If the thought of aging in place is daunting — whether it’s for yourself or a loved one — then you’re not alone. Living at home when you age comes with many challenges, one of which is the increasing need for healthcare services. Staying at home is typically much less expensive than moving to a nursing home or assisted living facility, but the costs for at-home care can add up.
Medicare may pay for many of your in-home healthcare needs, but there are a lot of guidelines you need to meet and follow in order to get coverage. Read on for Medicare’s home healthcare requirements for 2026.
Custodial care vs. Home healthcare
If you are living at home with an illness or injury, you may suddenly find yourself needing extra help. You could have trouble walking after surgery, find it more difficult to keep your house tidy, or need help injecting a medication like osteoporosis medication. Medicare may pay for some or all of those services, depending on your condition.
Medicare covers in-home health care that is considered medically necessary by your healthcare provider, including skilled nursing care, physical and occupational therapy, and services provided by a home health aide.
In-home care covered by Medicare includes:
Skilled nursing care — These are services that require a nurse’s supervision, like giving IV drugs, wound care after surgery, and managing your healthcare plan.
Physical, occupational, and speech therapies — These must be provided by, or under the supervision of, a licensed therapist. Occupational therapy is only covered if you qualify for home healthcare for another reason, like skilled nursing care.
Home health aide — Medicare coverage for a home health aide is free only if you also qualify for skilled nursing or therapy services. A home health aide can assist you with personal services like bathing, dressing, and meal preparation.
Social Services — Medicare pays for social and behavioral services, like therapy, to help you manage your condition if you also qualify for skilled nursing or therapy.
Medical supplies — Medicare covers medical supplies like catheters when they’re prescribed as part of your care plan.
Durable medical equipment — Medicare usually covers 80% of the approved cost for durable medical equipment, including a walker, cane, or wheelchair.
There are some in-home services excluded by Medicare. These are:
- 24-hour home care
- Prescription medications
- Meal delivery services
- Custodial or personal care — This includes help with bathing, dressing, and cleaning. These are only covered by Medicare if a home health aide performs these tasks when they are visiting to provide other approved home health services.
Medicare home healthcare requirements 2026
If you need Medicare coverage of home health services, there are strict criteria and coverage limitations to understand. Medicare has guidelines on why you do or don’t qualify, the number of visits available, and the length of time you can receive care. The requirements for receiving in-home care covered by Medicare are:
- You have to fit Medicare’s homebound definition. This means you can’t leave your home, or it is difficult to leave, because you need a wheelchair, crutches, or transportation (due to your qualifying illness or injury).
- The care has to be intermittent. Medicare’s definition of intermittent is needing care at least once every 60 days and no more than once a day for up to three weeks. It can take longer, particularly if you have a chronic condition, but it must be approved by your healthcare provider.
- You can receive skilled nursing care or help from an aide for eight hours a day, up to 28 hours a week. Medicare may approve help up to 35 hours a week if you have special needs.
- Your care must be provided by a Medicare-certified home health agency.
- You need to have an in-person assessment by a healthcare provider (or a hospital), within 90 days of when you need care or 30 days after your first in-home visit. This provider can order your in-home care.
- The medical specialist has to create a plan that they review and certify every 60 days.
- If you have a chronic condition, the in-home services have to help you maintain function, improve it, or slow down the decline of your condition.
Medicare in-home coverage limits and costs
Medicare will only pay for in-home care that is part-time and intermittent. If you qualify for these services, Medicare covers them completely. If you need more care, you can talk to your doctor to see what options are available.
If you need durable medical equipment like a wheelchair, cane, or walker, you will have to pay 20% coinsurance on those products. Your home health agency can also charge you up to 15% over the Medicare agreed-upon fee if it doesn’t participate in Medicare or doesn’t accept Medicare prices for this equipment.
Prior to starting your services, your home health agency is required to tell you — verbally and in writing — what Medicare will pay for and what portion of the costs are your responsibility. They should also tell you if there is anything that Medicare doesn’t pay for, and the cost for those services.
Paying for additional care
Medicare can cover many of your short-term healthcare costs while staying at home. But if you need long-term care or have custodial costs that Medicare won’t cover, there are other options to help lower your out-of-pocket costs.
Long-term care insurance will pay for some in-home care when you need help with activities of daily living (ADLs). ADLs include dressing, bathing, eating, and going to the bathroom. This insurance has different coverage amounts and benefit periods and can go a long way toward paying for long-term, in-home healthcare.
If you have a chronic illness, you should talk with your doctor to see if you qualify for palliative care, which may be covered by Medicare. Medicare may pay for palliative care, including therapy, social support, and assistance with activities of daily living.
If you qualify for Medicaid, it pays for many of the same services as Medicare, but will pay for longer periods of time. Depending on the state in which you live, Medicaid may also pay for some custodial, or personal, services.
If you need to pay for some of your in-home care out of pocket, you can consider options including:
- Use savings or consider a reverse mortgage.
- Use funds from your health savings account (HSA) for qualifying expenses.
- Talk with your local Office of Veterans’ Affairs (VA), which can help pay for both skilled nursing services and help with daily activities.
Aging in place is a good option for many people over the age of 65. But if an injury or illness is making it difficult for you, there are ways to reduce your healthcare spending. Talk to your doctor or health plan to see if you qualify for assistance.
