What Medicare covers for at-home care

The distinction that drives every coverage decision is skilled versus custodial. Skilled care requires the training of a licensed nurse or therapist, things like wound care, intravenous medication management, or physical therapy after a hospitalization. Custodial care covers bathing, dressing, meal preparation, and other daily-living tasks. Medicare does not cover custodial care when that is the only need.

Original Medicare (Part A and Part B, the traditional fee-for-service program) covers four categories of home health services when the conditions above are met.

Skilled nursing care. A registered or licensed practical nurse can visit to manage medications, monitor a new diagnosis such as diabetes or congestive heart failure, provide wound care, or teach you to manage a condition safely. Visits are typically intermittent, not around-the-clock.

Therapy services. Physical therapy, occupational therapy, and speech-language pathology are all covered when medically necessary. Therapy is often the qualifying skilled service that opens the benefit even when nursing needs are minimal.

Home health aide services. Personal care from a home health aide is covered only when the same Medicare-certified agency is also providing skilled nursing or therapy during that episode. Aide visits are limited to personal care activities directly related to the treatment plan and cannot stand alone as the only service.

Medical social services. A social worker can help assess the social and emotional factors affecting your health, connect you to community resources, and assist with care planning. This service is covered as part of the home health benefit, not separately.

For all of these services under original Medicare, there is no copayment for home health visits themselves. However, if you receive durable medical equipment (such as a walker or wound care supplies) through the home health agency, the standard 20% Part B coinsurance applies after the annual Part B deductible. In 2026, the annual Part B deductible is $283, and after meeting it, you pay 20% of the Medicare-approved amount for equipment with no annual cap on that cost.

A physician, nurse practitioner, clinical nurse specialist, physician assistant, or certified nurse-midwife must certify that you need skilled care and are homebound. That certifying provider must have seen you face-to-face within a defined window around the start of care. Without that face-to-face encounter documented, Medicare will not pay.

The agency you choose must be Medicare-certified. You can confirm certification at medicare.gov or ask the agency directly. Medicare does not require a prior hospital stay to qualify for home health; this is a common misunderstanding. The benefit is available after any qualifying medical need, including a new diagnosis managed entirely in an outpatient setting.

Once services begin, the agency develops a plan of care. A physician must review and sign that plan, and it must be reviewed periodically. Medicare pays the certified agency directly using a 30-day payment model. From your perspective, there is no bill per visit for the covered skilled services themselves.

Knowing the gaps is as important as knowing the coverage. Medicare does not pay for:

• 24-hour-a-day home care or continuous custodial care, regardless of medical need
• Homemaker services such as cooking, cleaning, or shopping when those are the only needs
• Personal care when a skilled service is not also being provided
• Home-delivered meals (some Medicare Advantage plans include this as a supplemental benefit; original Medicare does not)
• Personal emergency response systems as a standalone benefit

If you need long-term personal or custodial care at home, Medicaid may help if your income and assets meet state eligibility limits. Long-term care insurance, if purchased before a condition develops, is another mechanism. Medicare was designed as an acute and post-acute medical benefit, not a long-term care program.

Medicare Advantage (Part C) plans are required to cover everything original Medicare covers, including the same home health benefit. Many Advantage plans go further, offering supplemental benefits such as home-delivered meals after a hospitalization, personal emergency response devices, or in-home support following a qualifying event. These extras vary by plan and are not part of the core federal benefit.

In 2026, the federal in-network maximum out-of-pocket cap for Medicare Advantage is $9,250, according to KFF. Once a plan member reaches that cap, the plan pays 100% of covered in-network costs for the rest of the year, which can matter if home health services are combined with other care.

Prior-authorization rules also apply in Advantage plans. Under the CMS rule CMS-0057-F effective in 2026, a standard prior-authorization decision must come within 7 calendar days, and an expedited decision must come within 72 hours when a delay would seriously jeopardize your health.

To find out more about coverage in a specific Advantage plan's home care benefits, please contact us to discuss plan options.