Home Care
Home Care vs Home Health: What Differs, Who Pays, and How Families Mix Both
Home care is non-medical help at home. Home health is skilled medical care at home. The payer, the staff, and the rules differ. See what differs, who pays for each, and how families mix both.
Key takeaways
- Home care is non-medical help: bathing, dressing, meals, cleaning, rides, and company. An aide gives this help in most cases.
- Home health is skilled medical care at home: nurse visits, wound care, and physical, speech, or occupational therapy. A doctor must order it.
- The national median cost of a non-medical caregiver at home is $35 per hour (CareScout Cost of Care Survey 2025 median). That is a national survey median, not a quote for any one firm.
- The national median cost of skilled nursing in the home is $90 per hour (CareScout Cost of Care Survey 2025 median). That too is a national survey median.
- Covered home health services under Medicare cost $0 for the services. Durable medical equipment at home is paid at 20% of the Medicare-approved amount, and the Part B deductible applies.
- Medicare pays for home health when a person meets its rules. Medicare does not pay for non-medical home care on its own.
- Many families use both: home health for a short skilled phase, and home care for daily help that lasts longer.
A hospital nurse tells a family to arrange home care before discharge. The family nods. At home, they search online and find two kinds of firms with near the same name. One sends aides for bathing and meals. One sends nurses for wound care and therapy. They are not the same service. This guide shows what differs, who pays for each, and how families mix both with care. Our home care section holds more guides on help at home.
Two services, two jobs
The split is skill. Ask one question: does this task need a licensed medical worker?
Home care tasks do not. An aide can help a person bathe, dress, eat, and move around the house. An aide can cook, clean, do laundry, drive to a store or a doctor visit, and stay as company. An aide can remind a person to take drugs, but may not give skilled drug care in most state rules. Home care is booked by the hour, in most cases with a minimum block of hours per visit. You can book more or fewer hours as needs shift.
Home health tasks do need a licensed worker. A nurse can care for a wound, give injections, check a new drug for side effects, and teach a family how to give care. A therapist can rebuild strength, balance, speech, or daily skills after an illness or surgery. A home health aide under a home health plan can help with bathing for a short phase, as part of that skilled plan. That aide help ends when the skilled plan ends in most cases.
Our guide on how to compare home health agencies can help you test a home health firm. This guide tests the split itself, so you hire the right service first.
Who must order each service
Home care needs no doctor order. A family can call a home care firm, sign a service plan, and start. The firm reviews the person at home and sets tasks and hours. Start can be fast, in days in most towns.
Home health needs a doctor order and a plan of care. The doctor, or a qualified provider who saw the person face to face, certifies that the person needs skilled care and meets the home health rules. Our slot 11 guide on the face-to-face encounter rule explains that visit in full. The agency then works under that plan, with visits at set times for set tasks.
This order rule is a quick test. If a firm says it can send a nurse for wound care with no doctor order and no plan, be wary. Skilled care at home runs on orders.
What Medicare pays for, and what it does not
Medicare pays for home health if a person meets all of its rules. The person must need part-time skilled care, must be homebound under the Medicare test, and must be under a doctor plan of care, with a face-to-face visit that meets the timing rules. Our homebound guide, posted on November 7, explains that test.
When those rules are met, covered home health services cost $0 for the services. That holds for nurse visits and therapy visits in the plan. Durable medical equipment is distinct: you pay 20% of the Medicare-approved amount, and the Part B deductible applies.
Medicare does not pay for non-medical home care on its own. It does not pay for 24-hour care at home, meal delivery, or house help as a stand-alone service. If a person needs only aide help with daily tasks, that help is private pay or a state program, not Medicare home health.
Medicare Advantage plans must cover home health on the same base rules, but a plan can add its own approval steps and network limits. Read the plan rules for home health before discharge if you can.
What each service costs in private pay
Private pay rates vary by town and firm. The survey medians give a frame, not a quote.
Non-medical home care sits at a national median of $35 per hour (CareScout Cost of Care Survey 2025 median). At 20 hours per week, that frame is a large monthly sum. Families hold costs down by use of family help for some hours and paid help for the hard tasks or the work hours.
Skilled nursing in the home sits at a national median of $90 per hour (CareScout Cost of Care Survey 2025 median) in private pay. Most families do not buy skilled nursing by the hour for long. They use Medicare home health for the skilled phase when they qualify, since covered services cost $0 under that benefit. Private duty nursing is in most cases for a short gap, a complex need, or a case that fails the Medicare rules.
Ask each firm for its rate sheet in writing: hourly rate, minimum hours, night and weekend rates, and any fee for the first review. Compare total weekly cost, not just the hourly rate.
How families mix both
A common path starts at a hospital discharge. The person comes home weak, with a wound or a new therapy need. Home health starts: a nurse visits to tend the wound and teach the family, and a therapist visits to rebuild strength. This phase in most cases lasts weeks, not months.
At the same time, the family books home care for the daily work home health does not do: baths on non-visit days, meals, laundry, and safe company while family members work. As the wound heals and therapy ends, home health steps out. Home care can stay, shrink, or grow as daily needs settle.
A second path is long-term. A person with dementia needs no skilled care, but needs oversight all day. Home care is the main service. Home health enters only for a short skilled need, such as care after a fall or a hospital stay, then steps out again.
Mix with a plan. List each task, mark if it is skilled or daily, and assign it to the right service. A task list stops double pay: an aide and a nurse booked for the same hour to do the same job.
Who pays for what
- Original Medicare pays for covered home health services at $0 for the services, when the person meets the homebound, skilled need, doctor plan, and face-to-face rules. Durable medical equipment is paid at 20% of the Medicare-approved amount, with the Part B deductible.
- A Medicare Advantage HMO plan must cover home health on the same base, under its approval and network rules.
- Part D pays toward covered drugs under its own rules. It pays for neither home care aide hours nor home health visits.
- Medicaid can pay for home care and home health for people who qualify, through state plan or waiver programs. Tests, hours, and wait lists vary by state.
- A Medigap policy pays toward costs for care Original Medicare covers, such as the equipment share above. It does not pay for non-medical home care.
- The VA can pay for home health and homemaker help for enrolled veterans who qualify, under its own tests.
- Private pay covers non-medical home care in most cases, and skilled care that no program covers or that falls past a program limit.
Sample situation
Frank, age 80, comes home after hip surgery. He needs wound checks and physical therapy, and he needs help to bathe and dress. His doctor orders home health and certifies that Frank meets the homebound test for now. A nurse visits twice a week to check the wound, at $0 for covered home health services. A therapist visits three times a week to rebuild his gait. Frank's daughter, Pat, books a home care aide for two hours each morning, at her local firm's rate, to help Frank bathe, dress, and eat breakfast. As Frank heals, therapy ends at week six and nurse visits end too. Pat keeps the aide for three mornings a week, since Frank still needs help with bathing. Each service did its own job, and Pat paid for aide help only, since the skilled phase was covered. Pat keeps a one-page task list on the fridge. It shows which tasks the nurse held, which tasks the therapist held, and which tasks the aide holds now. When a new need comes up, she checks the list first and calls the right service.
What to check before you hire
Home care and home health sound alike and work alike in one way: both bring help to the house. In all else they differ: staff, tasks, orders, and payers. Name the task first, then hire the service built for it. That one step saves funds and gets the right help in the door.
- List each task at home. Mark each task as skilled or daily help.
- For skilled tasks, ask the doctor if home health can be ordered, and if the person meets the homebound test.
- Ask the home health agency what visits the plan holds, and what ends the plan.
- Ask the home care firm for its rate sheet: hourly rate, minimum hours, night rates.
- Do not book an aide and a nurse for the same task at the same hour.
- Ask what each payer covers in your case: Medicare, Medicaid, VA, or a policy.
- Review the task list each month. Needs shift, and hours should shift with them.