explain your appeal rights in writing.

Choosing and changing home health agencies

Medicare-certified agencies must meet quality and safety standards. Before choosing an agency, ask about their experience with your specific condition, their staff credentials, and how they handle emergencies. You can also check their quality ratings on Medicare Care Compare, which shows patient safety data and patient experience scores.

If you are unhappy with your agency — whether because of poor communication, missed visits, or quality concerns — you can switch to another Medicare-certified agency. Tell your doctor or the current agency that you want to change, and your doctor can refer you to a different provider. You do not need Medicare's permission to change agencies.

If you have concerns about the quality of care or believe you are being mistreated, contact your state's home health ombudsman or call 1-800-MEDICARE to file a complaint. Medicare investigates complaints about certified agencies.

Frequently Asked Questions

Do I have to use the agency my doctor recommends?

No. Your doctor can refer you to an agency, but you have the right to choose any Medicare-certified home health agency. Ask your doctor for other options in your area, or use Medicare Care Compare to find agencies near you. Once you choose an agency, your doctor will send the order there.

What if I need help with bathing but my skilled care has ended?

Medicare will not cover a home health aide for bathing alone. You would need to pay privately for a home care aide, look into Medicaid (which covers personal care in some states), or contact your local Area Agency on Aging to learn about other programs that might help. Some agencies offer private-pay services separate from Medicare.

Can I receive home health services if I live in an assisted living facility or nursing home?

Generally no. Home health is for people living in their own homes. If you live in a facility, the facility is responsible for providing care. However, if you are temporarily at home recovering from a hospital stay, you can receive home health services during that time.

How long can I receive home health services?

There is no set time limit. Services continue as long as your doctor orders them and you meet Medicare's requirements — you must be homebound and need skilled care. Your care plan is reviewed regularly, and services end when you no longer need skilled care or when you are no longer homebound.

Will my Medicare Advantage plan cover home health the same way Original Medicare does?

Medicare Advantage plans must cover home health services at least as well as Original Medicare does, but they may have different rules about which agencies you can use or how many visits are covered. Check your plan's coverage details or call the plan to understand your specific benefits before services begin.