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HomeHealth & FitnessWhat Are the Home Health Eligibility Criteria?

What Are the Home Health Eligibility Criteria?

Home care is an important part of the United States healthcare system. More than 4.5 million Americans are currently benefiting from it. Although the number of current beneficiaries appears to be high, it is estimated that the number will grow in the coming years. Read on if you’re interested in finding out the eligibility criteria for home healthcare at Interim Home Healthcare.

Qualifying for Home Health Care Services


Medicare is one of the available options for seniors and vulnerable people who wish to explore home healthcare benefits. If you’re wondering whether Medicare covers the cost of home health care services, the answer is yes. However, you must understand the fine print of this coverage.

Medicare coverage for home healthcare services only extends to certain circumstances. The important thing to note is that qualification hinges on a diagnosis and recommendation by a doctor. So, you are only entitled to Medicare coverage for your home health care needs if you have been certified by a doctor as needing home care. You may also qualify for this coverage under Medicare if you are deemed “homebound” under the Centers for Medicare & Medicaid (CMS) standards.

Please note that although Medicare covers your home health care services, it applies only to some hours. The fine print of Medicare coverage for home healthcare services allows you to receive rehabilitative services like physical or occupational therapy or skilled nursing care for certain hours.

The key point to note is that Medicare coverage is available but limited when it comes to home healthcare services.

Medicare’s Home Health Eligibility Checklist

Doctor’s Orders

Home health care eligibility hinges on whether your medical provider deems you fit or not. Doctors can order short or long-term home health care based on the specific health needs of their patients. One of the biggest indicators or eligibility criteria is worsening health conditions. However, other criteria may include a new diagnosis, new or change in medication, and frequent hospital visits or doctor’s appointments.

Doctors will also consider the patient’s need for skilled nursing, ongoing occupational therapy, physical therapy, or speech therapy on an intermittent or continuous basis.


Medicare requires eligible parties to be homebound or confined to their homes to qualify for home health care services. People like this find it difficult to leave their homes or may require a great amount of care and management to do so.

Care delivered by a Medicare-Certified Home Health Agency

Patients eligible for Medicare-covered home health care services must receive home health care from an agency that has been accredited and certified by the program. This means that patients must look for home health care service providers who have been accredited and are part of the program.


Medicare covers the skilled part of home care services but doesn’t extend to the non-skilled personal care needs. Under Medicaid, you may be able to explore other options for vulnerable and elderly care needs. Those requiring important home care services can leverage Medicaid home aid coverage. However, they must pass the medical requirement and the financial means test to be eligible.

Although Medicaid offers home care services that aren’t accessible under Medicare, the services are only available to specific people who fall within the program’s income requirement.

State Programs

Many states across the nation have understood the importance of home care services to residents. They, therefore, offer help to residents who need home care services. You may need to contact the appropriate quarters in your state to confirm the availability of such provisions and qualifying criteria.

Most states may require that you fall within a certain financial bracket or to have served at a capacity for eligibility. It is important to know what your state offers and how to benefit from it if you’re eligible.

Private Insurance Coverage

All of the options discussed above are available to the public and provide subsidized home health care services to Americans. However, those who do not wish to be confined by those rules or those deemed ineligible can choose a private and more personal option.

There are many insurance companies offering healthcare coverage as part of their products. You should speak to your insurance provider to understand what is covered and how you can take advantage of it. You may also need to speak to the home healthcare provider to know if they accept such insurance coverage.

While private insurance coverage offers you a more flexible yet expensive choice, it isn’t always available for long-term care needs. Most insurance companies offer short-term home healthcare coverage to clients, ensuring that they get the immediate and short-term healthcare services needed to boost recovery and health.


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