Medically reviewed by Dorothy Joy Balmaceda, M.D., Administrator at All Family Health Care in Chicago, IL.
How to Qualify for Medicare Home Health Care in Chicago
Many Chicago families are surprised to learn that Medicare covers home health care at $0 cost-sharing for qualifying beneficiaries. No copays. No deductibles. Just skilled clinical care delivered to you at home. Yet a significant number of people who are fully eligible never receive these services simply because they do not know where to start or whether they qualify.
This guide breaks down exactly what Medicare requires, what services are covered, and how All Family Health Care — a Medicare-certified, Joint Commission accredited home health agency serving Chicago — helps patients and families navigate the process from start to finish.
Three Medicare Eligibility Requirements
Medicare home health benefits are governed by federal guidelines. To qualify, a patient must meet all three of the following conditions:
- You must be homebound. Medicare defines “homebound” as a condition in which leaving your home requires a considerable and taxing effort. This does not mean you must be completely bedridden — it means that your health condition makes leaving home difficult and infrequent.
- Your doctor must certify your need for care. A physician, nurse practitioner, clinical nurse specialist, or physician assistant must examine you face-to-face and sign an order for home health services. This is commonly called a home health referral or order.
- You must need skilled care. Medicare home health is designed for patients who need skilled nursing or skilled therapy services — not just help with daily tasks. The care must be medically necessary and ordered by your physician.
If you meet all three criteria and your home health agency is Medicare-certified (as All Family Health Care is), Medicare Part A or Part B covers the full cost of covered services.
What “Homebound” Actually Means
One of the most common misconceptions about Medicare home health eligibility is that “homebound” means you must be completely confined to your bed or unable to walk. That is not the standard.
According to Medicare guidelines, you are considered homebound if leaving your home requires a considerable and taxing effort due to your illness or injury. This can include patients who use a wheelchair, walker, or cane; patients who experience shortness of breath, pain, or exhaustion with minimal exertion; and patients whose cognitive or psychiatric conditions make leaving home unsafe without assistance.
Importantly, being homebound does not mean you can never leave your home. Medicare allows homebound patients to leave for the following purposes without losing eligibility:
- Medical appointments and treatments
- Adult day care programs
- Religious services
- Occasional, infrequent outings for special family events or personal needs
If you are unsure whether you or a loved one qualifies as homebound, the best step is to speak with your physician or to contact our team directly. We can help assess eligibility at no cost to you.
What Counts as Skilled Care
Medicare home health is intended for patients who need professional clinical services — not simply companionship or help with household tasks. The following services qualify as “skilled care” under Medicare guidelines:
- Skilled Nursing — Wound care, medication management, IV therapy, catheter care, post-surgical monitoring, chronic disease management, patient education, and more.
- Physical Therapy — Restoring strength, balance, mobility, and function after surgery, injury, stroke, or illness. Fall prevention is also a key focus of home-based physical therapy.
- Occupational Therapy — Helping patients relearn or adapt everyday activities such as dressing, bathing, cooking, and self-care following a health event that has affected function or cognition.
- Speech Therapy — Evaluation and treatment of speech, language, cognitive communication, and swallowing difficulties caused by stroke, neurological conditions, or other diagnoses.
Once a skilled service is established in your care plan, Medicare may also cover visits from a home health aide for personal care assistance (such as bathing and grooming), as well as services from a medical social worker — provided these services are part of a plan that includes skilled nursing or therapy.
To learn more about the full range of services available, visit our home health services page or review the conditions we treat.
How to Get Started
The process of starting Medicare home health care involves a few straightforward steps. Most of the administrative work is handled by the home health agency — not the patient or family.
- Talk to your doctor. If you believe you or a loved one may qualify, bring it up at your next appointment. Your physician must conduct a face-to-face visit and sign a written order for home health care before services can begin.
- Choose a Medicare-certified agency. Not all home health providers are Medicare-certified. All Family Health Care is fully Medicare-certified and operating in the Chicago area.
- The agency handles the rest. Once a referral is received, All Family Health Care contacts the patient directly to schedule an initial assessment visit, collect necessary insurance information, and coordinate with the physician’s office to establish the care plan. You do not need to navigate Medicare paperwork on your own.
Referrals can be submitted to All Family Health Care 24 hours a day, 7 days a week. Hospitals, discharge planners, physicians, and families can call us directly at (773) 775-2588.
What Medicare Covers vs. What It Does Not Cover
Understanding the scope of Medicare home health coverage helps families plan realistically and avoid surprises.
Medicare Does Cover
- Skilled nursing visits as ordered by the physician
- Physical therapy, occupational therapy, and speech-language pathology
- Medical social worker services
- Home health aide services (personal care) when part of a skilled care plan
- Some medical supplies used in the home (wound care dressings, for example)
Medicare Does Not Cover
- Around-the-clock (24/7) home care or live-in care
- Meals delivered to the home
- Purely custodial care (assistance with daily activities only, with no skilled care component)
- Homemaker services (housekeeping, laundry, grocery shopping) when not part of a Medicare-approved care plan
- Personal care provided by a home health aide when skilled nursing or therapy is not also part of the plan
If a patient needs services that go beyond what Medicare covers, our care coordinators can discuss alternative options and community resources. Visit our FAQs page for more commonly asked questions about coverage and care.
How All Family Health Care Helps Chicago Families
Navigating Medicare eligibility and paperwork can feel overwhelming, especially when you are also managing a health situation for yourself or a family member. All Family Health Care takes that burden off your shoulders.
Our team handles all Medicare paperwork and coordination with your physician’s office. We work directly with hospitals and discharge planners to arrange a seamless transition from inpatient to home-based care. Our staff are available 24 hours a day, 7 days a week to accept referrals and answer questions from patients, families, and referring providers anywhere in the Chicago area.
All Family Health Care is led by Dorothy Joy Balmaceda, M.D., our Administrator, whose clinical expertise and more than a decade of home health leadership ensure that every patient receives care that meets the highest medical and regulatory standards. Our clinical operations are managed by Rachael Ptaszek, RN, BSN, Agency Supervisor and Clinical Manager, who personally oversees the development and supervision of individualized care plans for every patient we serve.
As a Medicare-certified agency and Joint Commission accredited organization, All Family Health Care is held to the most rigorous standards in home health care. Our Five-Star Rating from the Centers for Medicare & Medicaid Services and 4.5-star rating from U.S. News & World Report reflect the quality that Chicago families have come to rely on since 2004.
Frequently Asked Questions
Does Medicare cover 24/7 home care?
No. Medicare home health benefits are designed for part-time or intermittent skilled care visits — not around-the-clock supervision or live-in care. A typical week of Medicare home health might include two to five visits from a nurse or therapist, depending on the care plan. If continuous or custodial care is needed, there are other programs and private-pay options that may help. Our care coordinators can discuss alternatives if Medicare does not cover what you need.
How long does Medicare home health care last?
There is no fixed time limit on Medicare home health care. Medicare covers services for as long as you continue to meet eligibility requirements — meaning you remain homebound, your physician recertifies the need for skilled care every 60 days, and your care is medically necessary. Some patients receive services for a few weeks after a hospital discharge; others may receive ongoing care for months while managing a chronic condition.
Is there a copay for Medicare home health care?
For most Medicare beneficiaries, there is no copay or deductible for covered home health services. Medicare Part A or Part B covers 100% of the cost when you use a Medicare-certified agency like All Family Health Care and all eligibility requirements are met. However, coverage specifics can vary depending on your individual Medicare plan or if you have a Medicare Advantage policy. We recommend confirming your benefits with your Medicare plan directly, and our staff is happy to help you understand what your coverage includes.
For more answers, visit our Frequently Asked Questions page.
Ready to Get Started?
If you or a loved one may qualify for Medicare home health care in Chicago, our team is here to help — at no cost to you. Call us anytime at (773) 775-2588, email us at [email protected], or request care online. We accept referrals 24 hours a day, 7 days a week.
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