Medicare · Supporting
What Medicare covers for at-home care
Last reviewed August 2, 20264 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team
Medicare covers home health care as a targeted medical benefit, not an open-ended personal support program. The program pays for skilled services ordered by a physician or allowed practitioner and delivered to people who meet the homebound standard. "Homebound" means leaving home requires a considerable effort, such as assistance from another person or a mobility aid, or leaving is medically inadvisable. The term does not mean you can never leave; occasional short outings for medical appointments or religious services are permitted.
How Medicare defines home health 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.
What original Medicare pays for at home
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.
How to qualify and start services
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.
What Medicare does not cover at home
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 and home care extras
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.
Common questions about IRMAA appeals
Quick answers, fast .
Tap any question to expand. Each links to a fuller standalone answer.
Does Medicare cover durable medical equipment?
Yes.
Medicare Part B covers durable medical equipment (DME): reusable medical gear your doctor prescribes for use at home, such as wheelchairs, walkers, hospital beds, oxygen equipment, CPAP machines, and blood sugar monitors. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026, and Medicare pays the other 80%. To be covered, the item must be ordered by a Medicare-enrolled doctor and supplied by a Medicare-enrolled supplier, and some items are rented rather than bought. Equipment meant mainly for use outside the home, or only for comfort or convenience, is not covered.
Does Medicare cover mental health services?
Yes.
Medicare covers mental health care across its parts in 2026. Part B covers outpatient services like therapy, counseling, and visits with psychiatrists, psychologists, and clinical social workers, and since 2024 it also covers marriage and family therapists and mental health counselors. You pay 20% of the Medicare-approved amount after the $283 deductible, and one depression screening each year is free. Part A covers inpatient mental health care, with a lifetime limit of 190 days in a freestanding psychiatric hospital. Part D covers most mental health medications. Many of these services are also available by telehealth, and Medicare Advantage plans cover at least the same benefits.
Does Medicare cover vision care?
Mostly no for routine care.
In 2026, Original Medicare does not cover routine eye exams for glasses or contact lenses, and it does not pay for the glasses or contacts themselves. It does cover some medical eye care: yearly glaucoma screenings for people at high risk, diabetic retinopathy exams, treatment for eye diseases, and cataract surgery (including one pair of standard glasses or contacts afterward). For those covered services you pay 20% after the $283 Part B deductible. Many Medicare Advantage plans add a routine vision benefit covering eye exams and an allowance for glasses.
Does Medicare cover physical therapy?
Yes.
Medicare Part B covers outpatient physical therapy that is medically necessary to treat your condition. You pay 20% of the Medicare-approved amount after the yearly Part B deductible ($283 in 2026). There is no longer a hard dollar cap on therapy, but once your physical and speech therapy together pass $2,480 in 2026, your therapist must add a note (called a KX modifier) confirming you still need care. Claims above $3,000 may be reviewed for medical necessity. Part A covers physical therapy you receive as a hospital inpatient or in a skilled nursing facility. A doctor or therapist must set up and regularly review your plan of care.
Does Medicare cover chiropractic care?
Partly.
Medicare Part B covers one specific chiropractic service: manual manipulation of the spine to correct a subluxation (when one or more bones of the spine are out of position) that a doctor confirms is medically necessary. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026. Medicare does not cover other services a chiropractor might offer, such as X-rays, massage therapy, acupuncture, or routine wellness visits, so you would pay the full cost for those. Some Medicare Advantage plans include extra chiropractic or wellness benefits beyond this.
Does Medicare cover ambulance services?
Yes, in limited situations.
Medicare Part B covers emergency ambulance transportation when traveling any other way could endanger your health, taking you to the nearest appropriate hospital or facility. You pay 20% of the Medicare-approved amount after the $283 Part B deductible in 2026. Air ambulance is covered only when ground transport cannot reach you or would take too long. Non-emergency ambulance trips, for example to dialysis, are covered only when a doctor provides a written order stating they are medically necessary. Medicare does not cover ambulance rides taken purely for convenience.
Does Medicare cover skilled nursing facility care?
Yes, on a short-term basis.
Medicare Part A covers skilled nursing facility (SNF) care after a qualifying inpatient hospital stay of at least 3 days, when you need daily skilled care like nursing or therapy. In 2026 you pay $0 for days 1 through 20 of each benefit period, $217 per day for days 21 through 100, and all costs after day 100. Coverage is for skilled care while you recover, not for long-term or custodial care (help with daily activities like bathing or dressing), which Medicare does not cover. Long-term nursing home care is generally paid through Medicaid or private funds.
Does Medicare cover hearing aids?
No, not under Original Medicare.
In 2026, Original Medicare (Parts A and B) does not pay for hearing aids or the exams to fit them. Part B does cover diagnostic hearing and balance exams when your doctor orders them to help diagnose or treat a medical condition, and for those you pay 20% after the $283 deductible. Many Medicare Advantage plans, however, include a hearing benefit that helps pay for routine hearing exams and hearing aids, often through a specific network or allowance. If hearing coverage matters to you, it is worth comparing Advantage plans or a standalone hearing plan.
Does Medicare cover home health care?
Yes, when you qualify.
Medicare Parts A and B cover home health care if a doctor certifies that you are homebound (leaving home takes a major effort) and need part-time skilled care, such as skilled nursing, physical therapy, occupational therapy, or speech therapy. A Medicare-certified home health agency must provide the care under a plan your doctor reviews. You pay $0 for covered home health visits in 2026, and 20% for any durable medical equipment. Medicare does not cover 24-hour home care, meal delivery, or homemaker services like cleaning when that is the only care you need.
Does Medicare cover diabetes supplies and testing?
Yes.
In 2026 Medicare covers most diabetes care across two parts. Part B (outpatient care and equipment) covers blood sugar monitors, test strips, lancets, and continuous glucose monitors (CGMs) as durable medical equipment, plus diabetes screenings and a self-management training program. You pay 20% of the Medicare-approved amount after the $283 Part B deductible. Part D (drug coverage) covers insulin and related supplies like syringes, and in 2026 your insulin is capped at $35 for a month's supply. If you have a Medicare Advantage plan, it covers at least the same diabetes benefits, sometimes with added extras.
Which is better, Medigap or Medicare Advantage?
Neither is better for everyone; they suit different needs.
Medigap (also called Medicare Supplement, a private policy that pairs with Original Medicare) lets you see any doctor nationwide who accepts Medicare with no network and very predictable out-of-pocket costs, but you pay a monthly Medigap premium and add a separate Part D drug plan. Medicare Advantage (Part C, your Medicare benefits through a private plan) often has a lower or $0 plan premium, bundles drug coverage and extras like dental and vision, and caps your yearly out-of-pocket costs, but uses provider networks and may require prior approval. People who travel, want maximum doctor freedom, and prefer steady costs often lean Medigap; people who want low premiums, extras, and a network they are comfortable with often lean Medicare Advantage. With both, you still pay the Part B premium ($202.90 per month in 2026). To find out which fits your situation, reach out to a licensed Goodsurance advisor at 1-888-301-8091 (TTY 711), Mon to Fri 8 am to 5 pm PT.
Can I see out-of-network doctors on a Medicare Advantage PPO?
Yes.
A Medicare Advantage PPO (Preferred Provider Organization plan, where your Medicare benefits come through a private plan) lets you see doctors and hospitals outside the plan's network, but you usually pay more for out-of-network care than for in-network care. Staying in network keeps your costs lower, while going out of network is allowed and can be worth it if you want a specific provider. This flexibility is a key difference from a Medicare Advantage HMO (Health Maintenance Organization plan), which generally only covers in-network care except in emergencies. With a PPO, you also typically do not need a referral to see a specialist. Keep in mind the provider must accept the plan and Medicare. Emergency and urgent care are covered regardless of network on both plan types. The trade-off with a PPO is more freedom in exchange for generally higher costs than an HMO.