Medicare covers some home care costs, but not all of them, and the rules are strict about what counts
Medicare will pay for skilled home health care — nursing visits, physical therapy, occupational therapy, and speech therapy delivered in your home — but only if a doctor orders it after a hospital stay or may have access to event, and only while you are homebound. Medicare does not pay for help with daily tasks like bathing, dressing, or cooking unless that help comes as part of a skilled nursing visit. It also does not pay for custodial care, which is ongoing personal information without a medical purpose, or for live-in caregivers.
The difference between what Medicare covers and what it does not comes down to one question: does the care require a trained medical professional, or could a family member or aide do it? If a nurse needs to change a wound dressing or a therapist needs to retrain you to walk after a stroke, Medicare may cover it. If you need someone to help you shower or take your medications on schedule, Medicare will not.
Key Takeaways
- Medicare Part A covers skilled home health care for up to 60 days after a hospital stay of at least three days, with no copay for the visits themselves.
- You must be homebound — unable to leave home without considerable effort — and a doctor must order the care for a medical reason.
- Medicare does not cover personal care, meal preparation, housekeeping, or live-in caregivers, even if you need help with these tasks every day.
- If you need ongoing care after Medicare coverage ends, you will need to pay out of pocket, use Medicaid if you may have access to, or explore other programs.
- Medicare Advantage plans may offer additional home care benefits beyond Original Medicare, so check your plan documents.
What Medicare Part A Covers at Home
Medicare Part A covers skilled nursing visits, physical therapy, occupational therapy, speech-language pathology, and medical social work services in your home. A nurse might visit to manage a catheter, monitor a wound, or teach you to give yourself injections. A physical therapist might help you regain strength after a hip replacement. These visits are covered with no copay as long as the care is medically necessary and ordered by your doctor.
The coverage window is limited. Medicare Part A will pay for home health care for up to 60 days following a hospital stay of at least three consecutive days. If you need care after those 60 days, you will have to pay out of pocket unless you may have access to for Medicaid or another program. Some people receive home health care again after a new hospital stay, which resets the clock.
Home health agencies that accept Medicare must be certified by Medicare. When your hospital discharge planner or doctor arranges home care, they will typically send you to a certified agency. You can ask your doctor or hospital which agencies serve your area.
The Homebound Requirement
To receive Medicare-covered home health care, you must be homebound. This does not mean you cannot leave your house at all — it means leaving home requires considerable and taxing effort, usually because of illness or injury. A person recovering from surgery who can walk to the mailbox with help is still homebound. A person who can drive to the grocery store is not.
The home health agency will assess whether you meet this requirement during your first visit. If you start leaving home regularly — for example, to attend a senior center or go to restaurants — the agency may determine you are no longer homebound and stop visits. This is one reason to be honest with your home health team about your activities.
What Medicare Does Not Cover
Medicare does not pay for custodial care or personal care services. This includes help with bathing, dressing, grooming, toileting, and eating. It also does not cover meal preparation, housekeeping, laundry, or yard work. If you need someone to remind you to take your medications, that reminder alone is not covered — but if a nurse visits to teach you how to manage your medications and monitor your response, that visit is covered.
Live-in caregivers, home health aides who work for you directly (rather than through a certified agency), and companions are not covered by Medicare. Neither is respite care — temporary relief care so a family caregiver can rest. If you need ongoing personal care after your skilled nursing coverage ends, you will need to pay for it yourself, use Medicaid if you may have access to, or look into other local programs.
Homemaker services and chore services are not covered, even if you cannot safely do these tasks yourself. Some states and local Area Agencies on Aging offer these services at reduced cost or free to low-income seniors, so it is worth asking your local agency what is available in your area.
How to Start Medicare Home Health Care
Home health care usually begins during a hospital discharge. Before you leave the hospital, a discharge planner will ask whether you need care at home. If your doctor agrees it is medically necessary, the hospital will arrange a referral to a certified home health agency. The agency will contact you to schedule your first visit, usually within one or two days.
If you are not in the hospital but your doctor thinks you need home health care, ask your doctor to write an order and send it to a Medicare-certified home health agency in your area. Your doctor can recommend an agency, or you can search for one using Medicare's Care Compare tool at care.cms.gov. You will need to choose an agency and give them permission to contact your doctor.
The home health agency will send a nurse for an initial assessment. This visit is not billed to you — it is part of the intake process. The nurse will review your medical history, current medications, and what care you need. If the agency determines you do not meet Medicare's requirements (for example, you are not homebound or the care is not skilled), they will tell you at this point.
Costs and Copays
Medicare Part A covers home health visits with no copay for the visits themselves. You do not pay per visit or per hour. However, if the home health agency provides medical equipment — such as a hospital bed, oxygen, or a walker — you may owe a 20 percent copay for the equipment after you have met your Part A deductible.
Your Part A deductible applies to your hospital stay, not to home health care separately. Once you have paid your deductible for the hospital stay that may have access to you for home care, the home health visits themselves cost you nothing.
If you have a Medicare Advantage plan instead of Original Medicare, your costs may be different. Some Advantage plans cover additional home care services or offer lower copays. Check your plan documents or call your plan to understand what home care is covered under your specific plan.
What Happens When Medicare Coverage Ends
When your 60 days of Medicare-covered home health care end, or when your doctor determines you no longer need skilled care, the visits will stop. If you still need help at home, you have several options. You can hire a home health aide or caregiver privately and pay out of pocket. You can look into whether you may have access to for Medicaid, which covers personal care services in many states. You can contact your local Area Agency on Aging to ask about subsidized services.
Some people transition from skilled nursing care to ongoing personal care with a private aide or family member. Others move to assisted living or a nursing home. Your hospital discharge planner or home health social worker can discuss these options with you before your coverage ends.
If you believe you still need skilled care but Medicare has ended your coverage, you can ask your doctor to reconsider. If your condition has changed or worsened, your doctor may be able to order additional visits. However, Medicare will not extend coverage straightforward because you want help — the care must be medically necessary and skilled.
Medicare Advantage Plans and Home Care
If you have a Medicare Advantage plan (Part C), your home health coverage comes through your plan, not directly from Original Medicare. Most Advantage plans cover the same skilled home health services as Original Medicare, but some offer additional benefits. A few plans cover certain personal care services, adult day care, or meal delivery programs that Original Medicare does not.
To find out what your Advantage plan covers, check the plan documents you received when you enrolled, or call the plan's customer service number. Ask specifically about home health coverage, any limits on the number of visits, and whether the plan covers services beyond skilled nursing. If you are thinking about switching plans, compare home care benefits as part of your decision.
Frequently Asked Questions
Can I get home health care without a hospital stay first?
Yes, but only in limited cases. Your doctor can order home health care directly if you are homebound and need skilled care, even without a recent hospital stay. However, Medicare will cover it only if the care is medically necessary and ordered by a doctor. Not all situations may have access to — the agency will assess you during the first visit.
Does Medicare pay for someone to help me bathe and dress?
No. Medicare does not cover personal care or activities of daily living. If you need help bathing or dressing, you will need to pay for a home health aide privately, use Medicaid if you may have access to, or ask family members. Some Area Agencies on Aging offer reduced-cost personal care services — call yours to ask what is available.
What if I need home care but I am not homebound?
Medicare will not cover home health care if you are not homebound, even if you need help. You would need to pay out of pocket for a private caregiver or home health aide. Some states and local programs offer services to seniors who are not homebound but have low income — contact your Area Agency on Aging to learn what is available in your area.
Can my family member be paid as my home health aide through Medicare?
No. Medicare does not pay family members to provide home care. If a family member provides care, it is unpaid. If you need paid help, you must hire someone outside the family, either through a certified home health agency or as a private caregiver.
What should I ask my doctor before home health care starts?
Ask how long your doctor expects you to need care, what specific services are ordered, and what will happen when Medicare coverage ends. Ask whether your condition might improve enough to stop needing skilled care sooner. Ask your doctor to explain which tasks require a nurse and which you or a family member could handle. This helps you understand what Medicare will and will not cover.