Home care is non-medical help with everyday life — bathing, dressing, meals, errands, companionship — and families almost always pay for it privately. Home health is skilled medical care ordered by a doctor and delivered by nurses and therapists, and Medicare covers it in full for people who qualify. The names are nearly identical. The difference is worth tens of thousands of dollars a year.
The difference in one table
Home care vs. home health
| Home care | Home health | |
|---|---|---|
| What it is | Non-medical help with daily living | Skilled medical care |
| Who provides it | Caregivers, home health aides, companions | Registered nurses, physical/occupational/speech therapists |
| Who orders it | You do — no prescription needed | A doctor, after a face-to-face visit |
| Typical duration | Ongoing, often for years | Short-term — weeks, tied to an episode |
| Who pays | Private funds, LTC insurance, some Medicaid waivers | Medicare pays 100% of covered visits |
| Typical cost to you | About $35 per hour | $0 for covered visits |
Read that last row twice. The same person can be in the same house on the same afternoon, and whether you receive a bill depends entirely on which of these two services is being delivered.
What home care actually is
Home care is help with the parts of life that stop being easy. A caregiver comes to the house for a few hours, a full day, or overnight, and does the things your parent can no longer do safely alone.
- Bathing, dressing, grooming and toileting
- Meal preparation and help eating
- Medication reminders — not administration
- Light housekeeping, laundry, grocery shopping
- Transportation to appointments and errands
- Companionship, conversation, and simply being present so no one is alone
- Supervision for someone with dementia who cannot be left by themselves
None of that requires a medical license, and that is precisely why Medicare does not pay for it. In Medicare's vocabulary this is custodial care, and custodial care is excluded when it is the only care a person needs — no matter how essential it is to that person staying in their home.
WHAT IT COSTS
The national median for a non-medical caregiver is about $35 per hour. At 44 hours a week that is roughly $80,000 a year — approaching the cost of assisted living. Twenty hours a week runs about $36,000. Home care is often assumed to be the cheap option; past a certain number of hours, it stops being one.
What home health actually is
Home health is medicine delivered at the kitchen table. A nurse changes a surgical dressing and watches for infection. A physical therapist rebuilds strength after a stroke. A speech therapist works on swallowing. It is the same care a person would otherwise travel to an outpatient clinic for, brought to them because travelling is the problem.
It is ordered by a doctor, delivered by a Medicare-certified agency, and structured as an episode with goals and an end date — usually a few visits a week for a few weeks.
The three conditions for Medicare home health
- 1A doctor certifies you need it, after a face-to-face assessment, and signs a plan of care.
- 2You need part-time or intermittent skilled care — skilled nursing, or physical, occupational or speech therapy. Someone who needs more than part-time care does not qualify.
- 3You are homebound. Leaving home is not recommended because of your condition, or you cannot leave without help — and doing so takes a considerable effort.
"HOMEBOUND" DOES NOT MEAN NEVER LEAVING
This trips families up constantly. You can still attend medical appointments, go to religious services, and take occasional short outings — a family wedding, a haircut — without losing homebound status. What matters is that leaving is difficult and infrequent, not that it never happens.
Meet those three conditions and you pay nothing for covered home health visits. No deductible, no coinsurance. The one exception is durable medical equipment — a walker, a hospital bed, oxygen — where you pay 20% of the approved amount after the Part B deductible ($283 in 2026).
What home health will not do
This is where the two services collide, and where families feel misled even though nobody misled them. Medicare home health explicitly does not cover:
- 24-hour-a-day care at home
- Meal delivery
- Homemaker services — shopping, cleaning — that are unrelated to the care plan
- Custodial or personal care, when help with daily living is the only need
So the nurse comes twice a week to manage the wound, Medicare pays for it, and the other 166 hours of the week — when someone still needs to help your mother bathe and make sure she eats — are yours to arrange and yours to fund. Both services frequently run at the same time, from the same agency, on the same invoice, with only one of the two lines covered.
Medicare will pay a nurse to treat the wound. It will not pay anyone to help her get to the bathroom.
How families pay for the home care half
- Private funds — the most common by far.
- Long-term care insurance — most modern policies cover in-home care, often at the same daily benefit as a facility. Check the policy; this is exactly what it was bought for.
- Medicaid HCBS waivers — many states cover in-home personal care specifically to keep people out of nursing homes. Income and asset limits apply and waiting lists are common.
- VA Aid and Attendance — can add meaningful monthly income for eligible wartime veterans and surviving spouses. See our veterans benefits guide.
- Family caregiving — unpaid, and by far the largest source of care in the country. Our caregiver burnout guide is worth reading before you volunteer for more than is sustainable.
When home care stops being the answer
Home care is the right choice for a long time, and then, for many families, it quietly stops being. The arithmetic usually decides it: once you are buying more than about 40 hours a week, you are paying assisted living money for a fraction of assisted living's coverage — and nights and weekends are still uncovered.
The other signal is safety. If your parent cannot be alone at all, home care means paying for someone to be present 24 hours a day, which almost nobody can sustain. That is usually the point at which families look at assisted living or, if there is a medical need, skilled nursing. Our guide to the signs a parent cannot live alone is a more honest checklist than most.
Frequently asked questions
What is the difference between home care and home health care?+
Home care is non-medical assistance with daily living — bathing, dressing, meals, errands, companionship — arranged by the family and usually paid privately. Home health care is skilled medical care such as nursing or physical therapy, ordered by a doctor, delivered by a certified agency, and covered by Medicare for people who qualify.
Does Medicare pay for home care?+
Not for non-medical home care. Medicare excludes custodial care — help with bathing, dressing, meals and supervision — when that is the only care needed. It does cover home health: skilled nursing and therapy for homebound patients under a doctor's plan of care, at no cost to you for covered visits.
How much does home care cost per hour?+
The national median is about $35 an hour for a non-medical caregiver. Twenty hours a week is roughly $36,000 a year; 44 hours a week is about $80,000. Rates vary considerably by region and rise for overnight, live-in and dementia-experienced care.
What does homebound mean for Medicare?+
Leaving home is not recommended because of your condition, or you cannot leave without help, and doing so takes considerable effort. It does not mean you can never leave — medical appointments, religious services and occasional short outings are all permitted without losing eligibility.
Can you receive home care and home health at the same time?+
Yes, and many families do. A Medicare-covered nurse may visit twice a week to manage a medical need while a privately-paid caregiver covers daily help the rest of the week. They are frequently arranged through the same agency, with only the skilled portion covered.
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