Is your parent eligible for in-home primary care?

Many families discover home-based primary care only after a hospitalization, a fall, or a moment when getting their parent to a clinic becomes genuinely impossible. The service has been available through Medicare for decades, yet it remains underutilized, largely because eligibility requirements are misunderstood. This guide walks through who qualifies, what documentation is needed, which insurance plans cover it, and how the enrollment process works with Home Physicians Group in Central Florida.

The homebound standard: what Medicare actually requires

Medicare Part B covers physician home visits when a patient is considered homebound under the Social Security Act. The standard has two components. First, leaving the home must require a considerable and taxing effort due to the patient's condition. Second, the patient's condition must be such that leaving home would be medically contraindicated, or the patient requires the aid of a supportive device, another person, or special transportation.

Critically, homebound does not mean never leaving home. A patient can attend religious services, go to infrequent medical appointments outside the home, or go to adult day programs and still qualify. What matters is the effort required, not absolute confinement.¹

Conditions that commonly qualify

While any condition that limits mobility or makes travel taxing can qualify a patient, these are the most common clinical situations HPG encounters:

Insurance coverage: Medicare, Medicare Advantage, and Medicaid

Original Medicare (Parts A and B)

Medicare Part B covers physician home visits as Evaluation and Management (E&M) services, billed under the same codes as office visits. No prior authorization is required for medically necessary visits. The patient pays their standard Part B coinsurance, typically 20% after the deductible, which is covered by a Medigap supplement if they have one.

Medicare Advantage (Part C)

Most Medicare Advantage plans cover home-based primary care visits at parity with office visits, though some require prior authorization or have network restrictions. HPG participates in many Medicare Advantage networks; the complete list is on the insurance page. Call the plan's member services line or HPG's intake team to verify your parent's specific plan before enrollment.

Medicaid (Florida Medicaid)

Florida Medicaid covers home-based physician visits for eligible low-income beneficiaries. Patients dually eligible for Medicare and Medicaid (dual eligibles) often have zero out-of-pocket cost for covered visits. Managed care Medicaid plans may require network verification.

Questions families frequently ask about eligibility

How to enroll with HPG

The enrollment process involves four steps. First, call HPG's intake line or complete the new patient registration online. Second, the intake team confirms insurance eligibility and geographic coverage. Third, a clinical coordinator contacts you to collect the medication list, prior medical records, and any relevant specialist notes. Fourth, an HPG physician schedules the first home visit, which typically functions as a comprehensive new patient evaluation.

Families in Orange, Osceola, Seminole, Volusia, and surrounding counties are within HPG's service area. For questions about whether a specific address is covered, call HPG's intake team directly at the number on the contact page.