Medicare covers home health care when you meet specific medical conditions, but only for skilled care — not for help with daily tasks like bathing or cooking

Medicare Part A and Part B together pay for home health services when a doctor determines you need them and you meet three requirements: you must be homebound (unable to leave home without considerable effort), you must need skilled nursing or therapy, and you must be under a doctor's care with a plan for treatment. The services Medicare pays for include skilled nursing visits, physical therapy, occupational therapy, speech therapy, and medical social work. What Medicare does not cover is custodial care — information with bathing, dressing, toileting, or meal preparation — unless it happens during a visit for a skilled service.

Home health agencies that accept Medicare must be certified by Medicare. When your doctor orders home health, the agency handles the paperwork with Medicare, and you typically pay nothing for the covered services. If you have both Part A and Part B, Part A usually covers the visits. If you have only Part B, Part B covers them instead. The number of visits is not set in advance; it depends on your medical need and what your doctor orders.

Key Takeaways

  • Medicare covers skilled nursing, physical therapy, occupational therapy, speech therapy, and medical social work delivered at home when ordered by your doctor.
  • You must be homebound, need skilled care (not just help with daily tasks), and be under a doctor's care with a treatment plan for Medicare to pay.
  • A certified Medicare home health agency submits the paperwork to Medicare; you do not file a claim yourself.
  • Medicare does not cover custodial care such as bathing, dressing, or meal preparation unless it occurs during a visit for a skilled service.
  • If you need only help with daily living tasks, Medicaid, long-term care insurance, or out-of-pocket payment are other options to explore.

How Medicare Decides Whether to Pay

Your doctor must order home health and document that you need skilled care. "Skilled care" means a nurse or therapist must provide it — you cannot do it yourself, and it requires professional judgment. Examples include wound care, catheter management, physical therapy after surgery, or speech therapy after a stroke. If you need only personal care — someone to help you shower or dress — that is custodial care, and Medicare does not pay for it even if you are homebound.

Being homebound means you cannot leave your home without considerable effort and the help of another person or medical equipment. You do not have to be bedridden. You can leave for medical appointments or, in some cases, religious services, but leaving should be medically contraindicated or require supportive information. The home health agency assesses whether you meet this standard when your doctor refers you.

Medicare also requires that the home health agency be Medicare-certified. You can check whether an agency is certified by searching the Medicare Care Compare tool on Medicare.gov or by calling 1-800-MEDICARE. Using a non-certified agency means Medicare will not pay, and you will owe the full cost.

What Services Medicare Covers at Home

Skilled nursing visits cover wound care, injections, catheter care, medication management, and monitoring of medical conditions. A nurse assesses your health, performs treatments, and teaches you or a family member how to manage your condition. Physical therapy helps you regain strength and mobility after illness or injury. Occupational therapy helps you relearn daily tasks and adapt your home environment. Speech therapy addresses swallowing, communication, or cognitive issues.

Medical social work services help you understand your condition, find community resources, and plan for discharge from home health. Home health aides can information with personal care during a skilled nursing or therapy visit, but Medicare does not pay for aide visits on their own. Some agencies offer aide services for a fee if you want additional help between skilled visits.

Durable medical equipment — such as walkers, wheelchairs, oxygen, or hospital beds — may be covered under Part B when ordered by your doctor and used at home. The equipment must be medically necessary and prescribed by a doctor. You typically pay 20 percent of the approved amount after you meet your Part B deductible.

How Long Medicare Pays and When Coverage Stops

There is no set limit on the number of home health visits Medicare will pay for. Coverage continues as long as your doctor orders the services, you remain homebound, and you need skilled care. The home health agency must recertify your need every 60 days. If your condition improves and you no longer need skilled care, or if you become able to leave home without considerable effort, Medicare stops paying.

When you no longer need home health, the agency will discharge you. If you still need help at home but do not may have access to for skilled care, you will need to pay out of pocket, use Medicaid if you are low-income, or rely on family and friends. Some people transition to adult day programs, assisted living, or other community services. Your social worker or discharge planner can help you explore these options before home health ends.

What You Pay Out of Pocket

If you have Medicare Part A and Part B and use a Medicare-certified home health agency, you pay nothing for the skilled services themselves. You do not pay a copay or coinsurance for home health visits covered under Part A. If Part B covers your home health (because you do not have Part A), you still pay nothing for the visits, but you must have met your Part B deductible for the year.

You may have costs for services Medicare does not cover. If you want a home health aide to visit on days when you do not have a skilled visit, the agency can offer this as a private service, and you pay the full cost. Durable medical equipment carries a 20 percent coinsurance after your Part B deductible. If you have a Medigap or Medicare Advantage plan, your out-of-pocket costs may be lower; check your plan documents or call your plan.

If You Have a Medicare Advantage Plan

Medicare Advantage plans (Part C) must cover home health services the same way Original Medicare does, but the plan may require you to use agencies in its network. Call your plan before your doctor orders home health to confirm which agencies are in-network and whether you need prior authorization. Some Advantage plans cover additional services like non-skilled personal care or homemaker services that Original Medicare does not; check your plan's summary of benefits.

If your Advantage plan denies home health that your doctor ordered, you have the right to appeal. The plan must respond within 72 hours for urgent requests. If you disagree with the decision, you can file a grievance with your plan or contact your State Health Insurance information Program (SHIP) for help.

How to Start Home Health Services

Your doctor must order home health. This can happen in the hospital before discharge, in a doctor's office, or during a home visit if you already have a doctor managing your care. The doctor writes an order that includes your diagnosis, the type of care you need, and how often you should be seen. The order goes to a Medicare-certified home health agency.

You can choose which certified agency provides your care. Ask your doctor or hospital discharge planner for recommendations, or search Medicare Care Compare online. Once you choose an agency, it contacts Medicare to verify your coverage and schedules your first visit. The agency handles all communication with Medicare; you do not submit paperwork yourself. The first visit usually happens within a few days of the order.

At the first visit, the nurse or therapist assesses your home, your medical condition, and your support system. They create a care plan with specific goals — for example, "regain ability to walk with a walker" or "learn to change your wound dressing." The plan is sent to your doctor for approval. Visits then begin according to the plan.

Frequently Asked Questions

Does Medicare pay for someone to help me bathe and dress at home?

Not on its own. Medicare covers personal care only when it is part of a skilled nursing or therapy visit — for example, a nurse may help you bathe while assessing your skin. If you need daily help with bathing or dressing and do not may have access to for skilled care, you would need to pay privately, use Medicaid if you are low-income, or arrange family support. Some home health agencies offer aide services for a fee.

What if my doctor orders home health but I do not think I am homebound?

The home health agency makes the homebound information based on your medical condition and ability to leave home safely. If you disagree, you can discuss it with your doctor or the agency's nurse. If Medicare denies your claim because you do not meet the homebound requirement, you have the right to appeal the decision within 120 days.

Can I use any home health agency, or does it have to be in my insurance network?

With Original Medicare, you can use any Medicare-certified agency. With a Medicare Advantage plan, you may be required to use in-network agencies, though you can request an exception. Always check with your plan before your doctor orders home health to avoid unexpected costs.

How often will a nurse or therapist visit me?

The frequency depends on your medical need and what your doctor orders. Some people receive visits two or three times a week; others receive one visit per week. The home health agency and your doctor determine the schedule based on your condition and progress toward your care goals. You can discuss the schedule with your nurse if you need changes.

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

When your condition improves and you no longer meet the criteria for home health — usually because you no longer need skilled care or can leave home without considerable effort — the agency will discharge you. Before discharge, the social worker or nurse can help you plan for ongoing support, such as outpatient therapy, community programs, or family care.