Getting home health care starts with a doctor’s order, not a standard application form. Unlike signing up for an insurance plan or a government program, home health care requires a medical professional to certify that you need skilled services at home. The process involves a few key steps: qualifying medically, getting a face-to-face evaluation, choosing an agency, and coordinating coverage through your insurance, Medicare, or VA benefits.
Home Health Care vs. Home Care: Know What You Need
Before you start the process, it helps to understand which type of service fits your situation, because they follow different paths. Home health care involves medical services: skilled nursing, physical therapy, occupational therapy, speech therapy, wound care, and similar clinical tasks. A licensed professional delivers these in your home under a doctor’s plan of care.
Home care (sometimes called personal care or custodial care) covers non-medical help with daily living. That includes bathing, dressing, grooming, meal preparation, and companionship. You can typically hire a home care aide privately or through an agency without a doctor’s order, though insurance coverage varies. Medicare generally does not pay for custodial care alone.
If you need skilled medical services, the steps below apply. If you only need help around the house, you can contact a home care agency directly and arrange services out of pocket or through Medicaid (if your state covers it).
Step 1: Talk to Your Doctor or Provider
The process begins with a healthcare provider, not with a home health agency. Your doctor, nurse practitioner, or physician assistant must determine that you need skilled care at home and write an order for it. Thanks to the Home Health Care Planning Improvement Act, nurse practitioners and physician assistants can now independently order home health services for Medicare and Medicaid patients. Previously, only a physician could sign off, which caused delays.
Bring up home health care during a regular visit, a hospital discharge conversation, or a follow-up after surgery or illness. Be specific about what you’re struggling with at home: difficulty managing wounds, trouble with mobility after a fall, needing IV medications, or challenges following a rehab plan. The more concrete you are, the easier it is for your provider to build a case for coverage.
Step 2: Complete the Face-to-Face Evaluation
Medicare and most insurers require a face-to-face encounter before home health services can be certified. Your provider must see you in person (or via an approved telehealth visit, depending on your plan) and document the clinical reasons you need skilled care at home. This visit must happen before the certification is signed.
During this encounter, your provider will assess your condition, confirm what skilled services you need, and document everything in a clinical note. That documentation becomes the foundation of your home health certification. If you’re being discharged from a hospital or rehab facility, the discharge summary from that stay can serve as the face-to-face documentation.
Your provider then creates a plan of care that specifies which services you need, how often, and for how long. This plan gets sent to the home health agency that will treat you.
Step 3: Confirm Your Insurance Coverage
Medicare
Medicare covers home health care at no cost to you (no copay, no deductible for the services themselves) if you meet all the eligibility criteria. You must need part-time or intermittent skilled services such as nursing or therapy. You must be considered “homebound,” which Medicare defines with two conditions: leaving your home isn’t recommended because of your condition, or you need help from another person or assistive devices like a cane, wheelchair, or walker to leave. And normally, leaving your home requires considerable effort. You don’t have to be bedridden. You can still leave for medical appointments, religious services, or occasional outings and still qualify.
Your care must also be medically necessary, meaning it’s needed to diagnose or treat an illness, injury, or condition. A Medicare-certified home health agency must provide the services.
Medicaid
Medicaid home health benefits vary by state but generally cover skilled nursing and therapy for eligible individuals. Contact your state Medicaid office or managed care plan to find out what’s covered and whether prior authorization is required. Your doctor will still need to order the services.
VA Benefits
All enrolled veterans are eligible for skilled home health care if they qualify for community care and meet the clinical criteria. The VA’s program covers skilled nursing, physical therapy, occupational therapy, speech therapy, wound care, case management, and IV medications. Start by talking to your VA primary care provider, who can place the referral. If you’re not yet enrolled in VA health care, apply through VA.gov or your local VA medical center first.
Private Insurance
Most private health plans cover home health care to some degree, but the specifics (copays, visit limits, prior authorization requirements) depend on your policy. Call the member services number on your insurance card and ask what home health benefits are included, whether you need pre-approval, and which agencies are in-network.
Step 4: Choose a Home Health Agency
Sometimes your doctor or hospital discharge planner will recommend an agency. You’re not locked into that choice. You have the right to pick any agency that’s certified by your insurance or Medicare.
Medicare’s Care Compare tool at medicare.gov lets you search and compare home health agencies in your area. Each agency receives a quality of patient care star rating based on eight measures that track how well patients actually improve, plus a separate patient survey rating that reflects what past patients thought of their experience. Look for agencies with higher ratings in both categories.
When evaluating an agency, ask practical questions: How quickly can they start services? Will you have a consistent nurse or therapist, or will staff rotate? What happens if you need care on evenings or weekends? How do they communicate with your doctor? Are they Medicare-certified (required if Medicare is paying)? A good agency will walk you through the intake process and handle much of the paperwork for you.
Step 5: The Agency Intake Process
Once you’ve selected an agency and your doctor has sent the order and plan of care, the agency handles most of what comes next. An intake coordinator will contact you to schedule the first visit, verify your insurance, and collect your medical history. During the initial home visit, a nurse or therapist will do a full assessment: your physical condition, your home environment, fall risks, medication list, and what goals you’re working toward.
From there, the agency builds a schedule based on the plan of care your doctor ordered. Services are part-time or intermittent, meaning a few hours at a time, a few days a week. If your needs change, the agency coordinates with your doctor to update the plan. Medicare recertifies home health coverage every 60 days, so your provider will periodically reassess whether continued care is needed.
What to Do If You’re Denied
If Medicare or your insurer denies home health coverage, you’ll receive a written notice explaining why. Common reasons include not meeting the homebound criteria, the services being deemed not medically necessary, or incomplete documentation from the face-to-face encounter. You have the right to appeal. For Medicare, the first level of appeal is a redetermination by the Medicare Administrative Contractor, and you typically have 120 days to file. Your doctor can help by submitting additional documentation that strengthens the medical necessity argument.
If your doctor believes you need home health care and you were denied, ask them to review the denial letter and resubmit with more detailed clinical notes. Many denials are overturned on appeal when the documentation is more thorough.