Understanding How Medicare Defines Homebound In Qualifying You For Home Care Coverage

For Medicare to pay for services, home health care must be medically necessary. You must also be unable to leave your home without assistance. Even if you aren't bedridden, if you are confined to your home because of an illness or injury, you may still meet Medicare's homebound criteria -- a mandatory condition for qualifying for home health care coverage.

To meet Medicare's definition of homebound and be eligible for home care services:

  • You must be unable to leave your home without someone to help you. If your physical condition makes it exceedingly difficult to get in and out of a vehicle, or you need special transportation, you may qualify as homebound.

  • You need to use a cane, walker, wheelchair, or crutches to be mobile.

  • It must take considerable effort on your part to leave your home. An unsteady gait, mobility limitations, extreme weakness, or decreased endurance due to a recent surgery, serious cardiac disease, or a neurodegenerative disability, such as Alzheimer's or Parkinson's disease, are each factors that can affect your ease of mobility.

  • You must have dementia or be blind, paralyzed from a stroke, or unable to use your upper extremities because they are so weak you can't use handrails on stairs, open doors, or move yourself in a manual wheelchair.

  • Your doctor must order you not to drive or restrict or limit certain physical activities for a time.

What the definition of homebound allows:

  • You may leave your home to receive medical care that can't be provided in your home. Examples include leaving your home for doctor appointments, wound care therapy, chemotherapy or radiation therapy treatments, or outpatient kidney dialysis.

    You may also leave your home for psychosocial therapies with a psychologist, social worker, or other mental health counselor.

  • You may occasionally leave your home to attend religious services or for another non-medical reason and still qualify for home health coverage under Medicare. You cannot be denied home health services for absences defined as infrequent or of short duration.

  • You may leave your home to attend a licensed or accredited adult day-care program that provides medical or other therapeutic treatments.

What Else You Need to Know:

  • Your doctor needs to certify in writing that you are homebound.

  • The members of your health care team are required to provide regular documentation describing the level of your functional ability.

  • Although you are not considered homebound if you are a resident of a skilled nursing facility, you can be homebound if you live in: the home of a family member or friend, an assisted living facility, a senior apartment complex, or other senior housing.