Do you qualify for Homebound Status?

Medicare coverage for Home Health services partly hinges on whether a person qualifies for Homebound Status. Below are the criteria for eligibility:  

  1. If the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his/her home except with the assistance of another individual or the aid of an assistive device (crutches, cane, wheelchair, or a walker).
  2. If the individual has a condition in which leaving his/her home requires a considerable and taxing effort.
  3. The absences of the individual from their home are infrequent or relatively short in duration.

*Patients can drive and still be considered homebound by Medicare definition, like to attend medical appointments, religious events, grocery shopping, hair appointments, etc. Although, these absences from home must be short in duration and are a taxing effort to achieve.                              

Some examples that might indicate Homebound Status:

  • Unsteady gait/poor balance 
  • Decreased endurance with ambulation
  • Only able to ambulate short distances using assistive device
  • Episodes of vertigo or syncope
  • Frequent falls
  • Lower extremity edema impairing ambulation
  • Decreased endurance due to shortness of breath
  • Increased angina with activity
  • Fluid retention with increased shortness of breath
  • Unstable diabetes with potential for hypo/hyperglycemia        
  • Poor vision with increased risk for falls/Legally Blind
  • Open draining wound with potential for infection
  • Refuses to leave home alone-behavioral
  • Fear of leaving secure environment
  • Mental status decline with increased depression
  • Easily confused when out of home
  • Multiple functional limitations due to severe pain     
  • Immune-suppressed
  • Morbid obesity
  • Severe functional limitations
  • Back pain aggravated with movements