Home Care vs Home Health: The Difference, Who Pays for Each, and How to Get Started

September 8, 2026

A visiting nurse checking an older woman's blood pressure in her living room

Families use "home care" and "home health" interchangeably, and agencies do not always help, since many offer both. The distinction matters because it decides who pays. Get it right and Medicare may cover everything for a few weeks. Get it wrong and you can spend months chasing a benefit that was never going to apply.

The one-paragraph version

Home health is short-term, doctor-ordered medical care at home: a nurse, a physical or occupational therapist, a speech therapist, sometimes a home health aide, usually after a hospital stay or during a serious illness. Medicare pays for it in full when the patient qualifies. Home care (also called in-home care, personal care or companion care) is ongoing, non-medical help with daily life: bathing, dressing, meals, medication reminders, errands and company. Medicare does not pay for it.

Side by side

	Home health	Home care
Who provides it	Nurses, therapists, social workers, aides under a nurse's plan	Caregivers and personal care aides
What it is for	Recovery, wound care, injections, therapy, monitoring a condition	Daily living, safety, companionship, respite for family
How long	Weeks, in 60-day certification periods, until goals are met	As long as you want it, often years
How much	Intermittent visits, typically 1 to 3 per week	Whatever schedule you choose, a few hours to 24/7
Who orders it	A doctor, nurse practitioner or physician assistant	Nobody; you call the agency
Who pays	Medicare, Medicare Advantage, Medicaid, private insurance	Mostly you, plus long-term care insurance, Medicaid waivers, VA benefits
Quality data	Medicare star ratings and outcomes for every certified agency	State licensing, reviews, and your own interview

When Medicare pays for home health

Medicare covers home health when all of these are true:

A doctor, nurse practitioner or physician assistant certifies that you need it and signs a plan of care.
You had a face-to-face visit with that clinician within the 90 days before care starts or the 30 days after.
You need skilled care on an intermittent basis: nursing, physical therapy, speech therapy, or continuing occupational therapy.
You are homebound, meaning leaving the house takes considerable effort and you do it rarely, for medical appointments, religious services or the occasional outing.
The agency is Medicare certified.

When those conditions are met there is no copay and no deductible for the visits. Medicare will also cover a home health aide for personal care, but only while you are receiving skilled care from the same agency. Once the nurse or therapist discharges you, the aide visits end too. That is the moment many families discover they need home care.

What Medicare will not pay for

Medicare never covers what it calls custodial care: help with bathing, dressing, eating, toileting and housekeeping when that is the only care you need. It does not cover 24-hour care at home, meal delivery, or a homemaker. This is the single most common misunderstanding families bring to the first call, and it is worth settling early.

How to tell which one you need

Someone is coming home from the hospital or a rehab stay: start with home health. Ask the discharge planner to arrange it before they leave.
A doctor has said "you'll need a nurse to check on that" or "you need therapy at home": home health.
A parent is managing but slipping on meals, bathing, medications or loneliness: home care.
A family caregiver is exhausted and needs relief: home care, specifically respite care.
Both are true, which is common after a hospital stay: home health for the medical piece and home care for the hours in between. Some agencies provide both; more often you will use two.

Getting started

For home health, call your doctor's office or the hospital discharge planner and ask for a referral to a Medicare-certified agency; you can request a specific agency. You can also call the agency first, and most will contact the doctor for the order. Compare Medicare-certified home health agencies near you, each with Medicare's own star rating and outcome data.

For home care, no referral is needed. Call two or three agencies, ask for a free in-home assessment, and compare rates, minimums and how they handle a caregiver who cannot make a shift. Compare home care agencies near you, or tell us what you need and we will match you.