Clinical Need
A qualifying skilled need or recovery goal helps guide the review.
Eligibility
Understanding Your Coverage & Care Eligibility
Eligibility Requirements
Provider Orders
Assessment, certification, and orders support the plan for home health care.
Coverage Rules
Medicare or health-plan requirements are reviewed for the individual situation.
Service Availability
Location, needed disciplines, and current availability are confirmed.
The essentials
Reach the right person without the runaround.
- What skilled need is being addressed?
- Has a physician or allowed practitioner assessed and ordered care?
- For Medicare, does the person meet the homebound and other benefit requirements?
- Is the requested service available for the patient’s address and coverage?
Important: Only the appropriate provider, agency review, and payer can determine eligibility, admission, and coverage for an individual.
What this pathway is
A guided conversation—not an automated determination.
The website cannot determine Medicare eligibility, payer coverage, agency acceptance, or whether a particular discipline is appropriate. Intake can help identify the information needed for an individual review.
For Medicare questions
Several requirements generally must be met together.
- A qualifying part-time or intermittent skilled need
- Homebound status under Medicare’s definition
- Provider assessment, certification, and orders
- An established and periodically reviewed plan of care
- Services from a Medicare-certified home health agency
Before you call
Have the facts that shape the review.
- The general skilled need or recovery concern
- Ordering clinician or discharge-team information
- How the person currently leaves home and what help is required
- The requested services and patient location
- The exact insurance plan name without emailing member identifiers
Safety & escalation
Know when not to wait.
Eligibility questions are not emergency care. Call 911 for an emergency or follow the current clinician’s urgent instructions for concerning changes.
Frequently asked questions
Clear answers before the next step.
Can Healing Hands guarantee Medicare coverage?
No. Medicare or the patient’s health plan makes coverage determinations based on the individual facts and applicable rules.
Does a physician order guarantee admission?
No. Orders are important, but the agency still reviews clinical fit, documentation, eligibility, coverage, staffing, service area, and safe delivery.
Should I email my Medicare number?
No. Do not send Medicare, insurance member, Social Security, or detailed health information through ordinary email. Call for the approved workflow.