A doctor mentions home health. A neighbor says they hired home care for their mother. Someone else brings up hospice. All three mean care at home, and families I've worked with often assume they are the same thing.
They are not. Each starts differently and is paid for by different people. Picking the wrong one can mean waiting for help that never comes, or paying for something Medicare would have covered.
I'm an occupational therapist, and I've worked in home health. This guide explains each one, who pays, and the questions I would ask the doctor.
The Short Version
| Home health | Home care | Hospice | |
|---|---|---|---|
| Who it's for | Someone homebound who needs skilled care for an illness or injury | Someone who needs help with daily life | Someone with a terminal illness and a life expectancy of 6 months or less if the illness runs its normal course |
| What they do | Nursing and therapy, plus some aide help alongside that care | Bathing, dressing, meals, housework, errands, company | Comfort care and family support, instead of treatment to cure the terminal illness |
| Who starts it | A doctor or allowed practitioner orders it | Usually the family, directly with a home care company | A hospice doctor, and the patient's own doctor if they have one, certify it. Then the patient chooses it |
| Who pays | Medicare: nothing for covered services under Original Medicare | Usually the family. Sometimes long-term care insurance, Medicaid or the VA | Medicare Part A: nothing for covered care, with a small drug copay and 5% for respite care |
| How long | As long as the person still qualifies | As long as the family arranges it | Two 90-day periods, then unlimited 60-day periods, while the hospice doctor recertifies |
Home Health: Skilled Care, Paid by Medicare
CMS's manual and Medicare.gov list what Medicare requires. The person must:
- Be homebound. Medicare's site says you must need "part-time or intermittent skilled services" and be "homebound," which means you're normally unable to leave home and leaving takes a lot of effort.
- Be under a doctor's care, a physician or allowed practitioner, with a plan of care the doctor sets up and reviews.
- Need skilled care: skilled nursing on an intermittent basis, physical therapy, speech-language pathology, or a continuing need for occupational therapy. Occupational therapy can keep home health going once it has started, but it can't start it on its own (MBPM ch. 7 §30.4).
A doctor or a provider like a nurse practitioner must see the person and confirm the need, and a Medicare-certified agency provides the care. Under Original Medicare, Medicare.gov says "You pay nothing for covered home health services." Equipment like a walker is paid separately, and Medicare usually pays 80% of the approved amount for it.
Two details trip families up. An aide comes only alongside skilled care: Medicare covers aide help with bathing and dressing only if the person also gets skilled nursing or therapy. And it is part-time, in most cases up to 8 hours a day and 28 hours a week of nursing and aide time combined.
If you qualify, Medicare.gov says you can get unlimited home health visits. Our guide to who qualifies for home health care walks through the rules, and what home health costs with Medicare covers the money.
Home Care: Help With Daily Life, Usually Paid by the Family
Home care, also called personal care, companion care or homemaker services, is non-medical help: bathing, dressing, getting to the bathroom, meals, light housework, errands, and keeping someone company and safe.
In my experience, this is the help families need for the longest time. Medicare's home health booklet is clear that Medicare does not pay for:
- 24-hour-a-day care at home
- Meals delivered to your home
- Services like shopping, cleaning, and laundry
- Custodial or personal care like bathing, dressing, and using the bathroom, "when this is the only care you need"
The key words are "the only care you need." While your parent is on home health, an aide may come a few times a week. When the skilled care ends, Medicare stops paying for the personal care.
Who pays for home care
- The family. Medicare.gov: "You pay all costs for non-covered services, including most long-term care."
- Long-term care insurance. Medicare.gov names private long-term care insurance as an option. If your parent has a policy, ask the insurer what it covers at home.
- Medicaid. Medicare.gov says you may get long-term care through Medicaid if you meet your state's rules. Federal rules let states offer "home or community-based services," such as homemaker and personal care services, under a waiver. Each state sets its own, so call your state Medicaid office.
- The VA. The VA's Homemaker and Home Health Aide program is personal care for veterans, despite the name. Enrolled veterans can get it if they are eligible for community care, meet the clinical criteria, and the service is available. There may be a copay.
In my experience, many families combine the two. Home health comes a few times a week, and a paid caregiver or family member covers the rest of the day.
Hospice: Comfort Care When the Illness Can't Be Cured
Medicare.gov puts it simply: "Hospice is end-of-life care for people with illnesses that can't be cured." Medicare Part A pays for it.
Who qualifies
The person must have Medicare Part A and be certified as terminally ill (42 CFR §418.20). Medicare defines that as a prognosis that "life expectancy is 6 months or less if the illness runs its normal course" (42 CFR §418.3).
For the first period, the hospice's doctor and the patient's own attending physician, if they have one, both sign the certification (42 CFR §418.22(c)). CMS's hospice manual says, "The fact that a beneficiary lives longer than expected in itself is not cause to terminate benefits."
Choosing hospice
Hospice is not simply ordered. The patient, or their representative if the patient can't, chooses it by signing an election statement showing they understand "the palliative rather than curative nature of hospice care" (42 CFR §418.24(b)(2)). Medicare.gov says you accept "comfort care (palliative care) instead of care to cure your illness and related conditions." Hospice still treats pain and other symptoms.
Medicare.gov says "You pay nothing for hospice care if you get your care from a Medicare-approved hospice provider." There can be a copay of up to $5 per prescription for pain and symptom drugs, and 5% of the Medicare-approved amount for inpatient respite care, a short stay that gives the caregiver a rest.
The fear I hear most is that hospice can't be undone. Medicare's hospice booklet says: "You always have the right to stop hospice care at any time."
Can Someone Get Home Health and Hospice at the Same Time?
The honest answer has three parts.
For the terminal illness, no. Electing hospice gives up Medicare payment for services "related to the treatment of the terminal condition for which hospice care was elected or a related condition", except care from the hospice or the patient's own doctor, if that doctor doesn't work for the hospice (42 CFR §418.24(g)(2)). The hospice takes over that care.
For a completely unrelated problem, possibly. CMS's hospice manual says Medicare services "for a condition completely unrelated to the terminal condition for which hospice was elected remain available to the patient if he or she is eligible for such care." But the election statement must tell the patient that unrelated services "are exceptional and unusual and hospice should be providing virtually all care needed" (42 CFR §418.24(b)(3)). Allowed, but rare. You can ask the hospice for a list of the items, services and drugs it has decided are unrelated.
Before hospice, a terminal diagnosis does not rule out home health. CMS's home health manual describes a terminally ill patient who needs skilled nursing and has not elected hospice. That care "would be covered, notwithstanding that the condition is terminal." So someone who is seriously ill but still wants treatment can stay on home health if they qualify.
Where Palliative Care Fits
Palliative care is care focused on comfort and quality of life during a serious illness. Hospice is built around it, but as the section above shows, a serious diagnosis does not by itself rule out home health. Our article on palliative care under the home health benefit explains what CMS has said.
How to Tell Which One You Need
This part is my suggestion, from years of walking into homes. It is not a Medicare rule. Start with two questions:
- Does your parent need a nurse or therapist, or mostly help with daily tasks? Skilled needs point to home health. Daily help alone points to home care.
- Is the goal to treat the illness, or to stay comfortable? If treatment is no longer working or wanted, ask the doctor about hospice.
Then ask the doctor:
- Does my parent need skilled nursing or therapy right now? What for?
- Would you order home health? Do you think my parent is homebound?
- What would home health be working toward?
- When home health ends, what help will my parent still need day to day?
- Might my parent qualify for hospice? If we chose it, what would change, and what would still be treated outside it?
If home health is the answer, our free qualify checker asks a few questions and tells you whether your parent is likely to qualify, probably not, or whether to ask the doctor. Find an Agency lists the Medicare-certified home health agencies that serve your ZIP code.
Frequently Asked Questions
What is the difference between home health and home care?
Home health is skilled nursing and therapy, ordered by a doctor or allowed practitioner, for someone who is homebound. Original Medicare covers it with no copay. Home care is help with daily life, like bathing, meals and housework. Medicare does not pay for it when that is the only care needed.
Does Medicare pay for home care?
Not when personal care or housework is the only care needed. Families usually pay out of pocket, or through long-term care insurance, Medicaid if they qualify in their state, or a VA program for some veterans.
Can my parent get home health and hospice at the same time?
Not for the same illness. Once someone chooses hospice, the hospice provides the care for the terminal illness and related conditions. Medicare can still cover care for a completely unrelated problem, but CMS expects that to be unusual. Before choosing hospice, a person with a terminal illness can stay on home health if they qualify.
Can you stop hospice once you start?
Yes. Medicare's hospice booklet says you always have the right to stop hospice care at any time. If you're still eligible, you can go back to hospice later.
Sources
- Medicare Benefit Policy Manual, Chapter 7, Home Health Services, §§30 and 40.1.1 (CMS)
- Medicare Benefit Policy Manual, Chapter 9, Coverage of Hospice Services Under Hospital Insurance, §§10 and 70 (CMS)
- 42 CFR §418.3, Hospice definitions (Cornell LII)
- 42 CFR §418.20, Hospice eligibility requirements (Cornell LII)
- 42 CFR §418.22, Certification of terminal illness (Cornell LII)
- 42 CFR §418.24, Election of hospice care (Cornell LII)
- 42 CFR §440.180, Medicaid home or community-based services (Cornell LII)
- Home health services coverage (Medicare.gov)
- Hospice care coverage (Medicare.gov)
- Long-term care coverage (Medicare.gov)
- Medicare & Home Health Care, CMS Product No. 10969, July 2025 (Medicare.gov)
- Medicare Hospice Benefits, CMS Product No. 02154, March 2026 (Medicare.gov)
- Homemaker and Home Health Aide Care (U.S. Department of Veterans Affairs)
Does your parent qualify for home health?
Answer a few questions about your parent's situation. The checker tells you whether Medicare home health is likely, probably not, or something to ask the doctor about.