Will Congress Expand Medicare Home Care Coverage?

What does Medicare cover at home?

More than three million people on Medicare receive home health care each year. Most are recovering from a hospital stay. Since the COVID-19 pandemic, Medicare has allowed some heart and lung rehab programs to run virtually or at home. Medicare also covers nursing, therapy, medical supplies, and limited help from an aide. This care is usually short-term. Medicare does not normally pay for around-the-clock care, delivered meals, cleaning, or help with daily tasks when those are the only services needed. It also does not pay for most long nursing-home stays.

Each year, the federal Centers for Medicare & Medicaid Services (CMS) sets new payment rates for the home health agencies that provide care to Medicare recipients. In June 2025, CMS proposed the largest cut since its founding: a 6.4% payment cut for 2026. Home health agencies and lawmakers from both parties pushed back. In its final rule, issued on November 28, 2025, CMS lowered the cut to 1.3%. This reduction in funds has left both Democrats and Republicans responsible for developing plans to help older constituents and their families.

What might Congress propose?

The broadest idea being talked about in Congress is some form of an affordable home care guarantee for people with Medicare. In May 2026, Senator Ron Wyden and sixteen other senators asked Senate Finance Committee staff to develop such a plan. They want to make home care easier to get, reduce the need to become poor enough for Medicaid (which is how many of the gaps in end-of-life care are currently met), and improve care job opportunities. The announcement did not state who would qualify, how many hours Medicare would cover, or how the benefit would be financed, but it speaks to what might be on the agenda in the coming years.

Another option is the Well-Being Insurance for Seniors to be at Home (WISH) Act, which was introduced in 2025 by Representatives Tom Suozzi (D-NY) and John Moolenaar (R-MI). It would create federal insurance for very long periods of care. A person with a serious disability would qualify after an income-based waiting period of one to five years. The benefit would cover six hours of paid help each day.

Congress could also expand care one service at a time. The Sustainable Cardiopulmonary Rehabilitation Services in the Home Act, sponsored by both Republicans and Democrats, would permanently let Medicare pay for cardiac and pulmonary rehab delivered at home; this measure was introduced in 2025, but had not moved through Congress. The John W. Walsh Alpha-1 Home Infusion Act would let Medicare pay for at-home infusions for people with the genetic lung and liver condition Alpha-1 antitrypsin deficiency; this proposal was also introduced in 2025, but has yet to see movement. And another potential law is the Medicare Home Health Accessibility Act that would permit Medicare to cover in-home occupational therapy even if it was not simultaneously necessary for a person to also be receiving physical therapy, which is currently the only way Medicare can cover this sort of therapy.  

Would home health care be a way for Congress to save money?

In 2025, full-time nonmedical home care had a national median annual cost of about $80,080. A private nursing-home room costs about $129,575. Supporters of more in-home Medicare systems say public coverage could protect savings, ease the load on unpaid relatives, help people avoid institutions, and for some patients, home care may cost less than a nursing home.

But new in-home benefits would not always save the government money. Many people now rely on unpaid relatives or pay for care themselves. Moving those costs to Medicare could raise federal spending even when home care costs less per person. Congress would need to decide who qualifies, how many hours are covered, whether income affects the benefit, whether relatives can be paid, and how Medicare and Medicaid split the bill. Fraud and quality rules would also matter, as a number of states have recently come under scrutiny for insufficient verification measures for paid provisions for relative care, usually through Medicaid.

The Takeaway

Medicare covers limited medical care at home but not most long-term personal care.

A home-care guarantee would close a major gap in Medicare coverage but also create a large new federal entitlement program.  

Even though home care is less expensive than assisted living facilities, adding this benefit to Medicare would likely increase the cost of the program.