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How to Qualify for Home Health Care: Eligibility and Coverage Options, Explained

4 minute readLast updated February 27, 2023
Written by Leah Hallstrom
Reviewed by Denise Lettau, J.D., wealth management specialistAttorney Denise Lettau has over 15 years of experience in the wealth management industry.
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Whether your parent needs daily support to manage a chronic condition or they’re recovering from an illness after a hospital stay, bringing in a home health team can help provide them with expert care. Seniors with limited mobility or progressive illnesses often benefit from home health care, as they can get the support they need without leaving the comfort of home. Explore how to qualify for home health care, learn the eligibility requirements, and explore ways to start your search for an in-home care provider.

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Key Takeaways

  1. Home health services help seniors thrive. From managing chronic conditions to recovering from illness, patients can receive essential medical support at their residence.
  2. Eligibility requirements vary between insurance providers. While Medicare has specific guidelines for beneficiaries to qualify for home health services, Medicaid policies differ from state to state.
  3. Seniors may choose to pay for care out of pocket. Private insurance policies, tax credits, and reverse mortgages can help pay for home health care.
  4. Be prepared to start your search for in-home care. Talk to your parent’s insurance agent and general practitioner, and then decide which home health services you need most before hiring anyone. 

Understanding home health care services

Home health care includes a wide range of services that can help seniors thrive. This type of care focuses on medical support and is provided by trained professionals under the direction of a physician or nurse. Home health care services have to be authorized by a doctor who will reevaluate their patient regularly to make sure home health is still the right recommendation.

Home health care services often include the following:

  • Skilled nursing support like wound care, IV therapy, injections, and general monitoring
  • Occupational, speech, or physical therapy for patients recovering from illness, or an ongoing medical condition
  • Recovery from a surgery, such as a hip replacement
  • Caregiver education and patient care planning

If your parent could benefit from these support services, it may be time to talk to their doctor about next steps to arrange home health care.

Who qualifies for home health care services?

Any senior classified as homebound — due to a medical condition or limited mobility — whose physician has prescribed home health services is generally eligible to receive in-home health care.

However, additional requirements to qualify for home health care services will largely depend on your loved one’s insurance provider. Because all insurance policies and plans are different, coverage will vary from person to person.

Medicare

For Medicare to cover the cost of home health services, a senior must meet the following requirements:

  • Be under the current care of a physician who has recommended home health services like skilled nursing or therapy
  • Have a doctor confirm they’re homebound due to a serious medical condition or a specific situation that makes leaving the house extremely difficult
  • Be enrolled in Medicare Part A and/or Part B
  • Receive home health services from a Medicare-certified provider

While Medicare will cover intermittent care for less than eight hours a day or fewer than 28 hours a week, continuous or round-the-clock care is not covered by standard home health benefits. Plan to contact your loved one’s Medicare representative to find out how to get home health care coverage and explore Medicare-approved agencies.

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Our free tool provides options, advice, and next steps based on your unique situation.

Medicaid

Eligibility requirements vary on a state-by-state basis for Medicaid-covered home health services. For seniors with Medicaid to qualify for home health services, they must have an essential medical need. Medicaid also requires that the agency you hire is certified. Unlike Medicare, Medicaid will often cover home care services like housekeeping, meals, and help with activities of daily living.

To find out about eligibility requirements and learn more about the application process, seniors or their families should contact a Medicaid representative from the state where they’d like to arrange care.

Private funding

Many seniors and their families will pay for in-home services with private insurance policies, reverse mortgages, and tax credits.

Some who plan to pay privately will opt to hire a private, in-home caregiver. While this is often a cheaper option than using an agency, it’s up to families to organize payments, pay taxes, conduct background checks, and create employment contracts.

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Next steps: How to get home health care

If you think your parent could benefit from home health services, consider the following steps to start the process.

  • Determine what support your parent needs: Do they require daily IV therapy? Will they need toileting assistance? Are they rehabbing an injury that requires specific treatment?
  • Contact your parent’s insurance agent or senior care insurance representative to determine which home health services their plan covers.
  • Schedule an appointment with a physician to talk through a plan of care and learn if home health services are the best option.
  • Research local home health agencies to get an idea of pricing if your parent is uninsured or planning to pay privately.

While home health care may be the right path forward for some, others may simply be planning for the future. Before choosing a a home health caregiver, many seniors find they can benefit from home care, first.

Home care services include housekeeping, transportation, meal preparation, medication management, companionship, and help with activities of daily living (ADLs). Home care is a great option for seniors with minimal health concerns who are aging in place. Connect with one of A Place for Mom’s Senior Living Advisors today to learn more about in-home care options for your loved one.

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Meet the Author
Leah Hallstrom

Leah Hallstrom is a former copywriter and editor at A Place for Mom, where she crafted articles on senior living topics like home health, memory care, and hospice services. Previously, she worked as a communications professional in academia. Leah holds bachelor’s degrees in communication studies and psychology from the University of Kansas.

Edited by

Danny Szlauderbach

Reviewed by

Denise Lettau, J.D., wealth management specialist

The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.

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