Medicare does cover home health care, but only under specific conditions

Medicare Part A and Part B together cover home health care services when a doctor orders them and you meet certain requirements. You must be homebound (unable to leave home without considerable effort), have a medical need for skilled care, and be under the care of a physician who orders the services. Medicare pays the home health agency directly; you typically pay nothing if the agency is Medicare-certified.

The catch is that Medicare covers skilled nursing and therapy services — not custodial care like help with bathing, dressing, or housekeeping unless those services are tied to a skilled need. Many seniors think Medicare will pay for a home health aide to help them live independently at home, and that is not how it works. Understanding what Medicare actually covers before you need it prevents surprises when you are discharged from a hospital or facing a decline at home.

Key Takeaways

  • Medicare covers skilled nursing visits, physical therapy, occupational therapy, and speech therapy ordered by your doctor when you are homebound and recovering from an illness or injury.
  • Medicare does not cover custodial care — help with bathing, dressing, meals, or housekeeping — unless it is part of a skilled nursing or therapy visit.
  • You must be homebound, meaning leaving home requires considerable effort and is medically contraindicated, for Medicare to cover home health services.
  • Home health agencies must be Medicare-certified for Medicare to pay; you can check an agency's status on Medicare.gov or by calling 1-800-MEDICARE.
  • If you need ongoing help at home that is not skilled care, you will need to pay out of pocket, use Medicaid if you may have access to, or explore long-term care insurance.

What Medicare Part A and Part B actually cover at home

Medicare Part A covers home health care for up to 60 days after a hospital or skilled nursing facility stay of at least three days. Part B covers home health care without a prior hospital stay if your doctor orders it and you meet the homebound requirement. Both parts cover the same services: skilled nursing care (wound care, medication management, catheter care), physical therapy, occupational therapy, and speech-language pathology.

Medicare also covers medical equipment and supplies ordered by your doctor — hospital beds, wheelchairs, walkers, oxygen, diabetic supplies — when the equipment is medically necessary. The home health agency arranges and pays for this equipment; you do not. However, if you need equipment that is not medically necessary or that Medicare considers routine (like grab bars or shower chairs), you pay out of pocket or use your supplemental insurance if it covers those items.

The services must be intermittent, not daily ongoing care. If you need a nurse or therapist five days a week for two weeks, that is covered. If you need someone at home eight hours a day for months, Medicare will not pay for that level of service, and you will need to look at other funding sources.

What Medicare does not cover, and why many seniors are surprised

Medicare does not cover custodial care — the help most seniors actually need at home. Custodial care means information with activities of daily living: bathing, dressing, grooming, toileting, eating, and moving around the house. It also does not cover housekeeping, meal preparation, laundry, or shopping, even if you cannot do these things safely on your own.

The reason Medicare makes this distinction is that custodial care does not require a skilled nurse or therapist to provide it. A home health aide can provide custodial care, but only if a nurse is also visiting for a skilled reason. For example, if you are recovering from hip surgery and a physical therapist is coming twice a week, Medicare may cover a home health aide to help you bathe and dress on the days the therapist visits. But if you need only bathing help and no skilled care, Medicare will not pay.

This gap is where many seniors and their families run into trouble. You leave the hospital after a fall or surgery feeling weak, needing help at home, and Medicare covers the therapy but not the daily help you actually need to stay safe. You then face a choice: pay privately for a home health aide, move to assisted living, ask family to help, or go without.

The homebound requirement and what it really means

To receive Medicare-covered home health care, you must be homebound. This does not mean you never leave the house. It means leaving home requires considerable effort, is medically contraindicated (your doctor says you should not), or both. You can leave home for medical appointments, religious services, or adult day programs, and still be considered homebound. You can sit on your porch or in your yard.

Medicare uses this definition because home health is meant for people recovering from acute illness or injury, not for people who are generally frail but mobile. If you can get in a car and go to the grocery store, you are probably not homebound, even if you are weak or in pain. If you cannot safely leave your home because of recent surgery, a serious infection, or severe weakness, you likely meet the homebound requirement.

Your doctor makes the homebound information when ordering home health services. If you disagree with a denial based on homebound status, you can ask your doctor to reconsider or request a detailed explanation from Medicare. The definition is applied case by case, and circumstances change — you may be homebound for six weeks after surgery but not homebound three months later.

How to start Medicare home health services

Home health services usually begin with a doctor's order. If you are in a hospital or skilled nursing facility, the discharge planner will arrange this. If you are at home and your doctor thinks you need home health, ask your doctor to write an order and contact a Medicare-certified home health agency. Your doctor does not have to use a specific agency; you can choose one, or your doctor can recommend one.

To find a Medicare-certified home health agency in your area, visit Medicare.gov and use the Home Health Compare tool, or call 1-800-MEDICARE. The tool shows which agencies serve your zip code, their quality ratings, and whether they are certified. When you contact an agency, they will schedule an intake visit where a nurse assesses your medical needs and determines what services Medicare will cover.

Bring your Medicare card and a list of current medications to the intake visit. The nurse will ask about your medical history, your living situation, and what help you need. Be honest about what you cannot do safely — this information shapes the care plan. The agency will then bill Medicare directly for covered services. You should receive a notice explaining what services are covered and what your out-of-pocket costs are (usually zero for covered services).

What you pay and when coverage ends

If the home health agency is Medicare-certified and the services are covered, you pay nothing. Medicare Part A covers the full cost of home health services for the first 60 days after a hospital or skilled nursing stay. After 60 days, Part B takes over and covers services if your doctor continues to order them and you remain homebound. There is no limit to how long Part B can cover home health, as long as the medical need continues.

Coverage ends when you no longer meet the homebound requirement, when your doctor stops ordering services, or when the skilled need resolves. For example, if you are receiving physical therapy after a knee replacement and you reach your therapy goals, your therapist and doctor may decide therapy is no longer medically necessary. At that point, home health services end. If you still need help at home, you will need to pay privately or explore other options.

If you have a supplemental insurance policy (Medigap) or a Medicare Advantage plan, check your policy to see whether it covers any custodial care or home health aide services that Medicare does not. Some plans offer limited coverage for services like home health aides or homemaker services, but this varies widely by plan and by state.

Alternatives when Medicare does not cover what you need

If you need custodial care or ongoing help at home that Medicare does not cover, you have several options. You can hire a home health aide privately and pay out of pocket — costs vary by region but typically range from $20 to $35 per hour. You can also explore Medicaid, which covers home and community-based services in most states if you meet income and asset limits. Medicaid coverage for home care varies significantly by state, so contact your state Medicaid office to learn what is available.

Long-term care insurance, if you have it, may cover home care costs. Check your policy or call your insurance company to see what services and what dollar amounts are covered. If you do not have insurance and cannot afford private care, talk to your doctor or hospital social worker about local programs, senior centers, or volunteer organizations that may help with transportation, meals, or light housekeeping.

Some seniors move to assisted living or continuing care communities where meals, housekeeping, and help with daily activities are included. Others rely on family members or hire live-in caregivers. There is no single right answer — it depends on your medical needs, your finances, your family situation, and what is available in your area.

Frequently Asked Questions

Can Medicare pay for a home health aide to help me bathe and dress if I do not need therapy?

No. Medicare covers home health aides only when a skilled service (nursing, physical therapy, occupational therapy, or speech therapy) is also being provided. If you need only custodial help and no skilled care, Medicare will not pay for a home health aide. You would need to pay privately or explore Medicaid if you may have access to.

What happens if I leave home for a doctor's appointment while receiving Medicare home health services?

You can still be considered homebound and receive Medicare home health services. Leaving home for medical appointments, religious services, or adult day programs does not disqualify you. The homebound requirement means you cannot leave home without considerable effort or medical risk — not that you never leave at all.

How long does Medicare cover home health care after I leave the hospital?

Medicare Part A covers home health for up to 60 days after a hospital or skilled nursing facility stay of at least three days. After 60 days, Part B can continue to cover home health services if your doctor orders them and you remain homebound. There is no time limit on Part B coverage as long as the medical need continues.

What if the home health agency I want to use is not Medicare-certified?

Medicare will not pay if the agency is not certified. You can use an uncertified agency, but you would pay the full cost out of pocket. Before hiring any home health agency, verify its Medicare certification on Medicare.gov or by calling 1-800-MEDICARE. Using a certified agency ensures Medicare covers the cost of covered services.

Can I choose which home health agency provides my care?

Yes. Your doctor can recommend an agency, but you have the right to choose any Medicare-certified agency that serves your area. If your doctor's recommended agency does not work for you, ask for a different one. You can find certified agencies in your area on Medicare.gov or by calling 1-800-MEDICARE.