Home health eligibility
A hospitalization is not a requirement to receive home health care.
Many patients are referred by their doctor. To be eligible for home health, you must demonstrate:
Medical necessity
To qualify for home healthcare services, a patient must be under the care of a physician who certifies the need for intermittent skilled nursing care or the expertise of physical therapy, occupational therapy, or speech therapy.
Homebound
Your physician must confirm that the patient is "homebound," meaning they have a significant difficulty leaving home without considerable help. You can usually leave home as often as necessary for medical treatments that can’t be provided at home and still be considered homebound. You’re also permitted occasional, brief outings for non-medical reasons, such as visiting a barber or beauty shop, attending church, or participating in special family events like graduations or weddings. However, these trips should be infrequent and require a considerable and taxing effort.
Face to face encounter
Medicare requires that a physician or allowed non-physician practitioner (such as a nurse practitioner, physician assistant, or clinical nurse specialist) has a documented in-person visit with the patient related to the primary reason for home health services.
This visit must occur:
- Within 90 days before the start of home health care, or
- Within 30 days after services begin
During this visit, the provider must evaluate the patient’s condition and document why:
- Skilled services are medically necessary, and
- The patient meets homebound criteria
- The visit note must clearly describe the patient’s functional limitations (for example: weakness, fall risk, pain, shortness of breath, mobility deficits, or need for assistance) and how these conditions support the need for home health care. Telehealth visits are permitted when allowed by current Medicare guidelines.
Without a properly documented face-to-face encounter, Medicare cannot cover home health services.
Our service areas
Bringing care to your door in the broader Chicagoland area and Southern Wisconsin.
Illinois
- Boone
- Cook
- Dekalb
- DuPage
- Ford
- Grundy
- Iroquois
- Kane
- Kankakee
- Kendall
- La Salle
- Lake
- Livingston
- McHenry
- Ogle
- Will
- Winnebago
Wisconsin
- Kenosha
- Milwaukee
- Racine
- Rock
- Walworth
- Waukesha
Insurance coverage
Accepted insurance plans
While we see these plans most frequently, we do accept many other insurance plans. Please contact Aspire if you have any questions regarding your eligibility for home health under your health plan.
Aetna Aetna MMA Aetna MMAI Allied BCBS PPO/HMO BCBS MA BCBS MMAI Cigna Cigna Health Springs Humana PPO/HMO Humana MA Humana MMAI & Gold Plus Medicare Meridian Medicare Meridian Molina MA Molina Healthcare Options & Options Plus Molina MMA Trustmark United Health Care United Health Care MA UMR Workman's Comp Veteran's Affair Zing
Get in touch
Ready to experience a better standard of home health care?
Our team is ready to answer your questions and help you take the next step toward better care at home.
