Medicare covers home health care — skilled nursing visits, physical therapy, occupational therapy, speech therapy, and home health aide services. But it only covers them under specific conditions, and most families only discover this after a hospital discharge when they're already in crisis.
This guide explains exactly what Medicare covers, what the doctor needs to do to make it happen, and what to do when Medicare coverage ends.
The four conditions Medicare requires
To qualify for Medicare-covered home health care, all four of the following must be true:
- Homebound status. Your family member must be considered homebound — meaning leaving home requires considerable effort, a supportive device (walker, wheelchair), or the help of another person. They don't have to be bedridden. Attending medical appointments or occasional outings are permitted.
- Skilled care is needed. There must be a need for skilled nursing care, or physical, occupational, or speech therapy. Custodial care alone — help with bathing, dressing, meals — does not qualify without skilled care alongside it.
- Physician order. A doctor, nurse practitioner, clinical nurse specialist, physician assistant, or certified nurse midwife must certify the need for home health care and create or review a care plan. This is critical — without an order, there is no coverage.
- Medicare-certified agency. Services must be provided by a Medicare-certified home health agency.
Key action: Before or at hospital discharge, ask the doctor or discharge team: "Can you write a Medicare home health order?" Discharge planners often do this automatically — but not always. Don't assume it's happening.
What Medicare covers — and what it doesn't
Covered under Medicare Part A or Part B (no cost-sharing):
- Skilled nursing visits (wound care, medication management, monitoring)
- Physical therapy, occupational therapy, speech-language pathology
- Medical social services
- Home health aide services — but only when skilled care is also being provided
- Some medical supplies used at home
Not covered by Medicare:
- 24-hour-a-day care at home
- Meal delivery
- Homemaker services (cleaning, cooking) without skilled care
- Personal care (bathing, dressing) as a standalone service
- Custodial care in a nursing facility that isn't preceded by a qualifying hospital stay
Important distinction: Medicare home health does not cover ongoing personal care or companionship. Once skilled care needs resolve, Medicare coverage ends — even if your family member still needs help with daily activities. This is when families are often blindsided.
How long does Medicare cover home health?
There is no fixed number of days. Medicare covers home health as long as your family member is homebound and requires skilled care, and the physician continues to certify the need. Coverage is reviewed every 60 days.
When the skilled care need ends — for example, when a wound has healed or therapy goals are met — Medicare coverage ends. This is the critical handover moment where families need a plan.
After Medicare ends: what are the options?
Medicaid
For low-income individuals, Medicaid may cover ongoing personal care and home-based services. Eligibility and coverage vary significantly by state. Contact your state's Medicaid office or the local Area Agency on Aging (AAA).
Area Agency on Aging (AAA)
Every region has an AAA — a federally funded local resource for older adults. They can connect families with services including home-delivered meals, transportation, caregiver support, and local programs. Find yours at eldercare.acl.gov or call 1-800-677-1116.
Veterans benefits
If your family member is a veteran, the VA Aid and Attendance benefit can provide significant monthly payments to help fund home care. This is substantially underused. Contact the VA or a Veterans Service Organization (VSO) for help with the application.
Long-term care insurance
If your family member has a long-term care insurance policy, review it now — before the care crisis, not during it. Understand the elimination period, the daily benefit, and what triggers the benefit.
Private pay home care
Private home care agencies typically charge $25–40/hour for non-medical home care and $50–100/hour for skilled nursing. Costs vary widely by region.
The PACE program
If your family member needs nursing-home-level care but wants to stay at home, look into PACE (Program of All-inclusive Care for the Elderly). PACE provides comprehensive medical and social services, including adult day programs and home care, funded jointly by Medicare and Medicaid. It's only available in certain areas — check pace4you.org to see if there's a program near you.
GP tip: The single most important conversation to have before hospital discharge is with the hospital's discharge planner or social worker. They know what Medicare will and won't cover, which home health agencies are available locally, and whether Medicaid or other programs apply. Ask for this conversation explicitly — on the day of admission if possible, not 24 hours before discharge.
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Read the US guide →This article provides general information about Medicare home health benefits. Coverage and eligibility rules change — verify current details at medicare.gov or call 1-800-MEDICARE. This does not constitute medical, legal, or financial advice.