What is Medicare’s Homebound Requirement?

Homebound can sound like a scary designation, but don’t let it intimidate you. Medicare homebound status is a classification Medicare uses to describe someone who needs assistance leaving home or who isn’t generally advised to leave home. But being homebound doesn’t necessarily mean that you can’t ever leave the house. What’s more, receiving a homebound qualification from your doctor can be important for the continuation of your care. It’s also a first step toward receiving many of Medicare’s home healthcare services. Here’s how it works. 

What Are the Requirements for Medicare Homebound Status? 
Being homebound doesn’t mean you can never leave your home, as you’ll see below. Medicare uses the following criteria to define homebound: 

1. To leave your home, you need help, including the help of another person, crutches, a walker, a wheelchair, or special transportation. Your need for help must stem from an illness or injury. 
2. It’s difficult for you to leave your home and you typically can’t do so. In these cases, you may not technically need assistance, but your leaving home is not medically advised. People with dementia, for example, maybe physically capable of leaving home unassisted, but it might not be a good idea for them to do so, and if they do, it could cause further problems.   

Under Medicare guidelines, your doctor can evaluate your situation and determine if you are homebound. 

Again, don’t be put off by the word. The designation “homebound” status isn’t as restrictive as it sounds. Here are some reasons why you can leave your house, even if you’re considered homebound:  

• Medical treatment
• Religious services
• Licensed and accredited adult daycare services
• Family reunions
• Funerals
• Graduations
• Occasional trips to the barber or beauty parlor

What Does Medicare Cover When You’re Homebound?
Homebound status opens the door to Medicare’s home healthcare coverage. But it isn’t the only qualification you need to receive home healthcare. Being qualified as homebound doesn’t in itself guarantee any or all home healthcare services. 

That said, the following list includes what you might receive in-home healthcare benefits under Medicare Part A and/or Medicare Part B. You must be considered homebound to receive these benefits, though there may also be other criteria. 

• Part-time or “intermittent” skilled nursing care. If it’s determined that you need more than part-time care, you’ll no longer be eligible for Medicare coverage. Medicare doesn’t cover long-term care such as nursing homes or assisted living. 
• Physical therapy 
• Occupational therapy
• Medical social services
• Part-time or intermittent home health aide services (personal hands-on care)

If you need any of these services, your doctor prescribes the specific services and, in most cases, a home healthcare agency will coordinate them. After you start receiving home healthcare, your doctor is required to evaluate and recertify your plan of care every 60 days and maintain your homebound status.

What Medicare Doesn’t Pay for When You’re Homebound
There are several home healthcare services that Medicare doesn’t pay for, regardless of your homebound status. Those include: 

• 24-hour-a-day care at home
• Meals delivered to your home
• Shopping, cleaning, and laundry services when this is the only care you need
• Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need

Keep in mind that your doctor or other health care provider may recommend home health services that are not covered by Medicare, even if you have homebound status. When this happens, you may have to pay some or all of the costs. Be sure to ask if services recommended for you are covered by Medicare.

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