Home health vs. home care: what Medicare covers and what it doesn’t

“Home health” and “home care” sound like the same thing, and families often use them that way. To Medicare they’re very different, and the difference decides who pays. Home health is skilled medical care that Medicare can cover in full. Home care is help with everyday living, and Medicare doesn’t pay for it. Many families need both. This note explains each one, with Medicare’s rules and California’s, so you know what to ask for.

The short answer

• Home health is skilled care at home from licensed nurses and therapists, ordered by a doctor, given in visits. Medicare covers it in full for people who qualify.¹
• Home care is help with daily living: bathing, dressing, meals, light housekeeping, getting around, company. Medicare doesn’t pay for it when that’s the only help someone needs.¹
• In California, home care agencies must be licensed by the state, and their aides must be background checked and listed on a public registry.²
• People with Medi-Cal may qualify for help at home through In-Home Supportive Services.³

What home health is

Home health is medical care that needs a licensed professional. A nurse treats a wound, teaches someone to manage a new medicine or watches a condition that could turn serious. A physical therapist helps someone walk safely after a hospital stay. A speech therapist helps with swallowing after a stroke.¹

Medicare covers home health when a doctor or another allowed provider orders it, the person needs skilled care part time or now and then, and they’re homebound, which means leaving home takes a considerable and taxing effort.¹ When those conditions are met, covered home health services cost nothing.¹

Home health comes in visits, not shifts. A nurse or therapist comes, does the skilled work, teaches the family and leaves. A home health aide can help with bathing while someone is also getting skilled care.¹

What home care is

Home care is the help that keeps someone safe and comfortable between those visits: a caregiver who helps with showering and dressing, makes meals, does laundry, drives to appointments, reminds someone to take their medicines and keeps them company. It can be a few hours a week or around the clock.

Home care doesn’t need a license to practice nursing because it isn’t medical care. That’s also why Medicare doesn’t pay for it. Medicare doesn’t cover personal care like bathing or dressing when that’s the only help someone needs, and it doesn’t cover homemaker services or care around the clock at home.¹

The two side by side

• Who gives it: home health comes from nurses and licensed therapists; home care comes from caregivers and aides.
• What it’s for: home health treats an illness or helps someone recover; home care helps with daily living.
• How often: home health is visits, part time; home care can be hours or a full day.
• Who orders it: a doctor orders home health; anyone can arrange home care.
• Who pays: Medicare, Medi-Cal and health plans pay for home health; families usually pay for home care, with some help from Medi-Cal, long-term care insurance or veterans’ benefits.

How families pay for home care in California

Most families pay for home care themselves. A few programs help.

• Medi-Cal’s In-Home Supportive Services, known as IHSS, pays for help at home for people who are aged, blind or disabled and on Medi-Cal, so they can stay in their own homes instead of moving to out-of-home care. A county social worker decides what services are needed and how many hours to authorize, and the person hires their own provider.³ Ask the county whether a family member can be the paid provider in your situation.
• Long-term care insurance may pay for home care. Check the policy’s waiting period and daily limit.
• Veterans’ benefits can help some veterans pay for care at home. Ask the VA about home and community care.

You apply for IHSS through your county’s IHSS office.³

Choosing a home care agency in California

Since January 2016, California has required home care organizations to be licensed, and its law created a public online registry of home care aides who have been background checked.² Before you hire, check that the agency is licensed, and check that the aide who’ll come to the house is on the Home Care Aide Registry.²

Ask the agency how it supervises its aides, what happens if an aide calls in sick, and how it handles a change in someone’s needs.

When you need both

Many families need both at once. After a hospital stay, a person may qualify for home health visits from a nurse and a therapist, and still need someone to help with meals and showering on the days in between. Medicare pays for the first. The family arranges the second.

The two work best when they talk to each other. Tell the home health nurse who the caregivers are, and ask the nurse to show them what to watch for. A caregiver who knows the warning signs of a wound infection or a heart failure flare is part of the care team, even though Medicare doesn’t pay them.

Where HealthView fits

HealthView provides home health, the skilled side, along with palliative care and hospice. We don’t provide home care, but our nurses and social workers help families think through the help they’ll need between visits and where to find it.