Medicare's Coverage of Home Care: The Basic Answer

Medicare covers some in-home care, but not all of it, and the rules depend on whether you need skilled nursing care or personal information. Skilled care — like wound dressing, physical therapy, or medication management by a nurse or therapist — is covered under Medicare Part A (hospital insurance) or Part B (medical insurance) when ordered by a doctor and delivered by a Medicare-certified agency. Personal care — help with bathing, dressing, toileting, or meals — is not covered by Original Medicare at any point, though some Medicare Advantage plans may offer limited coverage.

The distinction matters because it determines whether Medicare pays anything at all. A home health aide who helps you bathe is not covered. A nurse who changes a surgical wound dressing is. If you need both, you will pay out of pocket for the personal care portion unless you have a Medigap policy, a Medicare Advantage plan with extra benefits, or you are also receiving Medicaid.

Key Takeaways

  • Medicare Part A and Part B cover skilled nursing and therapy services at home when a doctor orders them and a Medicare-certified agency provides them, but only after a may have access to hospital or skilled nursing facility stay for Part A.
  • Personal care information — bathing, dressing, grooming, meal preparation — is never covered by Original Medicare, even if you need it full-time.
  • To receive Medicare-covered home care, you must be homebound or have severe mobility limits, and a doctor must document that skilled care is medically necessary.
  • Medicare Advantage plans sometimes cover personal care or adult day programs, so reviewing your plan's benefits is the first step if you have one.
  • Medicaid covers personal care in most states, but may be able to access and coverage vary widely by state and income level.

When Medicare Part A Covers Home Care

Medicare Part A covers home health services only after you have been an inpatient in a hospital for at least three consecutive days, then discharged directly to home care. This is called the three-day may have access to stay. The home care must begin within 60 days of leaving the hospital, and a doctor must order it as part of your discharge plan.

Under Part A, Medicare covers the full cost of skilled nursing visits, physical therapy, occupational therapy, and speech therapy for up to 60 days. After 60 days, you pay a copay per visit. The agency must be Medicare-certified, and you must remain homebound — meaning leaving home requires considerable effort and is medically contraindicated, or you can only leave with help.

Part A does not cover personal care aides, meal delivery, or housekeeping, even during the period when skilled services are covered. If you need an aide to help you bathe while a nurse visits to manage your medications, Medicare pays for the nurse but not the aide.

Medicare Part B Coverage for Home-Based Therapy and Monitoring

Medicare Part B covers certain home-based services without requiring a prior hospital stay. These include physical therapy, occupational therapy, and speech-language pathology when ordered by a doctor and delivered by a Medicare-certified agency. Part B also covers remote patient monitoring — devices that track your blood pressure, weight, or heart rhythm and send data to your doctor — if your doctor orders it for a chronic condition.

For Part B home services, you pay 20 percent of the approved amount after you meet your annual deductible. Unlike Part A, there is no limit on the number of visits, but Medicare reviews the medical necessity of ongoing care. If your therapist cannot document that you are making progress toward a specific functional goal, Medicare may stop paying.

Part B does not cover routine check-ins, medication reminders, or personal care. A nurse cannot bill Medicare for visiting to remind you to take your pills or to help you dress, even if you live alone and have no other support.

What Medicare Advantage Plans May Cover

Medicare Advantage (Part C) plans are required to cover everything Original Medicare covers, but many plans add extra benefits that Original Medicare does not. Some plans include a limited number of personal care visits per year, adult day programs, or meal delivery. Others offer transportation to medical appointments or in-home safety assessments.

These extra benefits vary widely by plan and by year — a plan that covered personal care in 2023 may not in 2024, or the benefit may shrink. You can find out what your plan covers by calling the plan's customer service number (on your insurance card) or by reviewing the plan's Summary of Benefits and Coverage document, which is mailed to you each fall during the annual enrollment period.

If you are considering switching to a Medicare Advantage plan partly for home care coverage, confirm in writing that the benefit will be available to you before you enroll. Plans can change benefits between years, and some benefits may have waiting periods or require prior authorization from your doctor.

Medicaid Coverage of Personal Care and Home Support Services

Medicaid, the joint federal-state program for people with low income, covers personal care services in most states. This includes help with bathing, dressing, toileting, grooming, and meal preparation. Medicaid also covers home health aides, homemaker services, and sometimes adult day programs or respite care.

may be able to access and coverage rules vary significantly by state. Some states cover personal care only for people over 65 or with disabilities; others have income limits that are higher or lower than Medicare's. Some states limit the number of hours per week; others do not. You can find your state's Medicaid office through the Centers for Medicare & Medicaid Services website or by calling 211.

If you have both Medicare and Medicaid (called "dual may be able to access"), Medicaid typically pays for personal care and other services that Medicare does not cover. This is one reason why dual-may be able to access people often have more comprehensive home support than those with Medicare alone.

Medigap Policies and Home Care Coverage

Medigap (supplemental insurance) policies help pay for costs that Original Medicare does not cover — copays, coinsurance, and deductibles. However, Medigap does not cover services that Medicare itself does not cover, such as personal care or long-term custodial care. A Medigap policy will not pay for a home health aide.

If you are considering a Medigap policy, review the plan documents to see what it covers. Some policies are better suited to people who use frequent medical services; others are better for people who want predictable out-of-pocket costs. Medigap does not affect your ability to receive Medicare-covered home care.

How to Arrange Medicare-Covered Home Care

If you are leaving a hospital or skilled nursing facility, the discharge planner will help you set up home care before you leave. They will give you a list of Medicare-certified agencies in your area and help you choose one. The agency will contact you to schedule the first visit, usually within 24 to 48 hours of discharge.

If you are not in a hospital but your doctor believes you need home care, ask your doctor to write an order for home health services. Your doctor will specify what type of care (nursing, therapy, or both) and how often. You then contact a Medicare-certified home health agency directly or ask your doctor's office for a referral. The agency will verify that Medicare will cover the services before scheduling your first visit.

To find a Medicare-certified agency, use the Medicare Care Compare tool on Medicare.gov, call your local Area Agency on Aging, or call 211. When you contact an agency, ask whether they accept Medicare assignment (meaning they bill Medicare directly and you do not pay upfront). Most do, but it is worth confirming.

Common Reasons Medicare Denies Home Care Claims

Medicare denies home care claims most often because the person is not homebound, the care is not skilled (it is personal care), or the doctor did not order it. If you are denied, you have the right to appeal. The agency should tell you why the claim was denied and what you can do next.

Another common issue is that Medicare stops paying after a certain number of visits because your condition is not improving. If this happens, ask your therapist or nurse whether your goals can be adjusted or whether a different type of service might help. Sometimes a switch from physical therapy to occupational therapy, for example, allows care to continue.

If you believe the denial is wrong, you can file a written appeal with Medicare. The agency can help you with this, or you can contact your State Health Insurance information Program (SHIP), which offers free help with Medicare appeals.

Frequently Asked Questions

Does Medicare cover a home health aide to help me bathe and dress?

No. Original Medicare does not cover personal care aides under any circumstance. If you need help with bathing, dressing, or toileting, you must pay out of pocket, use Medicaid if you are may be able to access, or check whether your Medicare Advantage plan includes personal care benefits.

What if I need both skilled nursing and personal care at home?

Medicare will pay for the skilled nursing visits but not the personal care aide. You can hire an aide privately and pay out of pocket, or explore whether Medicaid or your Medicare Advantage plan covers the aide portion. Some families hire an aide for the hours when Medicare-covered services are not being provided.

Can I get home care without spending three days in a hospital first?

Yes, but only for certain services. Medicare Part B covers physical therapy, occupational therapy, and speech therapy at home without a prior hospital stay. Part A home care requires the three-day may have access to stay. Ask your doctor which type of service you need.

How long does Medicare cover home care?

Under Part A, Medicare covers up to 60 days of home health services after a hospital stay. After 60 days, you pay a copay per visit. Under Part B, there is no set time limit, but Medicare reviews whether you are making progress toward your therapy goals. If progress stops, Medicare may stop paying.

What happens if I cannot afford the copays for home care?

If you have limited income, you may be may be able to access for Medicaid, which can help pay Medicare copays and cover services Medicare does not. Contact your state Medicaid office or call 211 to learn about programs in your area. Some home health agencies also have financial information programs.