Resources
What Families Need to Know
Learn about home health eligibility, insurance coverage, and how to begin the referral process.
What You Need to Know
About Home Health
When you’re looking into home health care for yourself or someone you love, it’s normal to have questions.
This page is designed to help you understand who qualifies for home health, how services are covered, and how to get started with a referral.
If you’re unsure where to begin, our team is always here to help.
Eligibility
Who Qualifies for Care at Home?
Most patients — including Medicare beneficiaries — may be eligible for home health services when a physician certifies that the patient is homebound and in need of skilled care.
Eligibility is based on medical need, not age.
You May Be Eligible If You Need:
- Intermittent skilled nursing care, and/or
- Physical, Occupational, or Speech Therapy when:
- Improvement is expected within a reasonable timeframe
- A skilled therapist is needed to safely create or manage care
- Ongoing therapy is required to maintain function
What Does “Homebound” Mean?
A patient is considered homebound when illness or injury makes leaving home difficult. Patients may still leave home with assistance or supportive devices, such as a wheelchair.
Leaving home is typically limited to:
- Medical appointments
- Adult day care
- Short, infrequent outings (such as religious services)
Some private insurance plans do not require patients to be homebound.
Who May Not Be Eligible?
- Medicare patients who are not homebound
- Patients who need full-time or continuous nursing care
Common Reasons Patients Qualify
- Recent illness or diagnosis
- Medication changes
- Worsening medical condition
- Need for therapy services
- Difficulty leaving home
- Recent hospitalization
- Concerns about falling
Payment & Insurance
What families need to know about coverage.
Home health services are often covered by insurance, including Medicare and Medicare Advantage plans.
If you have questions about coverage, our team can help you understand your options.
Medicare & Medicare Advantage
For Medicare beneficiaries, covered home health services are provided at no cost to the patient. Medicare Advantage plans and private insurance may include co-pays depending on coverage.
Private Insurance
Most commercial insurance plans cover home health services with little to no out-of-pocket expense. Coverage details vary by plan.
How to Get Started with a Referral
Simple steps for physicians and healthcare providers.
Physicians and healthcare providers may refer patients for home health services by fax or email.
Referral Details
Fax: (844) 358-0261
Email: admissions@prohealthgroup.com
Once a referral is received, our team will review it and follow up within 24 hours to gather any additional information and schedule admission.