You can get home health aide services through Medicare, but only when you need skilled care, a doctor orders it, and a Medicare-certified agency provides it.
Medicare will cover part-time home health aide help for personal tasks like bathing or dressing when those tasks link to skilled nursing or therapy needs — it won’t cover long-term nonmedical care or 24-hour help.
Keep reading to learn which services qualify, common limits and costs, how to qualify, and where to find Medicare-approved aides.
If you want one-on-one help sorting benefits and plan options, The Modern Medicare Agency connects you with licensed agents who talk with you directly, match plans to your needs, and avoid extra fees.
Medicare Coverage for Home Health Aides
Medicare can pay for limited home health aide services when certain medical and care conditions are met.
Coverage hinges on a doctor’s order, skilled care needs, and use of a Medicare-certified agency.
Eligibility Criteria for Coverage
You must be under a doctor’s care and have a written plan of care that the doctor reviews regularly.
A physician must certify that you need skilled nursing or therapy (physical, occupational, or speech) on a part-time or intermittent basis.
You must also be considered “homebound,” meaning leaving home is difficult without help, special transportation, or assistive devices.
If you can safely leave for medical appointments occasionally, you may still qualify.
Services must be provided through a Medicare-certified home health agency.
If you do not meet these rules—such as needing only personal care without skilled services—Medicare will generally not pay.
Services Provided by Home Health Aides
Home health aides give hands-on personal care tied to your medical need.
Typical tasks include help with bathing, dressing, toileting, and basic mobility assistance.
Medicare covers aide visits only when they support your skilled care needs, not for sole custodial care like continuous supervision or household chores.
Skilled services covered alongside aide care can include nursing visits and therapy sessions.
Agencies also document care and report progress to your doctor.
That documentation helps Medicare verify that care remains medically necessary.
Duration and Frequency of Approved Services
Medicare limits coverage to part-time or intermittent visits, not 24-hour or round-the-clock care.
“Part-time” usually means a few hours per day or several days a week, as needed to meet your medical goals.
Your doctor and the home health agency set the plan of care and review it regularly.
If your condition changes, the plan can be adjusted to increase, decrease, or stop services.
If you need continuous personal care, you should discuss alternatives and costs with a trusted advisor.
Types of Home Care Services Under Medicare
Medicare covers different kinds of home care when a doctor certifies medical need and you meet eligibility rules.
You may get skilled nursing, therapy, and some personal care help.
Each type has limits and rules you should know.
Skilled Nursing Care
Skilled nursing covers medical tasks a registered nurse or licensed practical nurse must do.
Examples include wound care, injections, IV therapy, and monitoring complex conditions like heart failure or post-op recovery.
Medicare pays for these services when they are part-time or intermittent and ordered by a doctor as part of a written care plan.
You can expect visits that focus on medical treatment and clinical assessment.
Medicare does not cover long-term daily nursing for chronic personal care needs.
If you need skilled nursing at home, your doctor and a Medicare-certified agency will coordinate care and document progress.
Therapy Services
Medicare covers physical therapy, occupational therapy, and speech-language therapy when they are medically necessary and prescribed by your doctor.
These services aim to restore function after surgery, stroke, injury, or illness so you can perform daily activities safely.
Therapy must be provided on a part-time or intermittent basis and be reasonably expected to improve your condition.
Medicare pays for therapy visits through a home health agency that creates a therapy plan and tracks outcomes.
You may have limits based on need and progress rather than a fixed number of sessions.
Personal Care Assistance
Personal care help includes bathing, dressing, toileting, and meal-related tasks.
Medicare covers a home health aide to provide personal care only if you also need skilled nursing or therapy at the same time.
An aide supports the skilled services by helping with daily living activities under the clinical plan.
If you need personal care but do not require skilled medical services, Medicare usually will not pay.
Limitations and Exclusions
Medicare covers some skilled care at home but leaves out many non-medical and long-term services.
Know what it will not pay for, when coverage stops, and how that affects your care choices.
Services Not Covered by Medicare
Medicare does not pay for 24-hour-a-day custodial care at home.
If you need constant supervision or help only with daily tasks—like eating, dressing, or bathing—Medicare typically won’t cover those costs.
Medicare also excludes services that are not medically necessary.
Examples include routine homemaking (laundry, shopping), meal delivery when not part of a skilled plan, and lift or mobility devices that aren’t prescribed as durable medical equipment.
Durable medical equipment (DME) may be covered, but only if your doctor orders it and Medicare approves it.
If you need services beyond skilled nursing, physical therapy, or medically needed home health aide visits, you must plan for other payers—Medicaid, private insurance, or private pay.
Non-Medical Assistance Limitations
Medicare’s home health aide benefit covers hands-on skilled personal care only when tied to a medically reasonable skilled service plan.
Aide visits focused solely on non-medical tasks are usually not covered.
This means you may need to pay out of pocket for routine personal care.
Home health aides under Medicare cannot provide long-term custodial help by themselves.
If your primary need is help with activities of daily living, arrange backup funding.
You can mix services—Medicare-covered skilled visits and separately paid homemaker or companion services—but Medicare won’t pay for the latter.
Duration Restrictions
Medicare covers home health services only for a limited time and only while you continue to meet eligibility criteria.
Coverage is “intermittent,” meaning part-time skilled care or therapy, not ongoing full-time care.
If your condition improves or your doctor stops certifying skilled needs, Medicare ends coverage.
There is no fixed number of visits guaranteed; approval depends on your clinical condition, the plan of care, and periodic reviews.
You must have a doctor’s order and periodic recertification for more visits.
If you need extended care beyond Medicare limits, consider Medicaid or private plans to fill the gap.
Steps to Qualify for Home Health Aide Services
You need a doctor’s order, care from a Medicare-certified agency, and clear records proving medical necessity.
Follow these steps to get approved and start receiving aide services at home.
Obtaining a Doctor’s Order
Your doctor must certify that you are homebound and need skilled care.
The order should state the specific skilled services you need, such as skilled nursing or physical therapy, and say that these services are needed to treat an illness or injury.
Ask your doctor to date and sign the plan of care and to include how often the skilled visits should occur.
Keep a copy of the signed order.
If your condition changes, request an updated order promptly.
Medicare-Certified Home Health Agencies
You must get services from a Medicare-certified home health agency.
Certification means the agency meets federal standards for skilled care and billing.
Call the agency and confirm they accept Medicare and that they provide aides as part of a skilled care plan.
Ask about visit limits and whether they coordinate with your doctor.
Documentation Requirements
Medicare requires documentation showing you need skilled care and are homebound.
Important documents include the doctor’s signed plan of care, progress notes from skilled staff, and proof of homebound status (like statements about difficulty leaving home).
Agencies must keep these records and submit them to Medicare for coverage approval.
Track all visits, changes in condition, and any updates from your doctor.
If Medicare requests records, the agency provides them, but you should keep copies too.
Costs and Out-of-Pocket Expenses
Medicare may cover some medical home health services, but you still face coinsurance, copayments, and other charges.
Know what Medicare pays, what you must pay, and where gaps can appear so you can plan your budget.
Coinsurance and Copayments
Original Medicare (Part A and Part B) usually pays for most home health visits that are medically necessary.
You generally pay nothing for covered skilled nursing visits and therapy if Medicare approves them.
However, Part B may require a 20% coinsurance for durable medical equipment (DME) like hospital beds or portable oxygen after Medicare pays its share.
If you have a Medicare Advantage plan, your copays and coinsurance can differ.
Plans may set fixed copays per visit or a percentage of the cost.
Potential Additional Charges
Medicare does not cover non-medical personal care such as bathing, dressing, meal prep, or 24-hour care.
You must pay for private-duty aides or homemaker services out of pocket or through Medicaid, long-term care insurance, or a Medicare Advantage supplemental benefit if your plan offers one.
Other possible costs include costs for services not deemed medically necessary, charges from non–Medicare-certified agencies, and fees for extra supplies not covered by Part B.
Alternatives and Supplemental Coverage
You can use other programs or pay options to get more home help than Medicare covers.
These choices include state Medicaid rules, long-term care insurance, and paying privately.
Each option has rules, costs, and steps to apply.
Medicaid and State Programs
Medicaid can cover long-term personal care services that Medicare does not.
Eligibility depends on your income, assets, and the rules where you live.
Many states offer Home and Community-Based Services (HCBS) waivers that pay for aides, personal care, and sometimes homemaker services.
You must apply through your state Medicaid office and meet both financial and medical need tests.
Waiting lists are common for waivers, so start early.
Some programs require a care plan and regular reassessments.
If you qualify, Medicaid often pays more of the day-to-day personal care than Medicare.
Ask your state agency about specific services, co-pays, and whether your current home health agency accepts Medicaid.
Long-Term Care Insurance
Long-term care (LTC) insurance can pay for in-home aides, assisted living, and nursing homes depending on your policy.
Policies vary on daily benefit amounts, elimination periods (waiting days), and how long benefits last.
Read your contract for limits on services, provider networks, and whether you must meet a “skilled” or “activities of daily living” trigger.
Buyers typically choose a daily or monthly benefit and an inflation rider to keep pace with costs.
Premiums rise with age and health status, so earlier purchase usually lowers cost.
If you already have a policy, contact your insurer to confirm covered home aide services and claim steps.
Private Pay Options
Paying privately gives you the most control over who provides care and when.
You can hire licensed home health agencies, private-duty aides, or independent caregivers.
Typical costs range widely by region and level of care, so get quotes from multiple sources.
Consider written contracts that list duties, hours, background checks, and rates.
You may use savings, pensions, Veterans Aid & Attendance benefits, or sell assets to cover costs.
How to Find Medicare-Approved Home Health Aides
Start by asking your doctor if home health care is medically necessary and if they can certify it.\ Medicare requires a physician’s order and a plan of care before it pays for a home health aide.
Look for agencies that are Medicare-certified.\ You can call Medicare or search online for a list of certified providers in your area.
Certified agencies agree to be paid the Medicare-approved amount and follow federal rules.\ Talk with your local SHIP counselor or call The Modern Medicare Agency for help.
Our licensed agents are real people you can speak to one-on-one.\ They will explain which agencies take Medicare and which services are covered.
When you contact agencies, ask these questions:
- Are you Medicare-certified?
- Do you accept Medicare assignment?
- Which aides will be assigned and what training do they have?
Check agency reputation and reviews, but also confirm facts by phone.\ Ask about scheduling, supervision, and how the agency handles changes in your care plan.
You get clear answers, help with paperwork, and a licensed agent who can walk you through next steps.
Frequently Asked Questions
Medicare can pay for part-time skilled care at home, limited home health aide visits, and certain therapies when a doctor certifies medical need and a Medicare-certified agency provides care.\ Coverage often requires intermittent skilled services and homebound status.
How to qualify for home health care under Medicare?
You need a doctor to certify that you need skilled nursing or therapy.\ A Medicare-certified home health agency must provide the services.
You must be homebound, meaning leaving home takes considerable effort or requires help.\ Your doctor must review and approve your care plan regularly.
How much does Medicare reimburse for home health care services?
Medicare Part A and Part B cover approved home health services with no monthly premium for Part A if you qualify.\ You typically pay nothing for covered home health care, but you may owe 20% for durable medical equipment.
The agency bills Medicare directly, so you usually do not pay the full cost upfront.\ If services fall outside Medicare rules, you must pay out of pocket or use other coverage.
What services are included in Medicare’s coverage for home care?
Medicare covers skilled nursing care, physical therapy, occupational therapy, and speech therapy.\ It also covers limited home health aide visits for personal care when tied to skilled services.
Medicare may cover medical social services and certain medical supplies related to treatment.\ Custodial care, like full-time help with bathing or dressing alone, is not covered unless tied to skilled care.
For what duration will Medicare provide coverage for home health care?
Medicare covers home health services while you still need skilled care and remain homebound.\ Doctors must recertify your need for care over time to continue coverage.
There is no fixed day limit; coverage continues as long as Medicare criteria and doctor approvals are met.\ If your condition improves and skilled care is no longer needed, Medicare stops paying.
What are the eligibility requirements for home health care services with Medicare?
You must be enrolled in Medicare Part A or Part B.\ A doctor must certify that you need skilled nursing or therapy and create a care plan.
A Medicare-certified home health agency must provide the services.\ You must be homebound or getting skilled care under a plan of care.
Does Medicare provide coverage for in-home care for dementia patients?
Medicare may cover skilled services for dementia patients if a doctor documents medical need for skilled nursing or therapy.
Home health aides can provide personal care only when part of a plan that includes skilled care.
Medicare does not pay for long-term custodial care just for supervision or routine help.
For help choosing plans that may cover additional services, contact The Modern Medicare Agency.
Our licensed agents are real people you can speak with one-on-one.
They match Medicare packages to your needs without added fees and help you compare options clearly.
