Who Qualifies For Home Health Care Services?

Anyone considered homebound qualifies for home health care services and may be eligible to pay for care through federal or state programs. Seniors with Medicare Part A and/or Part B (jointly known as Original Medicare) are subject to the following requirements:

• They must currently be under a doctor’s care, with a regularly reviewed care plan
• A doctor must certify them as homebound
• A doctor must also certify the need for skilled nursing care or physical, speech or occupational therapy (or a combination of these)

To be classified as homebound, the individual must have an illness or injury that causes difficulty leaving their home unassisted by others or special equipment, such as a wheelchair, cane or walker. People who need more than part-time nursing care don’t qualify for home health care benefits. However, briefly leaving home for medical treatment or nonmedical reasons, such as religious worship, doesn’t affect eligibility.

Home health care services eligible for Medicare coverage include:

• Part-time nursing care
• Physical, speech and occupational therapy
• Medical social services
• Medical supplies and equipment for home use

Your doctor should be able to recommend a Medicare-certified home health agency. Alternatively, you can find certified agencies in your area using Medicare’s online search tool.

Medicare doesn’t cover 24/7 home care or services outside the scope of an individual’s care plan, such as shopping or laundry. Assistance with activities of daily living, such as dressing, eating and using the bathroom, isn’t covered if it’s the only type of care someone receives.

Generally, Medicaid enrollees may be able to receive some level of home health care coverage. To determine the eligibility requirements and which services are covered, the individual should contact their state’s Medicaid department. Contact and program information is available in each state’s profile on the Medicaid Home & Community Based Services page.

If a person is ineligible for Medicaid, several other options are available that could help them pay for home health care services. Low-income disabled veterans may be eligible for homebound benefits. If the person has long-term care insurance, it may partially or fully cover their care needs. The option to pay out of pocket is also available if financially feasible.