Core Definitions and Services
In home care refers to non medical assistance that helps individuals with daily living activities such as bathing, dressing, meal preparation, light housekeeping, companionship, and transportation. Home health care, by contrast, is a clinically regulated service delivered by licensed professionals, including registered nurses, physical therapists, and occupational therapists, who provide medical care at home. The distinction is critical because insurers, Medicare, and Medicaid treat these two categories differently when determining coverage and reimbursement rates.
In home care is typically private pay or funded through long term care insurance, while home health care is often covered by Medicare Part A and B, private insurance, or Medicaid when a physician certifies the patient as homebound and in need of skilled care. Understanding this difference helps families avoid unexpected out of pocket expenses and choose the right provider for their specific medical and personal needs.
Providers, Qualifications, and Oversight
In home care agencies employ home care aides and personal care assistants who may require only a high school diploma or equivalent, with training provided on the job. Home health care agencies must employ licensed professionals such as registered nurses, licensed practical nurses, and therapists who hold state licenses and, in many cases, national certifications. Regulatory oversight differs significantly, with home health agencies often subject to Medicare Conditions of Participation and state health department surveys.
Major companies in the home care space include BrightStar Care, Home Instead Senior Care, and Care.com, which connect families with non medical caregivers. Leading home health care providers include Amedisys, LHC Group, and Bayada Home Health Care, all of which operate Medicare certified agencies and are subject to federal quality reporting requirements. Families can verify agency credentials through state licensing boards and the Centers for Medicare and Medicaid Services provider directories.
Costs, Coverage, and Decision Factors
The national median hourly cost for in home care in the United States is approximately $27 to $30 per hour for a home care aide, according to recent Genworth Financial Cost of Care Survey data. Home health care costs can be higher when skilled nursing or therapy services are involved, but Medicare, Medigap, and Medicare Advantage plans often cover medically necessary home health services with minimal or no copayment when eligibility requirements are met.
When choosing between the two, families should assess the level of medical need, the expected duration of care, and the specific coverage rules of the payer. Medicare covers intermittent skilled nursing care, physical therapy, and speech language pathology services at home, but generally does not pay for long term custodial care provided by home care aides. For detailed eligibility and coverage rules, families can consult the official Medicare.gov home health services page or review guidance from the National Institute on Aging at nia.nih.gov.