What Is Home Care vs Home Health Care
Home care refers to non-medical assistance with daily living tasks such as bathing, dressing, meal preparation, light housekeeping, and companionship, typically provided by home care agencies or independent caregivers. Home health care involves skilled medical services ordered by a physician, including nursing, physical therapy, occupational therapy, and medical social work, delivered by licensed professionals such as registered nurses and therapists. According to the National Association for Home Care & Hospice, there are over 33,000 Medicare-certified home health agencies and tens of thousands of non-medical home care providers operating in the United States as of the latest survey data. The distinction matters because Medicare and most private insurers cover home health care when it is medically necessary and intermittent, but they generally do not cover non-medical home care, which is paid for privately or through long-term care insurance. For a detailed breakdown of Medicare home health benefit rules, see the official Medicare.gov guide on home health services https://www.medicare.gov/coverage/home-health-services.
The home care industry has consolidated rapidly, with the largest private-duty home care companies generating billions in annual revenue, while the home health care sector is dominated by large publicly traded chains such as Amedisys and LHC Group. In 2023, Amedisys reported total revenue of approximately $3.1 billion and served over 1.1 million patients, while LHC Group reported total revenue of approximately $2.6 billion and served over 1.2 million patients, according to their respective annual SEC filings. These companies operate thousands of locations across all 50 states and provide skilled nursing, therapy, and hospice services under Medicare and Medicaid. On the non-medical side, the largest home care franchises and agencies serve millions of clients annually, focusing on personal care, companion services, and Alzheimer's and dementia support. The Centers for Medicare & Medicaid Services publishes the Home Health Compare dataset, which ranks agencies by quality measures including timely initiation of care and improvement in mobility https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Compare.
Costs, Payment Sources, and Insurance Coverage
The median hourly cost for non-medical home care in the United States was approximately $27 in 2023, according to Genworth Financial's Cost of Care Survey, while the median hourly cost for skilled home health care services varies by Medicare reimbursement rates and geographic area. Medicare Part A and Part B cover 100 percent of approved home health care costs when a patient is homebound and under a physician-certified plan of care, with no copayment for skilled nursing visits and therapy services. Medicare does not cover custodial home care, which includes help with activities of daily living such as eating, toileting, and transferring, unless it is combined with skilled care under a qualifying home health episode. Long-term care insurance policies, Medicaid waiver programs, and veterans' Aid and Attendance benefits are the primary alternative payment sources for non-medical home care, with Medicaid covering home care for eligible low-income individuals in most states. Forbes has reported that the average annual cost of a home health aide is roughly $61,000, while private-duty home care can exceed $70,000 per year depending on hours and location https://www.forbes.com/advisor/long-term-care/average-cost-of-home-health-care/.
Out-of-pocket spending on home care and home health care is rising as the population ages and more