Medicare home health eligibility is not based on age, a diagnosis, or needing help at home by itself. The beneficiary generally must meet several requirements at the same time: need qualifying part-time or intermittent skilled services, meet Medicare’s homebound standard, be under the care of a physician or allowed practitioner, receive services under an established plan of care, and use a Medicare-certified home health agency.
The five requirements in plain language
1. A qualifying skilled need
The person must need intermittent skilled nursing, physical therapy, or speech-language pathology. A continuing need for occupational therapy may also qualify under Medicare’s rules. The service must require the knowledge and judgment of a qualified clinician; help with bathing, meals, cleaning, or companionship alone does not establish a skilled need.
Examples may include ordered wound care, assessment and teaching after a hospitalization, gait training after a functional change, or speech-language services after an illness or injury. The ordering provider and agency evaluate the actual situation.
2. Homebound status
Homebound does not mean a person can never leave home. In general, the person must have difficulty leaving without help, equipment, or special transportation, or leaving must be medically inadvisable. The person also must normally be unable to leave home, and leaving must require considerable effort.
Medical appointments and some short or infrequent absences may still be allowed. Read what “homebound” means for Medicare home health for a fuller explanation.
3. Care under an eligible provider
A physician or allowed practitioner must oversee the home health need. A face-to-face assessment related to the primary reason for home health is generally required within Medicare’s permitted timeframe, and the provider must certify eligibility and order the care.
4. An established plan of care
Home health does not begin as a collection of open-ended visits. The plan of care identifies the ordered disciplines, visit frequency, treatment or teaching needs, and goals. The ordering provider periodically reviews the plan, while the agency documents visits and communicates relevant changes.
5. A Medicare-certified agency
The agency delivering Medicare-covered home health must participate in Medicare. CMS’s July 2026 Provider Data Catalog lists Healing Hands Home Care, Inc. as a Medicare-certified home health agency under CCN 147727.
A quick eligibility conversation
Before a referral, patients and families can ask:
- What skilled service is needed?
- What makes leaving home difficult or medically inadvisable?
- Has a provider completed a related assessment and ordered home health?
- Which disciplines are included in the plan?
- Which agency serves the patient’s address and accepts the specific coverage?
A hospital recommendation or provider order is important, but it does not by itself guarantee agency acceptance or payment. The agency still reviews the referral, and Medicare or the health plan applies its coverage rules.
What if the person needs more help than home health provides?
Medicare home health is generally intermittent. It does not replace 24-hour care, ongoing supervision, meal delivery, or custodial care when personal assistance is the only need. Families may need to discuss other community, private-pay, Medicaid, or long-term-support options with a qualified professional.
Explore the Medicare home health overview, skilled nursing at home, and post-hospital care guidance. You can also review what Medicare may cover for home health.
This article is general education, not medical advice or an individual eligibility or coverage decision. For an emergency, call 911. For benefits questions, contact Medicare or the patient’s plan. For referral questions, contact Healing Hands intake.