In the first part of this series, we looked at the latest rankings from the U.S. News for the best home care agencies and the qualities that make them stand out. As you report on this topic — or on any aging or disability-related story that includes services delivered at home that incorporate a home care element, it’s crucial to understand the distinction between home care and home health care so you can fully explain it to your audience. Failing to do so can steer audiences in the wrong direction, create unrealistic expectations, and lead to real-world consequences for both their care decisions and out-of-pocket costs.
When I was a newbie reporter first writing about home care, I conflated the two services a few times. A kind editor schooled me on the differences, and the need to get the services right. Even the National Institute on Aging can sometimes use broader “home-based care” language that may blur the distinction for readers.
Home health care vs. home care
Home health care is not the same as home care — and misunderstanding this distinction can have significant financial and medical consequences, depending on what services are needed and who is paying for them.
Home health care refers to skilled medical services provided in a person’s home to treat an illness or injury, manage a chronic condition or assist with recovery after hospitalization or a medical procedure. Patients are often discharged from a hospital, skilled nursing or rehab facility into home health care services. The goal is to help the person remain as independent as possible for as long as possible. Home health care addresses medical tasks such as nursing, wound care, physical, occupational or speech therapy, pain management and other Medicare-approved services. In some cases, limited non-medical home care may be covered if it is provided in conjunction with skilled care.
Home care refers to services provided to people who need help with certain daily activities but don’t require medical care. That may include bathing, dressing, meal preparation, transportation to medical appointments, light housekeeping, companionship, and other tasks that support daily living and independence. Home care is typically paid for by some long-term care insurance, private pay, some Medicare Advantage plans (limited), Medicaid, or a combination of sources.
Some Medicare Advantage plans may pay for limited home care services, such as home-delivered meals or a temporary aide, although the Trump administration is considering rolling back these additional benefits.
What Medicare covers
Medicare covers certain home health services for people who are homebound and need part-time or intermittent skilled care. Covered services include:
- Skilled nursing care such as wound care, injections and patient education.
- Physical, occupational and speech therapy.
- Medical social services.
- Part-time home health aide services, but only when a patient is also receiving skilled nursing or therapy care at the same time.
For all covered home health services, Medicare beneficiaries pay nothing, although they may owe 20% of the Medicare-covered medical equipment after meeting the Part B deductible. Coverage is capped at eight hours per day, with a maximum of 28 hours per week in most cases.
Medicare won’t cover 24-hour-a-day care at home, meal delivery, homemaker services like shopping and cleaning unrelated to a care plan, or custodial personal care when that is the only care a person needs. To qualify, a health care provider must assess the patient face-to-face before certifying a need for home health services, and care must be provided by a Medicare-certified home health agency. Providers are required to give patients a list of agencies serving their area and must disclose any financial interest their organization has in any listed agency. That last requirement is worth keeping in mind when asking a hospital discharge planner for referrals.
What Medicaid covers
Medicaid’s home care coverage works quite differently from Medicare’s. For many lower-income older adults, it can cover significantly more. The federal government requires all 50 states to provide basic home health benefits through Medicaid, but the details vary widely depending on where a person lives and which Medicaid program they are enrolled in.
At minimum, all state Medicaid programs must cover medically necessary home health care, including skilled nursing services, home health aide services, and medical supplies and equipment. Unlike Medicare, Medicaid can also cover longer-term care, making it the primary payer for about two-thirds of all home care spending in the United States, according to KFF.
Beyond those baseline requirements, many states also cover services Medicare doesn’t touch, such as:
- Personal care and assistance with activities of daily living (bathing, dressing, eating, mobility).
- Homemaker services, including light housekeeping, laundry, and meal preparation.
- Adult day care and adult day health care.
- Home modifications for safety and accessibility, such as grab bars or wheelchair ramps.
- Transportation to medical appointments.
- Respite care for family caregivers.
- Personal emergency response systems.
These additional services are often available through Home and Community Based Services (HCBS) waivers. These are special programs states can use to offer a broader range of support to people who might otherwise require nursing home care. However, HCBS waiver programs can have enrollment caps and waiting lists, unlike standard Medicaid, which is an entitlement.
To qualify for Medicaid home care, applicants must meet their state’s financial eligibility requirements and demonstrate a medical or functional need. For HCBS waiver programs, states typically require a level of need equivalent to nursing home care.
Federal Medicaid cuts could affect the availability of home care services in the future. Journalists should check with their state Medicaid office or local Area Agency on Aging for the most current information on programs and services.
