Medicare covers some in-home care, but only under specific conditions

Medicare will pay for skilled nursing care and physical or occupational therapy delivered in your home — but only if a doctor orders it, you meet medical necessity requirements, and you use a Medicare-approved provider. Medicare does not pay for help with daily tasks like bathing, dressing, or meal preparation unless those services are part of a skilled care plan ordered by your physician. The difference matters: skilled care means a nurse or therapist is treating a medical condition. Custodial care means someone is helping you with activities of daily living, and that is your responsibility to pay for.

Home health services must be ordered by your doctor and provided by a Medicare-certified home health agency. You also must be homebound — meaning you cannot leave home without considerable effort or help — or the services will not be covered. Medicare Part A (hospital insurance) covers home health services with no copay if you meet these conditions, though you may owe a copay for any durable medical equipment like a walker or oxygen tank.

Key Takeaways

  • Medicare Part A covers skilled nursing and therapy in your home only when ordered by your doctor and provided by a Medicare-certified agency.
  • You must be homebound — unable to leave home without considerable effort — for Medicare to cover home health services.
  • Medicare does not cover custodial care (help with bathing, dressing, meals) unless it is bundled with a skilled care plan your doctor has ordered.
  • Your doctor must recertify your need for home health services every 60 days, or coverage will stop.
  • If you need ongoing help with daily tasks, you will need to pay out of pocket, use Medicaid (if you may have access to), or purchase long-term care insurance.

What counts as skilled care that Medicare will pay for

Skilled care means a licensed nurse or therapist is performing a service that requires professional training and judgment. Examples include wound care after surgery, injections or intravenous therapy, catheter management, physical therapy to regain strength after a fall or stroke, occupational therapy to relearn daily tasks after an injury, and speech therapy after a stroke. If the service could be performed safely by someone without medical training, Medicare will not pay for it.

Your doctor must document that the skilled service is medically necessary — meaning it is treating an acute condition or helping you recover from one. Ongoing maintenance therapy (like physical therapy to prevent future falls) is usually not covered. The home health agency will work with your doctor to create a care plan that specifies what services you need, how often, and for how long. Medicare will review this plan and may deny coverage if it determines the services are not medically necessary or are custodial rather than skilled.

What Medicare does not cover at home

Medicare does not pay for custodial care — the help most people think of when they imagine in-home care. This includes bathing, dressing, grooming, toileting, meal preparation, light housekeeping, laundry, and companionship. Even if a nurse is present in your home, if the primary service is helping you with these daily tasks, Medicare will not cover it. Many families are surprised by this limitation because custodial care is often what they need most.

Medicare also does not cover 24-hour care, live-in caregivers, or ongoing help with activities of daily living. If you need this type of support, you will need to pay privately, use Medicaid (which does cover some custodial care if you meet income and asset limits), or explore other options like adult day programs or assisted living facilities.

How to start the process with your doctor

If you think you need in-home care, start by talking to your doctor. Explain what tasks you are struggling with and why — for example, "I cannot safely bathe myself since my hip surgery" or "I need help managing my new insulin injections." Your doctor will assess whether you need skilled care and whether you are homebound. If your doctor agrees, they will write an order for home health services and choose a Medicare-certified home health agency, or you can request a specific agency if you have one in mind.

Your doctor will also need to certify that you are homebound. This does not mean you never leave home; it means leaving home requires considerable effort or help, and your doctor agrees that you should not be leaving regularly. If you are going to the grocery store or running errands, Medicare may decide you are not homebound and deny coverage.

Once your doctor's order is in place, the home health agency will contact you to schedule an intake visit. A nurse will assess your medical needs, review your medications, and create a detailed care plan. The agency will submit this plan to Medicare for approval. Approval usually takes a few days to a week. If Medicare approves, services can begin.

How long Medicare will pay and what happens when coverage ends

Medicare covers home health services for as long as your doctor certifies that you need them and meet the homebound requirement. However, your doctor must recertify your need every 60 days. If your condition improves and you no longer need skilled care, or if you are no longer homebound, your doctor will not recertify and coverage will stop.

Many people recover faster than expected and no longer need skilled services within a few weeks. Others need services for several months. The length of coverage depends entirely on your medical condition and recovery. When coverage ends, you will receive notice from the home health agency. If you still need help at that point, you will need to explore other options: paying privately for custodial care, explore for Medicaid, or moving to a facility like assisted living or a nursing home.

Private pay and Medicaid as alternatives

If Medicare does not cover the care you need, or if coverage has ended, you can pay privately for in-home care. Private home care agencies employ caregivers who can help with bathing, dressing, meals, and other daily tasks. Costs vary widely by location and the number of hours you need, but in-home custodial care typically ranges from $20 to $30 per hour for basic information, though rates are higher in urban areas and for specialized care.

Medicaid, the joint federal-state program for people with low income, covers custodial care in the home in most states. Medicaid coverage and income limits vary by state, so you will need to contact your state Medicaid office to learn whether you may have access to. Some people use Medicare for skilled care and Medicaid for custodial care at the same time.

Long-term care insurance, if you purchased it before you needed care, may also cover in-home custodial care. Check your policy to see what services and costs it covers.

Questions to ask your doctor and the home health agency

Before services begin, ask your doctor: "Will Medicare cover the care I need?" and "How long do you expect I will need these services?" Ask the home health agency: "Are you Medicare-certified?" "What is your experience with my specific condition?" "How often will a nurse or therapist visit?" "Will the same person visit each time?" and "What happens if I need care outside normal business hours?"

Also ask whether the agency bills Medicare directly or whether you will receive a bill. Most Medicare-certified agencies bill Medicare directly and you should owe nothing if you have met your Part A deductible. If the agency tells you that you will owe a large out-of-pocket cost, ask why — it may mean the service is not actually covered by Medicare.

Frequently Asked Questions

Can I choose which home health agency provides my care?

Yes. Your doctor can order services from any Medicare-certified home health agency. If your doctor recommends one, you can ask to use a different agency instead. You can find Medicare-certified agencies in your area by searching the Medicare Care Compare tool on Medicare.gov or by calling your local Area Agency on Aging.

What if I need help with daily tasks but my doctor says I do not need skilled care?

Medicare will not cover custodial care. You can pay privately for a home care aide, explore Medicaid if you meet income limits, or look into adult day programs or assisted living. Some people combine a small amount of Medicare-covered skilled care with private pay custodial care.

Does Medicare cover in-home care after I leave the hospital?

Yes, if your doctor orders it and you meet the homebound requirement. Many people receive home health services for a few weeks after hospitalization while they recover. Your hospital discharge planner can help arrange this, or your doctor can order it after you go home.

What if I disagree with Medicare's decision to stop covering my care?

You have the right to appeal. The home health agency or your doctor can help you file an appeal explaining why you still need services. You can also contact your State Health Insurance information Program (SHIP) for free help understanding your appeal rights.

Can Medicare pay for a live-in caregiver?

No. Medicare does not cover 24-hour care or live-in caregivers. If you need round-the-clock help, you will need to pay privately, use Medicaid, or move to a facility like a nursing home or assisted living community.