When a parent starts needing help at home, families quickly run into two terms that sound almost the same: home care and home health. Mixing them up is costly. Families sometimes wait for Medicare to send an aide for bathing that it will never pay for, or hire private help for wound care that Medicare would have covered in full.
This guide explains what each service includes, who provides it, who qualifies, what it costs, and who pays. It also covers personal care services, the Medicaid term for much of what families call home care. For the bigger picture, see our home care guide and types of senior care.
Home care vs. home health at a glance
| Home care (personal care) | Home health care | |
|---|---|---|
| What it is | Help with daily living: bathing, dressing, meals, housekeeping, company | Medical care: skilled nursing, physical, occupational and speech therapy |
| Who provides it | Personal care aides, homemakers, companions | Nurses, therapists, medical social workers, home health aides |
| Who decides | The family or person receiving care | A doctor or other provider orders it and approves a plan of care |
| How long | Ongoing, often months or years | Usually short-term, tied to recovery or a change in health |
| Hours | From a few hours a week to around the clock | Part-time or intermittent visits |
| Medicare | Not covered when it is the only care needed | Covered for eligible homebound patients |
| Medicaid | Covered in many states through personal care or waiver programs | A required Medicaid benefit for eligible people |
Coverage depends on eligibility and, for Medicaid, on the state.
The simplest test: if the main need is help living day to day, it is home care. If the main need is treatment that a nurse or therapist must provide or supervise, it is home health1. Our guide to does Medicare pay for home health care explains the coverage rules in detail.
What home care includes
Home care, also called personal care, in-home care or non-medical home care, helps an older adult with the activities of daily living (bathing, dressing, toileting, moving around, eating) and with the instrumental tasks that keep a household running (meals, light housekeeping, laundry, shopping, rides to appointments, medicine reminders). Companionship and supervision are part of it too, especially for someone with memory loss who should not be alone2. For nonmedical company and errands, see companion care.
- Companion or homemaker services. Company, meal preparation, light housekeeping, errands and rides. No hands-on body care.
- Personal care aide services. Everything above plus hands-on help with bathing, dressing, toileting, transfers and eating.
- Live-in or 24-hour care. One aide living in, or shifts of aides covering the full day.
Home care aides do not provide skilled nursing. Depending on state rules and agency policy, they generally cannot give injections, dress complex wounds or adjust medicines. When those needs arise, a nurse or a home health agency has to step in.
Personal care services in Medicaid
Federal Medicaid rules define personal care services as help provided in the home, authorized under a plan of treatment or a state-approved service plan, by a qualified person who is not a legally responsible relative such as a spouse3. States decide who qualifies, how many hours are approved, and whether care is delivered by an agency or managed by the person and family under a self-directed model. In some states and programs, self-direction lets a participant hire an adult child or other relative who is not legally responsible for them.
Agencies, registries and private hires
- Home care agencies. The agency screens, employs, trains, schedules and supervises aides, and sends a backup when an aide is sick. You pay the agency. See questions to ask a home care agency.
- Registries. A registry matches you with independent caregivers. You usually become the one who directs, schedules and supervises the caregiver.
- Private hire. You hire a caregiver directly. You may become the employer, with payroll tax and insurance duties.
State licensing of non-medical home care varies widely. Ask any provider which state license it holds and look it up. Our guide on how to check a license and inspection report shows where to look.
What home health care includes
Home health is medical care at home to help someone recover from an illness or injury, such as a stroke, keep their current level of function, or slow decline. Medicare-covered home health can include1:
- Part-time or intermittent skilled nursing. Wound care, patient and caregiver teaching, IV or nutrition therapy, injections, and monitoring an unstable condition.
- Therapy. Physical therapy, occupational therapy and speech-language pathology.
- Medical social services. Help with social and emotional issues tied to the illness and with finding community resources.
- Home health aide care. Part-time help with bathing, grooming or walking, but only while the person is also getting skilled nursing or therapy.
- Medical equipment and supplies. Durable medical equipment and supplies for use at home.
Care is delivered by a Medicare-certified home health agency that must meet federal conditions of participation, including a written plan of care, patient rights and aide training rules4. Staff visit as often as the provider orders and keep the doctor updated1.
When Medicare pays for home health
Original Medicare Part A or Part B pays for home health when all of these are true15:
- The person is homebound. Leaving home is not recommended because of their condition, or they need help (a walker, wheelchair, special transportation or another person) to leave, and leaving takes a major effort.
- They need part-time or intermittent skilled care. Skilled nursing, physical therapy or speech-language pathology, or continuing occupational therapy.
- A provider saw them in person. A doctor or certain other providers must have a face-to-face visit related to the reason for home health and certify the need.
- There is a plan of care. The provider orders the services, and the agency follows and updates the plan.
- A Medicare-certified agency provides it. The provider should give a list of agencies serving the area.
Homebound does not mean bedbound. People can still leave for medical care, adult day care or short, infrequent outings such as religious services1. That means a parent can attend an adult day program and still get Medicare home health. If home health is being set up after a hospital stay, our hospital discharge planning guide lists what to ask before your parent leaves.
For covered home health services, the person pays nothing. After the Part B deductible, they pay 20 percent of the Medicare-approved amount for covered medical equipment. The agency must say in advance, in writing, if Medicare will not pay for something, usually with an Advance Beneficiary Notice1.
Medicare Advantage plans must cover home health too, but they may require you to use in-network agencies and get prior approval. Medicare's home health booklet explains how to appeal if services end too early6. For a wider comparison, see Medicare vs. Medicaid for long-term care.
What each costs
Home care is usually billed by the hour, often with a minimum visit length such as three or four hours. CareScout's 2025 national survey put the median hourly rate for skilled nursing in the home at roughly two and a half times the median for a non-medical caregiver, and non-medical caregiver rates rose about 3 percent from the year before7. Local prices vary a lot, so call two or three providers.
The real cost question for home care is hours. A few visits a week can cost less than assisted living. Round-the-clock care with shifts of aides usually costs far more than a residential setting. When you compare, add up the hours your parent actually needs now and in six months.
For eligible Medicare patients, covered home health visits have no cost-share, so cost is rarely the deciding factor there. The question is whether the person qualifies and whether a certified agency has openings.
Who pays for home care
- Private funds. Most non-medical home care is paid out of pocket8.
- Long-term care insurance. Many policies pay for home care once a benefit trigger, such as needing help with two daily activities, is met. Check the elimination period and whether the agency must be licensed9.
- Medicaid. Home health is a required Medicaid benefit, and states may also cover personal care through the state plan10. Many states cover personal care, homemaker and home health aide services through home and community-based waivers11, and some use the Community First Choice option for attendant care12. Waivers can have waitlists.
- PACE. Where available, PACE can provide home care as part of an all-inclusive plan for people 55 and older who need a nursing home level of care13.
- Older Americans Act programs. Area Agencies on Aging may fund limited in-home help and caregiver respite1415.
- Veterans benefits. See the next section.
Veterans benefits for care at home
VA's Homemaker and Home Health Aide program sends trained aides, supervised by a registered nurse, to help enrolled veterans with personal care and daily activities at home. It is also used for veterans who are isolated or whose caregiver is under strain, and it can serve as an alternative to nursing home care or as in-home respite. Veterans qualify if they are eligible for community care, meet the clinical criteria and the service is available; a copay may apply16. VA Home Based Primary Care brings a VA medical team to veterans with complex chronic conditions17.
Wartime veterans and surviving spouses who need help with daily activities may qualify for VA Aid and Attendance, a higher VA pension rate that families often use to pay for private home care1819.
Read moreVA Aid and Attendance: Who Qualifies and How to Apply
Using home care and home health together
The two services often overlap. A common pattern after a hospital stay: Medicare home health sends a nurse twice a week for wound care and a physical therapist for strength and balance. The family adds a home care aide for morning bathing and meals, because the home health aide's short visits do not cover daily needs. When the wound heals and therapy goals are met, home health ends, and home care continues.
- Share the plan. Give the home care agency a copy of the home health plan of care so aides reinforce exercises and watch for warning signs.
- Name one coordinator. Decide which family member keeps the calendar and talks with both providers.
- Watch for the end date. Ask the home health agency when it expects to discharge, so private help can be ready.
- Reassess after changes. A fall or hospital stay may qualify your parent for a new home health episode. Our fall prevention guide covers how to lower the risk of the next one.
If daily needs keep growing, home care hours can become harder to staff and to pay for. Our comparison of assisted living vs. nursing home and the care quiz can help you weigh a move.
How to choose a provider
For home health, Medicare Care Compare lists certified agencies serving your area with quality measures and patient survey results21. Ask the agency whether it has staff available now for the visits ordered.
For home care, ask:
- Licensing. Which state license do you hold? Are you bonded and insured?
- Caregivers. Are aides employees or contractors? What background checks and training do they get, including dementia training?
- Supervision. Does a nurse or supervisor visit to check on care? How often?
- Matching and backup. How do you match caregivers, and what happens when an aide is sick or quits?
- Scheduling. Is there a minimum number of hours per visit or per week? What notice do you need to change the schedule?
- Billing. What is the hourly rate, and are nights, weekends and holidays priced differently? What does the service agreement say about cancellation?
- Communication. How will you tell us about a fall, missed visit or change in condition?
