Medicare & eligibility
Homebound meaning: who counts as homebound for Medicare home health
“Homebound” has a specific meaning in Medicare. It does not mean you can never leave the house — it means leaving takes a considerable and taxing effort. Here is Medicare’s two-part definition in plain language.
The definition
Medicare’s homebound definition, in two parts
A doctor or allowed practitioner must certify that you are homebound. You meet the definition when both criteria are true.
Criterion one — meet one of these
- Needs help to leave homeBecause of illness or injury, needs supportive devices such as crutches, canes, wheelchairs or walkers; special transportation; or another person’s help to leave home.
- Or: leaving is medically contraindicatedHas a condition that makes leaving home medically inadvisable.
Criterion two — meet both of these
- A normal inability to leave homeStaying home is the usual pattern, not the exception.
- And: leaving takes a considerable and taxing effortGetting out of the house is a real strain, given the person’s overall condition.
“There must exist a normal inability to leave home; AND leaving home must require a considerable and taxing effort.”
CMS Medicare Benefit Policy Manual, Chapter 7, §30.1.1Leaving the house
You can leave home and still be homebound
Being homebound does not mean being locked in. These absences do not, on their own, disqualify you.
Source: CMS Medicare Benefit Policy Manual, Chapter 7 — Home Health Services
- Medical careDoctor visits, outpatient kidney dialysis, chemotherapy or radiation therapy.
- Adult day care for medical careIncluding licensed or certified adult day programs that provide therapeutic, psychosocial or medical treatment.
- Religious servicesTreated by Medicare as infrequent or short absences.
- Occasional short outingsFor example a trip to the barber, a walk around the block or a drive, or a family reunion, funeral or graduation.
Examples
Examples Medicare gives of homebound patients
Medicare’s manual lists situations like these to show how homebound status is decided.
A patient paralyzed from a stroke who uses a wheelchair or needs crutches to walk.
A patient who is blind or has significant memory loss and needs another person’s help to leave home.
A patient who has lost the use of their arms and cannot open doors or use stair handrails without help.
A patient in the late stages of ALS or another neurodegenerative disease.
Next step
Homebound and in need of skilled care?
Being homebound is one of four Medicare requirements for home health care. You also need intermittent skilled care, an in-person visit and order from a doctor or allowed practitioner, and a Medicare-certified agency.
FAQ
Homebound status: questions, answered
What is homebound?
For Medicare home health, homebound means leaving home is medically inadvisable or requires help — another person, a device such as a walker or wheelchair, or special transportation — and leaving home takes a considerable and taxing effort, so you normally stay home.
What qualifies someone as homebound for Medicare?
Two criteria must be met. First, because of illness or injury, the person needs help to leave home (supportive devices, special transportation or another person), or leaving home is medically contraindicated. Second, there is a normal inability to leave home, and leaving requires a considerable and taxing effort.
Can you leave the house if you are homebound?
Yes. You can still be considered homebound if your absences are for health care — such as doctor visits, outpatient dialysis, chemotherapy or radiation, or adult day care for medical care — or are infrequent and short, like an occasional trip to the barber, a walk around the block or a drive.
Can I go to church if I am homebound?
Yes. Medicare treats attending a religious service as an absence of infrequent or short duration, so it does not by itself disqualify you from being homebound.
Does homebound mean bedbound?
No. Many homebound patients walk around their home with a cane or walker. Homebound is about how hard it is to leave home, not whether you can get out of bed.
Who decides if I am homebound?
Your doctor or allowed practitioner certifies that you are homebound when they order home health care, based on your condition. Your home health clinicians document your homebound status in your record.
Does homebound mean going home?
In everyday English, “homebound” can also mean heading home. In health care it means confined to the home, as Medicare defines it for the home health benefit.
Wondering if you or a parent qualify?
Call (818) 898-1100 and we'll explain the next steps, including what your doctor needs to send. Physicians can fax referrals to (818) 898-1145.