Who Qualifies

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Insurance coverage for home health care services in California varies depending on the type of insurance a patient carries. Your physician must decide that home health care is needed in order to qualify for coverage. The covered services will be determined based on the physician’s orders.

Medicare Requirements for Home Care

A patient requiring reasonable and necessary services that can be performed in a home setting may qualify for coverage by Medicare when all of the following conditions apply:

  • The patient is confined to the home or homebound due to illness, surgery or injury.  Whether someone is considered “homebound” for purposes of Medicare coverage is based on a number of factors.
  • The patient is under the care of a physician who has determined that in-home care is medically necessary, and has provided a plan for home health care.
  • The patient must be in need of skilled nursing care on an intermittent basis or in need of physical therapy, speech therapy, or occupational therapy.
  • The patient must choose a home health agency that is approved by Medicare.

Learn more about our Medicare and insurance coverage information.

What does the term “Homebound” mean?

Homebound patients typically have a difficult time leaving their homes. When they manage to leave, it is to receive medical treatment or for other allowable infrequent trips of short duration. The most common reasons for being homebound are due to illness and injury, including conditions that require the assistance of another person, special transportation, or the use of supportive equipment (crutches, canes, wheelchairs, walkers, etc.).