Types of Care
Home Health Care vs Home Care: What Medicare Covers
What Is the Difference Between Home Health Care and Home Care?
The difference in home health vs home care is skilled versus non-medical help. Home health care is part-time skilled nursing or therapy a doctor orders, and Medicare pays for it in full when your parent is homebound. Home care is help with bathing, dressing, meals and chores, which Medicare doesn't cover when it's the only care needed; families pay privately or through Medicaid, the VA or insurance.
Families hear “home health” and “home care” used as if they mean the same thing. They don’t, and the difference decides whether Medicare pays. Home health care is medical: a nurse or therapist comes to the house on a doctor’s orders. Home care is practical: an aide helps your parent shower, dress, eat and keep the house running.
Many older adults need both, sometimes at the same time. This guide explains the line Medicare draws, how long Medicare home health lasts, and how to pay for the help that continues after the nurse stops coming.
Home Health vs Home Care Side by Side
| Home health care | Home care | |
|---|---|---|
| What it is | Skilled nursing, physical, occupational or speech therapy, plus aide help during that care | Personal care, companionship, homemaking, meals and errands |
| Who provides it | A Medicare-certified home health agency’s nurses, therapists, aides and social workers | Home care agency aides and homemakers, or workers you hire |
| Who orders it | A doctor or allowed provider, with a plan of care | You or your parent |
| How long | While your parent stays homebound and needs skilled care | As long as you arrange and pay for it |
| Hours | Part-time: generally under 8 hours a day and up to 28 hours a week | Any schedule, including overnight |
| Medicare | Pays in full for covered services | Doesn’t pay when it’s the only care needed |
| Other payers | Medicaid, Medicare Advantage plans, VA | Private pay, Medicaid waivers, VA, long-term care insurance |
A simple test: if the task needs a nurse’s or therapist’s skill, it’s home health. Medicare’s booklet says skilled nursing doesn’t include services a non-medical person, including the patient, could do safely without a nurse’s supervision. Help bathing, dressing or using the bathroom is home care.
What Home Health Care Covers
When your parent qualifies, Medicare covers these services from a Medicare-certified home health agency:
- Skilled nursing, from a registered nurse or a licensed practical nurse supervised by one. Examples in Medicare’s booklet include certain IV drugs and injections, tube feedings, changing dressings, and teaching about prescription drugs or diabetes care.
- Physical therapy, occupational therapy and speech-language pathology, either to improve function or to maintain it and slow decline.
- Home health aide services, such as help with bathing, but only while your parent is also getting skilled care.
- Medical social services, such as counseling or finding community resources, also only alongside skilled care.
- Medical supplies like wound dressings, and durable medical equipment like a walker or wheelchair, billed separately.
Your parent pays nothing for covered home health services. For equipment, Medicare usually pays 80% of the approved amount, and your parent pays the other 20% after the Part B deductible.
Who Qualifies for Medicare Home Health
Medicare’s booklet sets out the conditions. Your parent must:
- Be under the care of a doctor or allowed provider, such as a nurse practitioner or physician assistant, with a plan of care that provider reviews regularly.
- Need intermittent skilled nursing (other than drawing blood), physical therapy, speech-language pathology or continued occupational therapy.
- Be certified as homebound.
- Have had a face-to-face visit with the provider, related to the reason for home health, within the required timeframe.
- Get care from a Medicare-certified home health agency.
What “Homebound” Means
Homebound doesn’t mean bedbound. Medicare says your parent is homebound if leaving home takes a major effort or requires help, such as a cane, walker, wheelchair, special transportation or another person, and leaving isn’t recommended because of an illness or injury.
Your parent can still leave for medical care and for short, infrequent outings: a trip to the barber, a walk around the block, a family reunion, a funeral or a graduation. Attending adult day care or religious services doesn’t disqualify them either.
What “Intermittent” Means
Medicare home health is not full-time nursing. The booklet defines intermittent skilled nursing as care needed fewer than 7 days a week, or daily for less than 8 hours a day for up to 21 days, which Medicare may extend in exceptional cases. Someone expected to need full-time skilled nursing for a long time usually doesn’t qualify and may need a skilled nursing facility instead.
How Long Medicare Covers Home Health Care
There is no fixed number of visits or weeks. Medicare pays the agency for 30-day periods of care, and your parent can have more than one 30-day period. Coverage continues while your parent stays homebound, still needs skilled care and the provider keeps the plan of care up to date.
That answers a common question about dementia. A diagnosis of dementia doesn’t change Medicare’s rules. A person living with dementia can get home health while they’re homebound and need skilled nursing or therapy, for example after a fall or a hospital stay. Supervision and help with daily routines, on their own, are home care, and Medicare doesn’t pay for them. The dementia care options guide covers the settings that fit as needs change.
When Medicare probably won’t pay for a service, such as personal care alone or care for someone who isn’t homebound, the agency must give your parent an Advance Beneficiary Notice of Noncoverage before providing it. The notice explains why and what it will cost.
What Home Care Covers and Who Pays
Home care is the help most families need month after month. NIA lists it as personal care (bathing, dressing, grooming, using the toilet, eating and moving around), household chores, meals, money management, rides and safety help. An aide might come for a few hours twice a week or every day.
Medicare.gov is plain about it: Medicare doesn’t pay for long-term custodial care like help with bathing and dressing, and you pay all costs unless another program helps. The usual payers:
- Medicaid. States cover personal care and homemaker help through home and community-based services waivers and state plan options. Programs carry state names, such as PASSPORT in Ohio or the Frail Elder Waiver in Massachusetts. The Medicaid waivers guide explains how to apply, and the Medicaid long-term care checker shows your state’s 2026 limits.
- VA. Enrolled Veterans who meet clinical criteria can get homemaker and home health aide care, supervised by a registered nurse, with a possible copay. The VA long-term care guide covers Aid and Attendance as well.
- Long-term care insurance. A policy may cover home care once its benefit triggers are met. See the long-term care insurance guide.
- Private pay. Savings, income and other private sources NIA lists, such as reverse mortgages.
The in-home care guide goes deeper on setting up and paying for home care.
When Home Health Ends: Notices and Fast Appeals
Medicare gives your parent written notice before home health changes. The agency must give a Home Health Change of Care Notice before it reduces or stops services in the plan of care, for example when the doctor hasn’t renewed orders or the agency makes a business decision to cut back.
When all covered services are ending, the agency should give a Notice of Medicare Non-Coverage at least 2 days before the last day. If you don’t get one, ask for it. The notice gives the end date and explains how to ask for a fast appeal.
In a fast appeal, an independent reviewer called a Beneficiary and Family Centered Care Quality Improvement Organization looks at your parent’s records, talks with the doctor and decides whether care should continue. Medicare’s booklet says to expect a decision generally no later than 3 days after the date on the notice. If the reviewer agrees care should end, your parent pays for services after that date, and the agency must give a cost estimate first.
If your parent keeps getting services Medicare may not cover, you can ask the agency to bill Medicare anyway so Medicare makes an official decision. If Medicare pays, your parent gets back what they paid, apart from any coinsurance or deductibles.
Using Both at Once
The two often overlap. A common pattern after a hospital stay: a home health nurse visits twice a week for wound care, a physical therapist works on walking, and a home health aide helps with bathing during that period. A private aide or a family member covers the rest of the day.
When skilled care ends, so does Medicare’s aide. Plan for that day before it arrives:
- Ask the home health agency when it expects to discharge your parent, and what help it thinks your parent will still need.
- Ask whether the agency also provides private-pay or Medicaid home care, so the same aides can stay on.
- Call the Area Agency on Aging through the Eldercare Locator at 1-800-677-1116 to start any Medicaid waiver application early.
- Talk with the family about who covers which days.
Choosing a Home Health Agency
If the doctor orders home health, your parent chooses the agency. Medicare says the doctor or hospital discharge planner should honor that choice, although it may be limited by which agencies serve the area or, for a Medicare Advantage plan, by the plan’s network. Medicare pays one agency at a time, and your parent can switch.
Questions from Medicare’s own checklist are a good start:
| Ask the agency | What you’re checking |
|---|---|
| Is it Medicare-certified, and Medicaid-certified if your parent has both? | Whether it can bill those programs |
| Does it offer the skilled services ordered, such as nursing or physical therapy? | Whether it can follow the plan of care |
| Can staff provide the hours ordered and start when needed? | Whether care begins on time after discharge |
| Is staff available at night and on weekends for emergencies? | What happens outside office hours |
| Does it offer personal care, or help arrange other services? | Whether it can cover home care after skilled care ends |
| Has it explained what Medicare covers and what you’ll pay? | That there are no surprise bills |
Medicare’s Care Compare lists the Medicare-certified home health agencies that serve your parent’s area. The State Survey Agency, which inspects home health agencies for Medicare, can give you an agency’s survey report. If home health won’t cover what your parent needs, the Care Options Guide can help you compare home care, respite care and residential settings, and the nursing home finder shows CMS ratings for every certified nursing home near your parent.
Frequently Asked Questions
Does Medicare Require a Hospital Stay Before Home Health Care?
Medicare's home health rules don't list a hospital stay as a condition. Your parent needs a doctor or allowed provider who certifies that they're homebound and need skilled care, a face-to-face visit related to the reason for home health, a plan of care and a Medicare-certified agency. The 3-day hospital stay rule applies to skilled nursing facility care, not home health.
Can My Parent Leave the House and Still Count as Homebound?
Yes, within limits. Medicare allows trips for medical treatment and short, infrequent outings such as a trip to the barber, a walk around the block, or a family reunion, funeral or graduation. Medicare also says your parent can still get home health care while attending adult day care or religious services.
Who Chooses the Home Health Agency?
Your parent does. Medicare says you have a say in which Medicare-certified agency you use, and the doctor or hospital discharge planner should honor that choice. Choices can be limited by which agencies serve the area, and a Medicare Advantage plan may require an agency in its network.
Can My Parent Switch Home Health Agencies?
Yes. Medicare pays for care from only one home health agency at a time, but your parent can end care with one agency and choose another at any time. Get a referral to the new agency from the doctor, and tell both agencies about the change.
What Should I Do if Home Health Is Ending but My Parent Still Needs Help?
Read the Notice of Medicare Non-Coverage the agency must give at least 2 days before services end, and ask for a fast appeal if you think care is ending too soon. Then line up home care for the personal help that continues. The local Area Agency on Aging, reached through the Eldercare Locator at 1-800-677-1116, can screen for Medicaid waivers and other services.
Does Medigap Change What I Pay for Home Health?
Covered home health services cost $0 under Original Medicare, so there's little for a Medigap policy to add there. The 20% coinsurance on medical equipment is where supplemental coverage can help. Neither Medicare nor Medigap pays for long-term personal care at home.
More on Types of Care
- Memory CareSecured dementia care in assisted living and nursing homes, state rules and how to pay
- Assisted Living vs Nursing HomeHow the two settings differ in care, rules and who pays
- Memory Care vs Assisted LivingWhen a person with dementia needs a secured memory care unit
- In-Home CarePersonal care, homemaker help and how Medicaid and VA pay for it
- Adult Day CareDaytime programs, health services and coverage
- Respite CareIn-home, adult day and short-stay respite and who pays
This guide explains long-term care in plain language from official sources. It isn't medical, legal or financial advice; a doctor, your state Medicaid agency or an elder law attorney can advise on your situation.