Medicare Homebound Requirements: Who Qualifies for Home Health Care
Reviewed October 5, 2026. To get Medicare home health care, you must be “homebound.” Medicare considers you homebound when leaving home isn’t recommended because of your condition, or you need help (such as a cane, wheelchair, special transportation or another person) to leave, and you’re normally unable to leave home because doing so takes a considerable and taxing effort. You can still leave for medical care, religious services, adult day care and short, infrequent outings.
Quick answer: If you’re homebound, a provider has seen you in person and certified that you need part-time or intermittent skilled care, and you use a Medicare-certified home health agency, you pay $0 for covered home health services. You pay 20% of the Medicare-approved amount for durable medical equipment after the Part B deductible ($283 in 2026).
What does homebound mean for Medicare?
CMS spells out two criteria in its Medicare Benefit Policy Manual. You must meet both (CMS, Chapter 7, §30.1.1).
| Criterion | Requirement | What it looks like |
|---|---|---|
| Criterion one (meet at least one) | You need supportive devices (crutches, cane, wheelchair, walker), special transportation, or another person’s help to leave home, or leaving home is medically contraindicated | A person recovering from surgery who can’t manage steps without help; someone whose doctor advises against leaving because of a weakened immune system |
| Criterion two (meet both) | You have a normal inability to leave home and leaving home requires a considerable and taxing effort | Leaving takes long rest breaks, causes significant pain or shortness of breath, or requires a lot of assistance |
Medicare.gov summarizes the same rule in plain language: leaving home isn’t recommended or is hard without help, and you’re normally unable to leave and it takes a lot of effort (Medicare.gov home health services).
Absences that don’t end homebound status
Being homebound doesn’t mean you can never go out. According to CMS, these absences don’t disqualify you:
- Medical care, including doctor visits, outpatient kidney dialysis, chemotherapy or radiation therapy
- Adult day care at a licensed or certified adult day center to receive therapeutic, psychosocial or medical treatment
- Religious services, which CMS treats as absences of infrequent or short duration
- Infrequent or short outings, such as a trip to the barber, a walk around the block, a drive, or attending a family reunion, funeral or graduation
Your home health agency and provider document your homebound status. They should describe your actual condition and limitations, not just check a box.
Other requirements for Medicare home health coverage
Being homebound is one of several conditions. Medicare.gov lists these requirements:
- You’re under the care of a doctor or allowed practitioner, and your care follows a plan of care they establish and review regularly.
- A provider certifies you need skilled care, such as intermittent skilled nursing, physical therapy, speech-language pathology or continued occupational therapy.
- You’ve had a face-to-face encounter. A doctor or allowed practitioner must see you in person (or via approved telehealth) no more than 90 days before or within 30 days after home health care starts.
- You’re homebound, as described above.
- The agency is Medicare-certified.
What “part-time or intermittent” means
Medicare doesn’t cover 24-hour care at home. Home health care must be part-time or intermittent. CMS defines intermittent skilled nursing as care needed on fewer than 7 days a week, or less than 8 hours each day, for periods of 21 days or less, with extensions in some cases when there’s a predictable end.
What Medicare covers if you’re homebound
| Covered (when requirements are met) | Not covered |
|---|---|
| Part-time or intermittent skilled nursing | 24-hour-a-day care at home |
| Physical therapy, occupational therapy and speech-language pathology | Meals delivered to your home |
| Medical social services | Homemaker services such as shopping and cleaning that aren’t part of your care plan |
| Part-time home health aide services, only when you’re also getting skilled care | Custodial or personal care (bathing, dressing) when that’s the only care you need |
| Durable medical equipment and medical supplies | |
| Injectable osteoporosis drugs for women who meet certain criteria |
Source: Medicare.gov home health services. If the agency expects Medicare not to pay for an item or service, it must give you an Advance Beneficiary Notice before providing it.
What you pay for home health care in 2026
| Service | Your cost with Original Medicare |
|---|---|
| Covered home health services | $0 |
| Durable medical equipment (walker, hospital bed, wheelchair) | 20% of the Medicare-approved amount after the $283 Part B deductible |
| Part B premium | $202.90 per month (standard amount) |
Sources: Medicare.gov and CMS 2026 Parts A and B premiums and deductibles. Read more about Medicare and durable medical equipment.
Homebound rules with Medicare Advantage
Medicare Advantage (Part C) plans must cover home health care that Original Medicare covers, and they apply the same basic eligibility rules. Plans can require you to use an in-network home health agency and may require prior authorization. Some plans offer extra in-home support services as a supplemental benefit. Check your plan’s Evidence of Coverage, and if home care matters to you, compare 2027 plans during Medicare Open Enrollment.
Home health vs. other kinds of care
- In-home nursing for long-term needs: Medicare doesn’t pay for ongoing custodial care. Read does Medicare cover in-home nursing?
- Skilled nursing facility care: Part A covers short-term SNF care after a qualifying 3-day inpatient hospital stay, with $0 for days 1-20 and $217 per day for days 21-100 in 2026.
- Hospice care at home: if you’re terminally ill and choose hospice, you don’t need to be homebound. See does Medicare cover hospice care?
- Outpatient therapy: if you aren’t homebound, Part B covers outpatient physical therapy.
Frequently asked questions
Can you leave the house if you’re homebound on Medicare?
Yes. You can leave for medical appointments, adult day care, religious services and occasional short outings like a haircut or a family event without losing homebound status.
Who decides if I’m homebound?
Your doctor or allowed practitioner certifies that you’re homebound, based on your condition and the face-to-face encounter. The home health agency documents it in your records.
Can I drive and still be considered homebound?
Driving doesn’t automatically disqualify you, but if you regularly drive and leave home without considerable effort, you probably don’t meet the criteria. CMS looks at your overall condition and how often and how easily you leave.
Does Medicare pay for a home health aide if I’m homebound?
Only part-time and only if you’re also receiving skilled care such as nursing or therapy. Medicare doesn’t cover an aide for personal care alone.
How long can I get Medicare home health care?
There’s no fixed limit as long as you remain eligible. Your provider reviews and recertifies your plan of care periodically.
This article is general information, not medical or individual insurance advice. Medicare365 is not affiliated with or endorsed by the U.S. government or the federal Medicare program.