How Medicare Covers Home Health Services in Texas

One of the most common questions we hear from families in the Rio Grande Valley is simple: "Does Medicare pay for home health care?" The answer is yes — and for qualifying patients, it covers the full cost. No copays. No deductibles. No out-of-pocket expenses.

But navigating Medicare's home health benefit can be confusing. The eligibility rules, covered services, and certification process are not always clearly explained. This guide breaks it all down for Texas families considering home health care for themselves or a loved one.

What Is the Medicare Home Health Benefit?

Medicare Part A and Part B together cover home health services for beneficiaries who meet specific eligibility criteria. Unlike many Medicare benefits, home health care has no cost-sharing requirement — patients pay nothing when they qualify.

This benefit covers medically necessary, skilled care delivered in the patient's home by a Medicare-certified home health agency. It is not designed for long-term custodial care or 24-hour assistance. It is targeted, skilled, and time-limited — focused on helping patients recover, maintain function, or manage a condition safely at home.

Eligibility Requirements

To qualify for Medicare-covered home health services in Texas, four conditions must be met:

1. You Must Be Enrolled in Medicare

Most Americans become eligible for Medicare at age 65. Others qualify earlier due to disability or end-stage renal disease. You need active Medicare Part A or Part B coverage — most patients have both.

2. A Physician Must Order the Services

Home health care begins with a doctor's order. Your physician must certify that you need skilled care and establish a plan of care. This is not optional — Medicare will not cover home health services without a physician's certification.

If you are being discharged from a hospital, your attending physician or discharge planner typically handles this referral. If you are at home and your condition has changed, your primary care doctor can initiate the order.

3. You Must Be Homebound

Medicare's homebound requirement is frequently misunderstood. Being homebound does not mean you are bedridden or can never leave your home. It means that:

• Leaving your home requires considerable and taxing effort, or
• Leaving your home is medically contraindicated

You can still qualify as homebound if you leave the house for medical appointments, religious services, or occasional short trips. The key is that leaving home is difficult and not routine.

Examples of patients who typically meet the homebound criteria:

• A stroke survivor who needs assistance to walk and cannot drive
• A patient with severe COPD who becomes short of breath with minimal exertion
• A post-surgical patient who is restricted from weight-bearing activity
• A patient with advanced Parkinson's disease who has significant mobility limitations

4. You Must Need Skilled Care

Medicare requires that the patient need at least one of the following skilled services:

• Skilled nursing — wound care, injections, IV therapy, medication management, disease education
• Physical therapy — mobility training, balance exercises, fall prevention, strengthening
• Speech therapy — communication rehabilitation, swallowing therapy, cognitive-linguistic treatment
• Occupational therapy — training in daily living activities, adaptive techniques, home safety modifications

Occupational therapy alone cannot establish eligibility — it must be paired with one of the other three services initially. However, once home health services are established, occupational therapy can continue even if the other services end.

What Services Does Medicare Cover?

Once you qualify, Medicare covers the following home health services at zero cost to you:

Skilled Nursing

Registered nurses (RNs) and licensed vocational nurses (LVNs) provide clinical care including:

• Wound assessment and treatment
• Medication management and education
• Chronic disease monitoring (diabetes, heart failure, COPD)
• Post-surgical care
• Catheter and ostomy care
• Pain management
• Patient and caregiver education

Learn more about our [skilled nursing services](/services/skilled-nursing).

Physical Therapy

Licensed physical therapists help patients regain mobility, strength, and balance. Common goals include:

• Walking safely with or without assistive devices
• Reducing fall risk
• Recovering from joint replacement or fracture
• Managing pain through therapeutic exercise
• Building endurance for daily activities

Speech-Language Pathology

Speech-language pathologists address communication, cognition, and swallowing disorders. Treatment areas include:

• Aphasia and language recovery after stroke
• Dysphagia (swallowing difficulty) management
• Cognitive rehabilitation for memory, attention, and problem-solving
• Voice therapy
• Communication strategies for progressive conditions

Learn more about our [speech therapy services](/services/speech-therapy).

Occupational Therapy

Occupational therapists focus on helping patients perform everyday activities independently:

• Bathing, dressing, and grooming techniques
• Kitchen and meal preparation safety
• Medication management routines
• Adaptive equipment training
• Home modification recommendations

Learn more about our [occupational therapy services](/services/occupational-therapy).

Home Health Aide Services

Medicare covers home health aide services when a patient is also receiving skilled care. Aides assist with:

• Bathing and personal hygiene
• Dressing
• Light housekeeping related to the patient's care
• Assistance with exercises prescribed by the therapist

Aide services are supervised by a nurse or therapist and are included at no additional cost.

Medical Social Services

When medically necessary, a medical social worker can help with:

• Connecting patients to community resources
• Counseling related to illness adjustment
• Assistance with advance directives
• Coordination with other agencies and programs

The Certification Process: How It Works

Understanding the process from referral to active care helps set expectations:

Step 1: Physician Referral

Your doctor determines that you need home health services and sends a referral to a Medicare-certified home health agency. The referral includes your diagnosis, medical history, and the type of services needed.

Step 2: Initial Assessment

Within 48 hours of the referral (or your return home from a facility), a clinician from the home health agency visits your home. They perform a comprehensive assessment using the OASIS (Outcome and Assessment Information Set) tool required by Medicare. This evaluation covers your medical condition, functional abilities, living situation, and care needs.

Step 3: Plan of Care Development

Based on the assessment, the home health agency develops a detailed plan of care specifying:

• Which services you will receive
• How often visits will occur
• What goals the care team is working toward
• The expected duration of services

Your physician must review and sign this plan of care. Medicare requires the plan to be recertified every 60 days if services need to continue.

Step 4: Active Treatment

Licensed clinicians visit your home on the schedule outlined in the care plan. They document every visit, track progress toward goals, and communicate regularly with your physician. If your condition changes, the plan is updated accordingly.

Step 5: Discharge

When you have met your goals, reached maximum improvement, or no longer meet eligibility criteria, the care team prepares you for discharge. This includes a home exercise program, caregiver training, and referrals to community resources or outpatient services if needed.

Common Misconceptions

"I have to pay a copay for home health."

False. Medicare home health services have no copay, no coinsurance, and no deductible. If a home health agency asks you for payment, something is wrong.

"I have to be hospitalized first to qualify."

False. While many patients are referred after a hospital stay, there is no prior hospitalization requirement for Medicare home health services. Your doctor can refer you directly from the community.

"Medicare only covers a few weeks of home health."

Not exactly. There is no fixed time limit. Medicare covers home health services as long as you continue to meet the eligibility criteria — homebound status, physician certification, and skilled care need. Services are recertified every 60 days.

"Home health is only for elderly patients."

False. Any Medicare beneficiary who meets the eligibility criteria can receive home health services, regardless of age. Younger patients on Medicare due to disability qualify on the same terms.

"I have to choose between home health and outpatient therapy."

Not necessarily. In some cases, patients can receive home health services for one condition while attending outpatient therapy for another. Your physician and home health agency can help determine the right approach.

How Texas Families Get Started

If you or a loved one in the Rio Grande Valley may need home health services, here is how to begin:

1. Speak with your physician. Explain your symptoms, limitations, and concerns. Ask whether a home health referral is appropriate.

2. Contact Professional Rehab Services. We are a Medicare-certified home health agency serving McAllen, Edinburg, Mission, Pharr, Weslaco, Harlingen, Brownsville, and communities throughout the RGV. Call us or visit our website.

3. We handle the rest. We verify your Medicare coverage, coordinate with your physician, schedule your initial assessment, and begin services — typically within days of the referral.

Why Professional Rehab Services

We are a locally owned, bilingual home health agency specializing in [speech therapy](/services/speech-therapy), occupational therapy, skilled nursing, and rehabilitation services across the Rio Grande Valley. Our team understands the unique needs of this community — the language barriers, the transportation challenges, the cultural values that make home-based care the right choice for so many families.

Medicare gives you the right to choose your home health agency. Choose one that knows your community.

Take the Next Step

If you believe you or a family member qualifies for Medicare home health services in Texas, contact Professional Rehab Services today. We will answer your questions, verify your eligibility, and connect you with the care you deserve — at no cost to you.