Home health care vs home care: the difference and who pays

Home health care is skilled medical care at home that a doctor or other provider orders, and Medicare may pay for it. Home care is non-medical help with daily living, and Medicare does not pay for it when it is the only care you need.

Side by side

	Home health care	Home care
What it is	Skilled nursing, therapy and related services	Help with bathing, dressing, cooking, housework and companionship
Who orders it	A doctor or other provider must see you in person, confirm you need it and order it	You or your family arrange it
Who provides it	A Medicare-certified home health agency	A home care agency, or an independent caregiver
Medicare	Pays for covered services if you meet the rules	Does not pay when it is the only care you need
Other payers	Medicaid in some cases	Private pay, Medicaid waivers in some states, long-term care insurance

Sources: Medicare.gov and 42 CFR 440.180. "Typical other payers" is a summary, and your state and plan decide.

What Medicare covers for home health

Medicare.gov says Medicare covers medically necessary part-time or intermittent skilled nursing care, plus physical, occupational and speech-language therapy if conditions are met. It also covers medical social services, some home health aide care, certain injectable osteoporosis drugs, durable medical equipment and home medical supplies.

Two conditions apply.

1. You are homebound. You must need part-time or intermittent skilled services and you are "homebound": leaving your home is not recommended because of your condition, or you have trouble leaving without help, and you are normally unable to leave your home and leaving takes a lot of effort.
2. A provider has confirmed the need. Before you can get home health services, a doctor or health care provider such as a nurse practitioner must see you in person and confirm you need home health care. They must also order your care, and a Medicare-certified home health agency must provide it.

You pay nothing for covered home health services, according to Medicare.gov. You pay 20% of the Medicare-approved amount for covered medical equipment after you meet the Part B deductible. Home health aide care is covered only if you are also getting skilled nursing care. The agency should tell you, verbally and in writing, if Medicare will not pay for any items or services it provides.

Use the Medicare home health checker to compare your situation with the conditions Medicare lists. For the bigger picture see Medicare and home health agencies near you.

What counts as skilled care

Medicare.gov gives help changing sterile dressings as an example of a skilled service. It describes custodial or personal care as help with daily living activities, such as bathing, dressing or eating. The line between the two decides which path you are on: a need for skilled care points to home health, and a need for help with daily activities alone points to home care, which you or another payer covers.

What Medicare does not cover

Medicare does not pay for 24-hour-a-day care at home, home meal delivery, homemaker services unrelated to your care plan, or custodial or personal care when this is the only care you need.

Medicare.gov also says that Medicare does not pay for long-term care, whether in a nursing home or in the community, and that you pay all costs for non-covered services, including most long-term care.

Who pays for home care

• You, your family or your savings. This is the default for most non-medical help.
• Medicaid, if you qualify. Medicare.gov says Medicaid may pay if you meet your state's requirements, and that it covers benefits Medicare does not, such as nursing home care and personal care services. Under 42 CFR 440.180, a state's home and community-based waiver can include services such as case management, homemaker services, home health aide services, personal care, adult day health, habilitation and respite care. Each state decides which to include. See Medicaid and long-term care.
• Private long-term care insurance. Medicare.gov says you can buy it. See long-term care insurance.
• VA benefits for some veterans and survivors, such as Aid and Attendance, which VA describes as an increase to a monthly pension for people who need another person's help with daily activities. See the VA guide.
• Pay for a family caregiver. Some programs pay a family member to provide care, and they vary by state. See paid family caregiver programs.

To work out what a care schedule would cost you, use the home care hours and cost calculator.

How to choose

1. Start with the need. If a provider has said you need nursing or therapy at home, ask whether you qualify for Medicare home health. If you need help with bathing, meals or housework, you are looking for home care.
2. Ask for the cost in writing. Home health agencies must tell you what is expected to be covered. For home care, ask for the rate, minimum hours and extras.
3. Combine them if you need both. Skilled care that Medicare covers and non-medical help that is paid for another way are separate services.
4. Check the agency. Our guide to choosing a home care agency lists the questions to ask, and home care agencies are in our directory.

What catches people out

• Assuming "home care" is covered because "home health" is. The names are close and the coverage is not.
• Looking at homebound too late. If you do not meet it, Medicare home health may not apply.
• Aide-only plans. Medicare covers home health aide care only alongside skilled nursing care. Aide help alone is custodial care.
• Care that is open-ended. Medicare does not pay for 24-hour-a-day care at home.

Carevo is a connection platform, not a provider. It does not assess eligibility or give medical, legal or financial advice. Ask your doctor and your Medicare plan about coverage, and your state Medicaid agency about Medicaid.