Getting in-home health care starts with understanding what type of care you need, then following specific steps to get a doctor’s order, find a qualified agency, and sort out payment. The process differs depending on whether you need skilled medical care (nursing, therapy) or non-medical personal care (help with bathing, meals, housekeeping), and the path to each involves different requirements.
Skilled Home Health vs. Non-Medical Home Care
These two categories look similar from the outside but work very differently in terms of who provides care, who pays, and what’s required to start services.
Skilled home health care means a licensed nurse or therapist comes to your home to treat a medical condition or help you recover from surgery, illness, or injury. Services include nursing care, physical therapy, speech therapy, occupational therapy, wound care, and medical social work. A home health aide may also assist with bathing and dressing as part of the medical plan. These visits are typically a few hours per week, not around-the-clock, and they require a doctor’s order to begin.
Non-medical home care covers help with daily life: bathing, grooming, meal preparation, housekeeping, transportation, medication reminders, and companionship. It does not include nursing or therapy. You can arrange it on your own without a prescription, and it continues as long as you want and can pay for it. This type of care is sometimes called personal care, companion care, or homemaker services.
How to Start Skilled Home Health Care
If you or a family member needs medical-level care at home, the process begins with a physician. Medicare and most insurers require a doctor’s order that specifies the type of professional providing care, the nature of the services, and how often visits will happen. You can’t self-refer.
The most common way people enter home health is after a hospital stay or surgery. If you’re being discharged, ask the hospital’s discharge planner or case manager to arrange a home health referral before you leave. They handle the paperwork and coordinate with a home health agency directly. If you’re not in a hospital but believe you need skilled care at home, call your primary care doctor and describe what’s going on. They can evaluate you and write the order.
For Medicare coverage, there’s also a face-to-face encounter requirement. A physician, nurse practitioner, physician assistant, or certified nurse specialist must see the patient in person, and that visit must occur within 90 days before or 30 days after home health services begin. The encounter has to be related to the same condition driving the need for home care. Starting in 2026, the rules around who can perform this encounter are being expanded, giving physicians more flexibility even if they weren’t the ones who treated the patient in the hospital.
How to Arrange Non-Medical Home Care
Because non-medical care doesn’t involve clinical services, there are no eligibility hoops to jump through. You contact a home care agency directly, describe the help you need, and set up a schedule. Most agencies will do an in-home assessment first to understand the living situation and build a care plan around specific needs.
You can find agencies through your state’s aging and disability resource center, your local Area Agency on Aging, or simply by searching online. Some families hire independent caregivers rather than going through an agency, which is usually cheaper but means you’re responsible for vetting, taxes, backup coverage, and liability.
What Medicare Covers
Medicare covers skilled home health services with no copay. You pay nothing for nursing visits, therapy sessions, or home health aide services that are part of your medical plan of care. The only cost you might face is a 20% coinsurance on durable medical equipment (hospital beds, walkers, oxygen equipment) after meeting the Part B deductible.
To qualify, you generally need to meet these criteria: you have a doctor’s order for home health, you need skilled nursing or therapy on an intermittent basis, and you’re considered “homebound,” meaning leaving home requires considerable effort and you typically don’t leave except for medical appointments or short, infrequent outings. You don’t have to be bedridden. Coverage continues as long as your doctor recertifies the need and you still meet eligibility requirements.
Medicare does not cover non-medical home care. It won’t pay for a caregiver to help with housekeeping, cooking, or companionship alone.
Medicaid and Waiver Programs
Medicaid is the main public option for people who need non-medical home care but can’t afford to pay out of pocket. Every state runs Home and Community-Based Services (HCBS) waivers, which fund personal care, homemaker services, and other supports designed to keep people in their homes rather than nursing facilities.
Eligibility has two layers. First, you need to qualify financially for Medicaid, which varies by state but generally involves low income and limited assets. States can apply spousal impoverishment rules so that a healthy spouse isn’t forced into poverty when the other spouse needs care. Second, you need to demonstrate a clinical need equivalent to what would qualify you for a nursing home. In other words, HCBS waivers are targeted at people whose care needs are significant, not just anyone who wants occasional help around the house.
Wait lists for these waivers are common. Some states have wait times of months or even years, so apply as early as possible through your state Medicaid office or aging services department.
VA Benefits for Veterans
All enrolled veterans are eligible for the VA’s Homemaker and Home Health Aide program if they meet the clinical criteria and qualify for community care. This program covers personal care services and help with daily activities for veterans who need hands-on assistance, are socially isolated, or whose family caregiver is experiencing burnout. Contact your local VA medical center’s social work or geriatrics department to request an evaluation.
Paying Out of Pocket
Non-medical home care costs a national median of $35 per hour, though prices vary significantly by region. In areas with lower minimum wages, you might find rates between $20 and $25 per hour. In higher-cost areas, $35 or more is standard. If you need a private duty nurse for skilled care outside of what insurance covers, expect around $90 per hour.
At 20 hours per week of non-medical care at the median rate, you’re looking at roughly $2,800 per month. Long-term care insurance policies often cover these costs if you have one, so check your policy. Some families also use a combination of paid care and help from family members to keep costs manageable.
How to Compare Home Health Agencies
For skilled home health agencies that accept Medicare, the federal government publishes quality ratings on the Care Compare website at medicare.gov. Each agency receives two star ratings: one for quality of patient care and one based on patient satisfaction surveys.
The quality rating is built from seven clinical measures, including how quickly the agency starts care after a referral, whether patients improve in walking, getting in and out of bed, bathing, managing shortness of breath, and handling medications, and how often patients end up back in the hospital during a home health episode. An agency needs data from at least 20 completed care episodes to even receive a rating, so a brand-new or very small agency may not have one.
The patient survey rating comes from a standardized questionnaire covering how well the agency communicates, how it handles specific care issues, and an overall satisfaction score. Agencies need at least 40 completed surveys to qualify for this rating. Comparing both scores gives you a more complete picture than either one alone.
Beyond the star ratings, ask agencies practical questions: How quickly can they start services? What happens if your regular nurse or aide calls out sick? Do they provide care on weekends? Can they coordinate with your doctor’s office on changes to your care plan? A high-rated agency that can’t staff your schedule isn’t the right fit.
Steps to Take Right Now
- If you need medical care at home: Call your doctor or ask your hospital’s discharge team for a home health referral. They’ll handle the order and connect you with a Medicare-certified agency.
- If you need help with daily activities: Contact your local Area Agency on Aging (find yours at eldercare.acl.gov or by calling 211) to learn what programs are available in your area, then reach out to home care agencies directly.
- If cost is a concern: Apply for Medicaid and ask specifically about HCBS waiver programs. Do this early because wait lists are common.
- If you’re a veteran: Call your VA medical center and ask about the Homemaker and Home Health Aide program.
- When comparing agencies: Check star ratings on Medicare’s Care Compare tool, then call your top choices to ask about availability, staffing, and scheduling flexibility.