Medicare defines homebound as: leaving home requires considerable and taxing effort, OR leaving home is medically contraindicated. Using a walker or wheelchair, having difficulty with stairs, or significant fatigue typically qualifies. Once a patient can drive or regularly leaves home for leisure, they generally no longer qualify for home health.

For most stroke deficits, yes — outpatient therapy allows higher intensity, better equipment, and specialized programs (constraint-induced movement therapy, body weight-supported treadmill training) not available at home. Home health is valuable in the early post-discharge phase, but outpatient should be the goal.

Under Medicare Part B, you pay 20% of the Medicare-approved amount after your Part B deductible. With a Medigap supplement, most or all of this copay is covered. Without supplemental insurance, outpatient therapy copays can add up significantly over months of treatment.

Generally not simultaneously under Medicare. Once a patient is receiving Medicare Part B outpatient therapy, they typically no longer qualify as homebound and aren’t eligible for the Part A home health benefit concurrently. The transition should be planned with the therapy team.