What Is the Difference Between Home Health Care and Home Care Under Medicare?

The difference between home health care and home care under Medicare is whether services are medical or therapeutic, or provide nonclinical assistance with everyday tasks. While Medicare pays for medically essential home health care, it doesn’t pay for domestic-focused home care.

Home health care agencies include medically trained personnel, such as nurses, therapists and certified aides. Teams follow personalized, doctor-approved care plans to deliver physician-ordered, medically essential services in an individual’s home. Examples of care include:

• Skilled nursing, such as medication administration, respiratory therapy and diabetes management
• Occupational therapy
• Physical therapy
• Speech therapy
• Dietary supervision
• Medical social services

Home care companies employ nonmedical aides who visit people at home to help them with everyday tasks and provide company. While caregivers can remind individuals to take medicine, they can’t offer skilled medical care. Standard home care services include:

• Helping seniors with activities of daily living, such as using the toilet, bathing and moving from room to room
• Performing domestic tasks, such as vacuuming, laundry and washing dishes
• Preparing meals and shopping for groceries
• Running errands
• Facilitating at-home recreational activities, such as playing card games, discussing current events and watching TV

For qualifying seniors, Medicare pays the full cost of intermittent home health care. Funding includes nursing services and rehabilitation therapies delivered in an individual’s residence. The national health insurance program covers up to 35 hours of weekly care, although many seniors qualify for fewer contact hours.

Medicare doesn’t usually pay for custodial care, which is nonmedical support with everyday tasks. The program never pays for domestic assistance or companionship. However, it covers help from a home health or personal care aide for those also receiving skilled services at home. For example, seniors who get Medicare-funded in-home nursing also qualify for caregiver assistance with specific activities of daily living, such as bathing, dressing and moving around their home. Essentially, Medicare covers medically necessary home health care and limited aspects of home care.  

Seniors receiving home health care often need additional support around the home. Sometimes, family members provide such help. Volunteer-led initiatives, such as Senior Companion Programs, offer assistance. Older adults who meet the level of care and financial criteria may qualify for Medicaid funding for agency- or family-delivered care, either through state plans or waivers. Likewise, those who served in the U.S. Armed Forces might qualify for VA benefits for in-home help.

Many long-term care insurance policies cover home care for those who meet specific triggers, typically a dementia diagnosis or an inability to perform several daily living tasks. Seniors who don’t qualify for financial assistance or hold long-term care insurance must use private resources or consider alternative payment methods, such as reverse mortgages or bank loans.