What Medicare covers at home
Part A and Part B cover home health care when you're homebound, a doctor or other provider such as a nurse practitioner has seen you in person and orders the care, and a Medicare-certified home health agency provides it. Covered services include:
- Part-time or intermittent skilled nursing care, such as wound care or injections.
- Physical therapy, speech-language pathology and, under certain conditions, occupational therapy.
- Home health aide care, but only while you also get skilled nursing or therapy.
- Medical social services, and medical supplies for use at home.
You pay nothing for covered home health services. For durable medical equipment you usually pay 20% of the Medicare-approved amount after the Part B deductible. Medicare doesn't cover 24-hour care, homemaker services such as shopping and cleaning, or personal care when that's the only care you need.
A Medicare review that applies in North Carolina
Medicare.gov notes that if you get services from a home health agency in Florida, Illinois, Ohio, North Carolina or Texas, a Medicare demonstration lets the agency ask Medicare for a pre-claim review, so you both know early whether Medicare is likely to pay. Your benefits are the same, and the review shouldn't delay your care.
Help at home in North Carolina beyond Medicare
- NC Medicaid Personal Care Services (PCS). For people with NC Medicaid living in their own home who need hands-on help with at least three of five daily activities (bathing, dressing, mobility, toileting, eating), or extensive help with two. Adults can be approved for up to 80 hours a month after a doctor's referral and an independent assessment (Clinical Coverage Policy 3L).
- CAP/DA. NC Medicaid's waiver for adults 18 and older who need a nursing-home level of care and want to stay home. It adds services such as in-home aides, adult day health, respite and home modifications. There has been a statewide waitlist since February 16, 2024; call NCLIFTSS at 1-833-522-5429 for a referral or your place on the list.
- Home Care Independence. A Division of Aging program for people 60 and older to hire family, friends or others as a personal assistant; not offered in every county.
- Your area agency on aging. The Division of Aging funds local services for people 60 and older, such as meals and caregiver support, through 16 regional area agencies on aging. Find yours on the NCDHHS area agency on aging map.
Find Medicare-certified agencies on Care Compare. A licensed insurance agent who works with Benefits Life can explain how home health works under Original Medicare and Medicare Advantage, at no cost to you; you can request a call from a licensed insurance agent.
Related questions
Does Medicare cover nursing home care?
The 100-day skilled care rule.
Does Medicare cover assisted living?
Adult care homes and Special Assistance.
How do I get rides to the doctor?
County DSS rides and more.
Sources
- Medicare.gov — Home health services
- Medicare.gov — Care Compare
- NC Medicaid — Clinical Coverage Policy 3L, State Plan Personal Care Services in In-Home Settings (amended Jan. 1, 2026)
- NC Medicaid — Community Alternatives Program for Disabled Adults (CAP/DA)
- NC Medicaid — Waitlist for the CAP/DA program (March 5, 2024)
- NCDHHS Division of Aging — Home Care Independence
More questions in this guide
- Can I keep my doctor when I go on Medicare in North Carolina?
- Does Medicare cover assisted living in North Carolina?
- Does Medicare cover dental in North Carolina?
- Does Medicare cover eye exams and glasses in North Carolina?
- Does Medicare cover hearing aids in North Carolina?
- Does Medicare cover mental health care in North Carolina?
- Does Medicare cover nursing home care in North Carolina?
- How do I get rides to the doctor with Medicare in North Carolina?
Part of the guide: Medicare basics for North Carolinians · All questions
Frequently asked questions
What does homebound mean for Medicare?
You're homebound if leaving home isn't recommended because of your condition, or you need help such as a wheelchair or another person to leave, and leaving takes a lot of effort. You can still go to medical appointments, religious services or adult day care.
Why did my North Carolina home health agency ask Medicare to review my care first?
North Carolina is one of five states in a Medicare demonstration where home health agencies may send a pre-claim review request. Medicare.gov says your home health benefits haven't changed and your access to care shouldn't be delayed by the review.
Does NC Medicaid pay for an aide to help at home?
Yes, for people with NC Medicaid who qualify. Personal Care Services cover hands-on help with bathing, dressing, mobility, toileting or eating, up to 80 hours a month for adults, after a doctor's referral and an independent assessment. CAP/DA can add more services for people who need a nursing-home level of care.
Medicare in your North Carolina county
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