Medicare covers some in-home care, but not all of it, and the type of care matters

Medicare will pay for skilled nursing care and physical therapy at home if a doctor orders it after a hospital stay or may have access to event. It will not pay for help with bathing, dressing, meals, or housekeeping — even if you need it every day. The difference comes down to whether the care requires a trained medical professional or is personal information. Understanding what Medicare actually covers prevents you from discovering mid-care that you are paying out of pocket.

Coverage also depends on whether you are in Original Medicare (Parts A and B) or a Medicare Advantage plan. Each has different rules about what services they will pay for and how long they will pay. Your plan documents spell out the exact limits, but this guide explains the main categories so you know what questions to ask your plan.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy at home only after a hospital stay of at least three days, and only for the medical condition you were hospitalized for.
  • Medicare Part B covers some home health services ordered by a doctor, including nursing visits, physical therapy, occupational therapy, and speech therapy, but not personal care or housekeeping.
  • You must be homebound or have a doctor document that leaving home is medically contraindicated for Medicare to cover any home care at all.
  • Medicare Advantage plans may cover additional services like meal delivery or non-medical transportation, but coverage varies by plan and by year.
  • If Medicare stops paying, you are responsible for the full cost unless you have supplemental insurance or Medicaid.

Skilled nursing and therapy covered under Part A after hospitalization

Medicare Part A covers skilled nursing care, physical therapy, occupational therapy, and speech therapy at home, but only if you meet three conditions. First, you must have been admitted to a hospital (not just the emergency room) and stayed for at least three consecutive days. Second, a doctor must order the home care within 30 days of leaving the hospital. Third, the care must be for the same condition you were hospitalized for — not a different problem that developed later.

Part A pays for up to 100 days of home health care per benefit period, but the copay structure is unusual. You pay nothing for the first 20 days. From day 21 to day 100, you pay a copay per visit (the amount varies by year). After day 100, you pay the full cost yourself. A benefit period starts when you are admitted to the hospital and ends 60 days after you leave the hospital or skilled nursing facility.

The home health agency sends a nurse or therapist to your home on a schedule the doctor sets. They perform medical tasks, teach you how to manage your condition, and monitor your progress. If you improve enough that skilled care is no longer needed, Medicare stops paying even if you have days remaining.

Home health services covered under Part B without hospitalization

Medicare Part B covers some home health services even if you were not hospitalized, but the rules are stricter and the coverage is narrower. A doctor must order the care and document that you are homebound — meaning you cannot leave home without help or it would be medically harmful to do so. The homebound requirement is the biggest barrier; Medicare interprets it strictly, and the home health agency will assess whether you meet it before they start.

Part B covers intermittent skilled nursing (not full-time care), physical therapy, occupational therapy, and speech therapy. It does not cover full-time nursing, personal care, or housekeeping. You pay 20 percent of the approved amount after you meet your Part B deductible. The number of visits is not capped, but Medicare reviews the care regularly to make sure it is still medically necessary.

If you need ongoing personal care — help with bathing, dressing, toileting, or meals — Medicare will not pay for it under Part B, even if a nurse visits for other reasons. You would need to pay out of pocket, use Medicaid (if you may have access to), or rely on family or volunteers.

What Medicare does not cover at home

Medicare does not cover personal care services, which is the largest gap for many seniors. Personal care includes bathing, dressing, grooming, toileting, eating, and transferring in and out of bed. It also does not cover homemaking services like cleaning, laundry, shopping, or meal preparation. These services are considered custodial care — information with activities of daily living — rather than skilled medical care.

Medicare also does not cover 24-hour care, live-in companions, or non-medical transportation. If you need someone at home around the clock, you pay for that privately or through Medicaid. Some Medicare Advantage plans offer supplemental benefits like meal delivery or transportation to medical appointments, but coverage varies widely and changes year to year.

Respite care — temporary relief for a family caregiver — is not covered by Medicare. If you need someone to stay with you so your adult child can take a break, you pay for that out of pocket or through a community program.

How Medicare Advantage plans handle home care differently

Medicare Advantage (Part C) plans must cover at least what Original Medicare covers, but many offer additional services. Some plans include non-medical transportation, meal delivery, home safety modifications, or personal care for a limited number of hours per week. These extra benefits are called supplemental benefits, and they differ by plan and by year.

To find out what your specific plan covers, check your plan's Summary of Benefits document, which you receive every year. You can also call the plan's member services number and ask directly what home care services are included. Do not assume your plan covers something just because another plan does — each plan sets its own limits.

If you switch plans during open enrollment, your new plan's home care coverage may be different. If you are currently receiving home care, ask your new plan before the switch takes effect whether they will continue to cover the same services.

The homebound requirement and how it is assessed

To receive any home health care under Medicare, you must be homebound. This does not mean you never leave home — it means leaving home requires supportive information or is medically contraindicated. Examples include someone who uses a wheelchair and has no accessible transportation, someone whose doctor has ordered bed rest, or someone whose medical condition makes travel unsafe.

The home health agency will send a nurse to assess whether you are homebound before they begin care. They will ask about your mobility, your medical conditions, and whether you can leave home safely. If the assessment concludes you are not homebound, Medicare will not cover the care. You can appeal this decision, but the bar is high.

Occasional trips outside the home — to a doctor's appointment, to church, or to a family event — do not disqualify you from being homebound. What matters is whether leaving home is the exception or the rule, and whether you need help to do it.

What happens when Medicare coverage ends

Medicare stops paying for home care when a doctor determines you no longer need skilled care, when you have used up your benefit period, or when you no longer meet the homebound requirement. The home health agency must notify you in writing before they discharge you. If you disagree with the decision, you have the right to appeal.

Once Medicare stops paying, you are responsible for the full cost of any care you continue to receive, unless you have supplemental insurance (Medigap), Medicaid, or another source of payment. Some people transition to paying privately for personal care, while others rely on family or community resources.

If you need ongoing care after Medicare ends, ask the home health agency about their private-pay rates. Some agencies offer both Medicare-covered and private-pay services. You can also contact your local Area Agency on Aging to learn about community programs that may help with personal care or housekeeping.

Questions to ask your doctor and Medicare plan

Before home care begins, ask your doctor: "Will Medicare cover this care, and for how long?" and "What do I need to do to stay may be able to access?" Ask whether the care is considered skilled nursing or personal care, because Medicare only pays for skilled care.

Call your Medicare plan's member services and ask: "What home health services does my plan cover?" and "How many visits will Medicare pay for?" If you are in a Medicare Advantage plan, ask specifically about supplemental benefits for home care. Request a written summary of coverage so you have it in writing.

Ask the home health agency: "How many visits will Medicare cover?" and "What will I owe if I need care after Medicare stops paying?" Get an estimate in writing before care begins.

Frequently Asked Questions

Can Medicare cover help with bathing and dressing at home?

No. Medicare does not cover personal care services like bathing, dressing, grooming, or toileting. These are considered custodial care, not skilled nursing. You would need to pay out of pocket, use Medicaid if you may have access to, or arrange care through family or community programs.

Do I have to be hospitalized first to get home care from Medicare?

Not always. Part A requires a three-day hospital stay, but Part B can cover some home health services without hospitalization if a doctor orders it and you are homebound. The coverage is narrower under Part B, and the homebound requirement is strictly assessed.

What if I need care longer than Medicare will pay for?

Once Medicare stops paying, you are responsible for the full cost unless you have supplemental insurance, Medicaid, or another payment source. Ask the home health agency about private-pay rates and contact your local Area Agency on Aging about community programs that may help.

Does Medicare Advantage cover more home care than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, and many offer additional services like meal delivery or limited personal care hours. Coverage varies by plan and changes yearly. Check your plan's Summary of Benefits or call member services to find out what your specific plan includes.

How do I appeal if Medicare denies home care coverage?

You have the right to appeal any coverage denial. The home health agency or your doctor can help you file an appeal, or you can contact Medicare directly at 1-800-MEDICARE. You have 120 days from the denial notice to file an appeal.