What Medicare pays for in care, and what it does not

Medicare pays for medical care at home, in a skilled nursing facility and in hospice when a doctor orders it and you meet the rules. It does not pay for long-term custodial care, 24-hour care at home, or personal care when that is the only care you need.

That gap catches many families. Medicare is health insurance, not a long-term care plan. This page explains what it covers, what it leaves out and what you pay. Carevo does not decide what Medicare will pay in your case. The agency and Medicare do.

Home health care under Medicare

Medicare covers part-time or intermittent skilled care at home. According to Medicare.gov, that includes:

• Skilled nursing such as wound care, injections, IV or nutrition therapy and monitoring of a serious or unstable condition
• Physical, occupational and speech-language therapy
• Medical social services
• Home health aide help with walking, bathing, grooming and feeding, but only when you also get skilled nursing or therapy
• Durable medical equipment and medical supplies for use at home

You need all of the following. A doctor or other provider, such as a nurse practitioner, must see you in person, confirm you need home health care and order it. You must be homebound. A Medicare-certified home health agency must provide the care.

You pay nothing for covered home health services. For Medicare-covered medical equipment you pay the Part B deductible first, then 20% of the Medicare-approved amount. If you qualify, Medicare.gov says you can get unlimited home health visits, and skilled nursing and aide services typically total up to 8 hours a day and 28 hours a week combined. For a short time, more frequent care may be allowed if your provider considers it necessary.

If you are checking whether a situation fits, try the Medicare home health checker. It is a prompt for questions to ask, not a coverage decision.

What "homebound" means

Medicare.gov says you must meet both parts of the test. Leaving home is not recommended because of your condition, or you need help to leave. And you are normally unable to leave home, so leaving takes a lot of effort.

Medical treatment does not count against you. Short, infrequent non-medical outings, such as religious services, also do not. Going to adult day care is allowed.

Skilled nursing facility stays

Part A covers a short stay in a Medicare-certified skilled nursing facility. It covers a semi-private room, meals, skilled nursing, therapy, medications and supplies used in the facility. The conditions are strict:

• A medically necessary inpatient hospital stay of at least 3 days in a row. Time under observation or in the emergency room does not count.
• You generally enter the facility within 30 days of leaving the hospital.
• A provider decides you need daily skilled nursing or therapy.

Part A covers up to 100 days per benefit period. In 2026 you pay nothing per day for days 1 to 20 after the Part A deductible of $1,736. For days 21 to 100 you pay $217 a day. After day 100 you pay all costs. Medicare Advantage plans can set different copayments, so ask your plan.

If you want to compare facilities, see nursing homes on Carevo. Medicare rates certified nursing homes with stars, and we show what CMS published.

Hospice and therapy

Hospice covers care for a terminal illness. You need Part A, certification that you are terminally ill with a life expectancy of 6 months or less, a choice of comfort care instead of care to cure the illness, and a signed statement choosing hospice. Medicare.gov says you pay nothing for hospice care from a Medicare-approved provider, with a small copayment for some outpatient drugs used for pain and symptom control.

Medicare does not cover room and board when hospice care is given at home, or if you live in a nursing home or hospice facility. Find hospice providers near you.

Outpatient physical therapy falls under Part B. A doctor or other qualifying provider must certify you need it, and it must be medically necessary. In-home therapy that fits the home health rules is covered as home health. See in-home therapy.

What Medicare does not pay for

Medicare.gov says Medicare does not pay for:

• Long-term care, also called custodial care, which is mostly non-medical help with bathing, dressing and using the bathroom
• 24-hour-a-day care at home
• Home meal delivery
• Homemaker services, such as shopping or cleaning, that are unrelated to your care plan
• Custodial or personal care when it is the only care you need

Medigap does not cover long-term care in a nursing home or in the community either. If a provider suggests a service Medicare does not cover, ask the agency for the notice that explains what you would owe before care starts.

Does Medicare cover assisted living?

No. Medicare.gov describes assisted living as one place where non-medical long-term care is received, and says Medicare does not pay for that care. The same goes for the room, meals and daily help in an assisted living community.

Families usually pay for assisted living from savings, income or long-term care insurance. Some state Medicaid programs help with services in these settings, and the rules differ by state. See Medicaid and long-term care and private pay. To see local options, browse assisted living or personal care.

What you pay under Original Medicare

Original Medicare has no yearly limit on what you pay out of pocket unless you add supplemental coverage, such as Medigap or a Medicare Advantage plan. For 2026:

• Part B premium: $202.90 a month, or more depending on income
• Part B deductible: $283 a year, then usually 20% of the Medicare-approved amount
• Part A deductible: $1,736 per benefit period

If you cannot afford these costs, see Medicare Savings Programs and Medicaid. The Medicare vs Medicaid comparison shows how they fit together.

What to do next

1. Ask the doctor whether your situation fits home health, SNF or hospice rules, and what exactly they will order.
2. Ask the agency or facility, before care starts, what Medicare will and will not pay for.
3. For care Medicare does not cover, look at the other routes: Medicaid, VA benefits, long-term care insurance and private pay.
4. When you are ready, tell us what you need and we will show providers that serve your area.