Yes, Medicare does cover a home health aide, but only in a narrow situation. Original Medicare (Part A and Part B) pays for a home health aide when you are homebound, a doctor has ordered home health care under a plan of care, you need part-time or intermittent skilled nursing or therapy, and a Medicare-certified home health agency provides the care. The aide comes as part of that skilled care package, not on its own.
What Medicare does not cover is the kind of help many families are really looking for: 24-hour care, a caregiver who only helps with bathing, dressing, and meals, or someone who cleans and shops. If personal care is the only need, Medicare pays nothing for it. That is where Medicaid, veterans benefits, long-term care insurance, and your own savings come in.
How Medicare home health aide coverage works
Medicare’s home health benefit is built around skilled care. A nurse or therapist is the core of the service. A home health aide can be added to help with personal care while that skilled care is going on. Once the skilled need ends, the aide visits end too.
When you qualify, Medicare covers these home health services:
- Part-time or intermittent skilled nursing care
- Physical therapy, occupational therapy, and speech-language pathology
- Medical social services
- Part-time or intermittent home health aide services, such as help with bathing, dressing, and using the bathroom, but only while you are also getting skilled care
- Durable medical equipment and medical supplies for use at home
- Injectable osteoporosis drugs for some women who meet certain criteria
Who qualifies for home health care under Medicare
To qualify for Medicare home health, all of these have to be true:
- You are under the care of a doctor (or another allowed health care provider), and you get services under a plan of care that the provider sets up and reviews regularly.
- A provider saw you in person and confirmed that you need home health care. This face-to-face visit is a requirement, and it has to relate to the main reason you need care.
- You need skilled services. That means part-time or intermittent skilled nursing care, or physical therapy, speech-language pathology, or continued occupational therapy.
- You are homebound. Leaving home is not recommended because of your condition, or you need help (a cane, a wheelchair, special transportation, or another person) to leave, and you normally are unable to leave home. You can still go to medical appointments, religious services, adult day care, or take a short trip to the barber and remain homebound.
- A Medicare-certified home health agency provides the care. The agency must accept Medicare and be approved by it.
If you meet these rules, you are eligible for Medicare home health benefits for as long as you keep meeting them. There is no fixed number of weeks. Your provider reviews and recertifies your plan of care, usually every 60 days.
How many hours will Medicare pay for a home health aide?
Medicare pays for part-time or intermittent care. For skilled nursing and home health aide services combined, that means up to 8 hours a day and no more than 28 hours a week. In some cases, when your provider shows it is medically necessary, Medicare will pay for up to 35 hours a week for a short time.
In real life, most people get far fewer hours than the maximum. A typical schedule might be a few aide visits a week, each an hour or two long, to help with a shower and dressing. The agency decides the schedule with your provider based on your plan of care.
How much does Medicare pay for a home health aide?
If you qualify, Medicare pays the full cost of covered home health services. You pay $0 for the nurse, the therapist, and the home health aide. There is no deductible or coinsurance for the home health care itself.
The one cost you may see is for durable medical equipment, such as a walker, hospital bed, or wheelchair. After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for that equipment.
Before care starts, the home health agency must tell you in writing if any service or supply will not be covered and what you would owe. Read that notice carefully before you sign.
What Medicare does not cover at home
Medicare does not cover:
- 24-hour-a-day care at home
- Meals delivered to your home
- Homemaker services, like shopping, cleaning, and laundry, when they are not related to your care plan
- Custodial or personal care, like bathing, dressing, and help using the bathroom, when this is the only care you need
This last point trips up many families. A home health aide is covered only when you also need skilled care. If your mother just needs help getting dressed and a watchful eye during the day, Medicare will not pay for a home health aide or a caregiver to do that.
Skilled care vs. custodial care
The difference between skilled care and custodial care decides most coverage questions.
Skilled care must be done by or under the supervision of a licensed nurse or therapist. Wound care, injections, teaching a new diabetic how to manage insulin, and physical therapy after a hip replacement are examples.
Custodial care is help with daily activities: bathing, dressing, eating, getting in and out of bed, and using the toilet. It can be done safely by someone without a nursing license. Medicare does not pay for custodial care when it is the only thing you need, whether at home or in a nursing home.
A home health aide under Medicare does custodial-type tasks, but only as part of a skilled plan of care. If you want to know what that aide can and cannot do on each visit, see what a home health aide does and what home health aides cannot do.
Does Medicare cover home health care for dementia?
Only when there is a skilled need. A diagnosis of dementia or Alzheimer’s disease does not on its own qualify someone for Medicare home health. If a person with dementia also needs skilled nursing, for example after a hospital stay, or therapy, and is homebound, Medicare can cover home health care, including an aide, for that period. Day-to-day supervision and personal care for dementia are not covered by Medicare.
Medicaid home health aide coverage
Medicaid is the largest payer of long-term care in the United States, and it covers much of what Medicare leaves out. Each state runs its own program, so the details differ, but the main pathways look similar.
State plan home health
Home health services, including skilled nursing and home health aide services, are a required Medicaid benefit for people who qualify for nursing home care in their state. Unlike Medicare, Medicaid cannot require you to be homebound to get home health services. A face-to-face visit with a provider is still required.
Personal care and HCBS waivers
Many states also cover personal care services through their Medicaid state plan, and most offer home and community-based services (HCBS) waivers. These programs are designed to help people who would otherwise need a nursing home stay at home. They can pay for a home health aide or personal care aide for help with daily activities, even with no skilled need, plus services like homemaker help, adult day care, respite care, and home changes. Waivers often have waiting lists, so apply early.
Self-directed programs
Many states let you direct your own care. You choose, hire, and manage your caregiver, and in many programs that caregiver can be a family member, sometimes even an adult child. This is the main way a family member can be a paid caregiver. Medicare does not pay family caregivers.
To find out what your state offers, contact your state Medicaid agency or your local Area Agency on Aging. Medicaid has income and asset limits, and the rules vary from state to state.
Does Medicare Advantage cover home health aides?
A Medicare Advantage plan must cover everything Original Medicare covers, including the home health benefit. The difference is in how you get it. Your plan may require you to use home health agencies in its network, and it may need to approve care before it starts.
Some Medicare Advantage plans offer extra benefits that Original Medicare does not, such as a set number of hours of in-home support services for help with daily tasks. These benefits vary widely from plan to plan and are usually limited. Check your plan’s Evidence of Coverage or call the plan to ask what it covers.
Other ways to pay for a home health aide
- VA benefits. Veterans enrolled in VA health care may qualify for the Homemaker and Home Health Aide program, which sends a trained aide to help with daily activities. Some veterans also qualify for Veteran-Directed Care or for a pension with Aid and Attendance to help pay for care. Ask the VA social worker at your local medical center.
- Long-term care insurance. A long-term care insurance policy often covers home care once you need help with a set number of daily activities or have cognitive impairment. Read the policy for the waiting period, daily limit, and whether you must use a licensed agency.
- Private pay. Many families pay out of pocket for some or all of the care. CareScout’s 2025 Cost of Care Survey puts the national median for a non-medical in-home caregiver at $35 an hour. At 44 hours a week, that adds up to about $80,080 a year.
- Hospice. If your loved one has a terminal illness and chooses hospice, the Medicare hospice benefit covers hospice aide visits as part of the care team. Learn more in who pays for hospice care at home.
How to get Medicare home health services started
Home health usually begins in one of two ways: a hospital or rehab center sets it up when your loved one goes home, or you ask the doctor for a referral. Ask the doctor directly: “Do you think my father needs skilled nursing or therapy at home, and would he qualify as homebound?”
You have the right to choose the home health agency, as long as it is Medicare-certified and serves your area. Use Medicare’s Care Compare tool to find a Medicare-certified home health agency and compare quality ratings. Our guides on finding a home care provider and interviewing home care or hospice providers walk you through the questions to ask.
If you are unhappy with the quality of home health care, talk to the agency first. If that does not help, you can file a complaint with your state survey agency or with your Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO). If Medicare ends your home health care and you disagree, you have the right to a fast appeal.
For free, unbiased help with your options, contact your local State Health Insurance Assistance Program (SHIP). Counselors there can explain your Medicare coverage and plan choices at no cost.
Checklist: next steps
- Write down the care your loved one needs each day, and mark which tasks are skilled (nursing, therapy) and which are personal care.
- Ask the doctor whether your loved one is homebound and needs skilled care, and request a home health referral if so.
- Choose a Medicare-certified home health agency, and ask how many aide visits per week the plan of care includes.
- If you have a Medicare Advantage plan, confirm the agency is in network and ask about extra in-home support benefits.
- If personal care is the main need, apply for Medicaid, an HCBS waiver, or VA benefits, and check any long-term care insurance policy.
- Plan for the gaps: family help, paid hours, and in-home respite care so the main caregiver gets a break.
- Call your local SHIP for free help comparing your Medicare coverage and plan options.
