Home Care vs. Home Health Care: What Is the Difference and Who Pays
Non-medical home care and Medicare home health are different services with different licenses and payers. Here is how to tell them apart.
Families often use "home care" and "home health" as if they mean the same thing. They do not, and confusing them is the most common reason people are surprised by a bill or a denial. The difference determines which license the agency needs, who can pay, and what the worker is allowed to do.
Home care: help with daily life
Home care, sometimes called personal care, companion care or custodial care, is non-medical help. Typical tasks are bathing and dressing, getting in and out of bed, toileting, meal preparation, light housekeeping, medication reminders, errands and company. Caregivers may be called aides, attendants or companions. In Texas this is licensed as Personal Assistance Services. In California it is done by licensed Home Care Organizations that employ registered Home Care Aides.
Home health: skilled care ordered by a clinician
Home health care is medical. It includes skilled nursing, physical, occupational and speech therapy, and related services delivered at home under a plan of care from a doctor or other allowed practitioner. Home health agencies are licensed as healthcare providers, and many are also certified by Medicare. You can compare Medicare-certified agencies on Medicare Care Compare.
What Medicare covers
Original Medicare covers home health when the patient is under the care of a doctor, needs skilled care such as intermittent nursing or therapy, and is certified as homebound, and when the agency is Medicare-certified. Medicare's own description of home health services also lists what it does not pay for: 24-hour care at home, and meal delivery, homemaker services and personal care when that is the only care you need. Medicare may pay for an aide's help with bathing or dressing only while you are also receiving skilled care.
The practical result is that a family who needs someone to help their mother get dressed and cook lunch every day is almost always looking at a private payment, long-term care insurance, a veterans benefit or a Medicaid program, not Medicare.
Why the license category matters
An agency that holds only a non-medical license may not give injections, change wound dressings or perform other nursing tasks. If the person you are caring for needs both, some agencies hold several licenses. In Texas roster data, a large group of agencies hold Personal Assistance Services plus a home health license, and those listings say so. In California, Home Care Organizations are non-medical by definition, and home health agencies are licensed by the Department of Public Health instead.
How to decide what you need
- Recovering from surgery, a hospital stay or a new wound: ask the discharge planner or doctor about home health. It may be covered.
- Managing daily life with dementia, frailty or a chronic condition: non-medical home care, paid privately or through a benefit.
- Both: home health for the medical need and a home care agency for the rest. Agencies coordinate more smoothly if you give each the other's contact details.
Warning signs of a mismatch
Be careful if a non-medical agency offers to manage medications beyond reminders, or if a caregiver is asked to do tasks such as wound care that need a nurse. Ask the agency what its caregivers are and are not permitted to do under its license, and how nursing tasks are handled.
Where to look next
Use the state license lookups to confirm the category, and compare providers by city on this site. If the person needs care after a hospital stay, the hospital's discharge planner is free, knows local agencies, and must give a list of options for Medicare-certified home health.