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

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.

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 surgery, illness, or an ongoing medical condition
• Caregiver education and patient care planning

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.

Let our care assessment guide you

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.

Read more:Medicare, Medicaid, and Long-Term Care

Talk with a Senior Living Advisor

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, many seniors find they can benefit from nonmedical home care.

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.