In Colorado, calling for the wrong kind of agency can mean Medicare pays nothing for care a family expected it to cover, and that bill runs near $94,952 a year for full-time help at home. "Home care" and "home health" sound like the same thing, but the license class an agency holds is what draws the line between them. The state licenses every home care agency in one of two classes: a Class A agency provides skilled health care that Medicare can cover when someone is homebound and needs intermittent skilled care, while a Class B agency provides only non-medical personal care that Medicare won't pay for, though low-income Coloradans may cover it through Health First Colorado.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services,CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care
This guide draws the line between the two. The license class decides what care an agency can deliver, whether it can bill Medicare, and which program pays the bill. Getting it right is how a family avoids paying out of pocket for care a program would have covered, or waiting on Medicare coverage that was never going to come.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: Skilled Care and What Medicare Covers
- Home Care: Personal Care and Who Pays
- Home Care vs. Home Health: Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is medical versus non-medical, and in Colorado the agency's license class settles it. CDPHE licenses every home care agency as Class A or Class B, and that class decides what the agency can legally deliver and whether it can bill Medicare.
Class A is skilled care. A Class A agency provides skilled health care: licensed nursing, certified nurse aide services, and therapy.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services It can also provide personal care on top of that. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall: those are skilled needs, and they're physician-ordered because they require a licensed professional. A Class A agency that also holds Medicare certification is the one that can bill Medicare for covered home health.
Class B is personal care only. A Class B agency provides non-medical help and nothing skilled.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services That means help with the activities of daily living, bathing, dressing, getting to the bathroom, eating, and moving around. The person can be medically stable and still need this help every day. A Class B agency cannot provide nursing or therapy, and it cannot bill Medicare for home health.
The same person often needs both kinds of care. Someone discharged after hip surgery might need skilled home health (a nurse and a physical therapist for a few weeks) and also ongoing personal care (an aide for bathing and meals for months). A Class A agency can deliver both; a Class B agency can deliver only the personal care. Either way the two services run on separate payer tracks, which is exactly why the distinction is worth knowing before you start making calls.
Home Health: Skilled Care and What Medicare Covers
Skilled home health in Colorado comes from a Class A home care agency that also holds Medicare certification.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. Holding a Class A license is the floor; adding Medicare certification is what lets the agency bill Medicare for covered services.
Medicare's home health benefit covers this care when a beneficiary meets the conditions.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualification requirements, home health (govinfo.gov). govinfo.gov. Retrieved Jun 23, 2026, from https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol2/xml/CFR-2023-title42-vol2-sec409-42.xml The two that trip families up most:
- Homebound. Leaving home takes considerable, taxing effort, and the person generally needs help or an assistive device to do it. Short, occasional trips out, to a medical appointment or to religious services, don't disqualify someone.
- Intermittent skilled need. A physician certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care the physician reviews, and the care comes from a Medicare-certified agency.
When those conditions are met, Medicare pays for the covered skilled services: the nursing visits, the therapy, and the home health aide help that's attached to that skilled care. What Medicare home health will not do is staff an aide in the home for general daily help with no skilled-care purpose. That's personal care, and it's the next section.
Home Care: Personal Care and Who Pays
Non-medical personal care in Colorado is the everyday help that keeps someone safe and supported at home: help with daily activities, and the routines of living rather than any medical treatment.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services A Class B agency provides only this kind of care, and a Class A agency can provide it alongside skilled services. It isn't skilled medical care, so it doesn't depend on Medicare certification, and the payer picture looks different.
Who pays for personal care comes down to a few routes:
- Private pay. Many families pay out of pocket, by the hour. This is the default when no one qualifies for a public program and the need is non-medical.
- Health First Colorado. For eligible low-income Coloradans, the state's Medicaid program funds in-home personal care through its Home and Community-Based Services (HCBS) waivers and through the In-Home Support Services option.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services Eligibility for these long-term services runs through the state, so that's where a family starts.
- Long-term care insurance. A private policy, if the person holds one, may reimburse personal care hours.
On the Health First Colorado side, two pathways fund in-home personal care, and they work differently. The HCBS waiver for the Elderly, Blind, and Disabled (HCBS-EBD) is the main route for older adults: it pays for personal care and other long-term supports at home for someone who would otherwise need a nursing facility, so it carries a nursing-facility level-of-care test on top of the financial rules. The In-Home Support Services (IHSS) option lets a member who already qualifies for certain waivers direct their own personal-care attendant, including, in many cases, hiring a family member or friend to provide the care.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
The eligibility lever for both is the same Medicaid financial test. In 2026, Health First Colorado long-term care covers a single applicant with countable income at or below about $2,982 a month (300% of the federal Supplemental Security Income (SSI) benefit rate) and countable assets at or below $2,000, with spousal-impoverishment protections for a married couple. A five-year look-back applies to asset transfers.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Implementation Guide: Individuals in Institutions Eligible Under a Special Income Level (42 C.F.R. 435.1005). medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-individuals-in-institutions-eligible-under-a-special-income-level.pdf A family that thinks they may qualify applies through Colorado PEAK (the state's online benefits portal at coloradopeak.secure.force.com) or the local county human-services office; the HCPF long-term services and supports page lists where to begin. Because eligibility determination and any waiver enrollment can take weeks, families who need care right away often pay privately in the interim and seek reimbursement or a switch to Medicaid coverage once approved, so it is worth starting the application as early as possible.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Implementation Guide: Individuals in Institutions Eligible Under a Special Income Level (42 C.F.R. 435.1005). medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-individuals-in-institutions-eligible-under-a-special-income-level.pdf
One line is worth stating plainly. Medicare does not pay for non-medical personal care.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services A family expecting Medicare to cover an aide for daily help will find it won't, no matter how much that help is needed. The ways to pay for personal care are private funds, long-term care insurance, or, for those who qualify, Health First Colorado.
Home Care vs. Home Health: Which One Do You Need?
Start with the need, not the brochure. The table maps the two license classes across the dimensions that decide what care you get and who pays.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
| Class A (skilled) | Class B (personal care) | |
|---|---|---|
| What it is | Skilled health care: licensed nursing, certified nurse aide, and therapy; may also provide non-medical personal care | Non-medical personal care only: help with daily activities such as bathing, dressing, eating, and mobility; no skilled care |
| Who provides it | A Class A agency and its clinical staff (nurses and therapists), plus aides for any personal care | Aides and caregivers employed by a Class B agency |
| Who pays | Medicare for the skilled home health (Class A + Medicare certification, when homebound and intermittent skilled need); private pay or Health First Colorado for any personal care | Private pay, long-term care insurance, or Health First Colorado for eligible low-income Coloradans |
A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at a Class A agency with Medicare certification, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, a Class B agency can handle it, and the question becomes whether to pay privately or qualify through Health First Colorado. Plenty of families arrange both, sometimes through a single Class A agency that delivers each.
What It Costs
Skilled home health, when Medicare covers it, costs the beneficiary nothing for the covered services.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services,U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualification requirements, home health (govinfo.gov). govinfo.gov. Retrieved Jun 23, 2026, from https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol2/xml/CFR-2023-title42-vol2-sec409-42.xml The cost question really lives on the personal-care side, where families pay out of pocket unless Health First Colorado covers it.
For non-medical personal care in Colorado, a non-medical caregiver ran about $94,952 a year in the CareScout 2025 Cost of Care Survey (released March 2026), which works out to roughly $7,913 a month on a basis of 44 hours a week (about $41 an hour at that pace).CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care Those are industry survey medians, not government rates and not a maximum, so what a specific Colorado agency charges can land above or below them, and the Denver metro and mountain-resort areas tend to run higher than rural counties. A family using fewer hours than the full-week assumption will of course pay less than the annual figure suggests.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care
For most families, a private-pay bill near $95,000 a year is more than a household budget can absorb for long, which is exactly why checking Health First Colorado eligibility is worth doing before defaulting to private pay.CareScout. (n.d.). Cost of Long Term Care by State. carescout.com. Retrieved Jun 25, 2026, from https://www.carescout.com/cost-of-care Even families who expect to be over the income limit often find the asset rules or spousal-impoverishment protections leave more room than they assumed.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Implementation Guide: Individuals in Institutions Eligible Under a Special Income Level (42 C.F.R. 435.1005). medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-individuals-in-institutions-eligible-under-a-special-income-level.pdf
For low-income Coloradans who qualify, that private cost can be covered instead through Health First Colorado as HCBS waiver personal care or In-Home Support Services.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
Frequently Asked Questions
Does Medicare pay for home care in Colorado?
No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and daily activities that a home care aide provides.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services Medicare's home health benefit covers skilled, physician-ordered care (nursing and therapy) from a Class A agency with Medicare certification, for people who are homebound and need it on an intermittent basis. For non-medical personal care, the options are private pay, long-term care insurance, or, for eligible low-income Coloradans, Health First Colorado.
What is the difference between home care and home health in Colorado?
Home health is skilled medical care a physician orders and a licensed clinician delivers, covered by Medicare when the person is homebound and needs intermittent skilled care. Non-medical home care is everyday personal help that Medicare does not cover.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services In Colorado the line is drawn by license class: a Class A agency can provide skilled care (and bill Medicare with certification), while a Class B agency provides personal care only.
What is the difference between a Class A and a Class B home care agency?
CDPHE licenses every home care agency in Colorado as Class A or Class B.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services A Class A agency provides skilled health care (licensed nursing, certified nurse aide, and therapy) and may also provide personal care; an agency must hold Class A plus Medicare certification to deliver Medicare-covered home health. A Class B agency provides only non-medical personal care and may not provide skilled care.
Who pays for personal care if Medicare won't?
The routes are private pay, long-term care insurance, or Health First Colorado for those who qualify.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services The state's Medicaid program funds in-home personal care for eligible low-income Coloradans through its HCBS waivers and the In-Home Support Services option. Eligibility for these long-term services runs through the state, which is where a family begins.
How do I find a Medicare-certified Class A agency in Colorado?
Two lookups confirm the two licenses that matter. To confirm Medicare certification, search Medicare's Care Compare, which lists Medicare-certified home health agencies and lets you compare quality ratings by location.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services To confirm the Colorado license class, check the CDPHE home care agency list, which shows whether an agency holds a Class A or Class B license. An agency needs both, a Class A license and Medicare certification, to deliver Medicare-covered home health.
How do I apply for Health First Colorado personal care?
Apply through Colorado PEAK, the state's online benefits portal (coloradopeak.secure.force.com), or through your local county human-services office.Centers for Medicare & Medicaid Services. (n.d.). Medicaid.gov - Implementation Guide: Individuals in Institutions Eligible Under a Special Income Level (42 C.F.R. 435.1005). medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/resources-for-states/downloads/macpro-ig-individuals-in-institutions-eligible-under-a-special-income-level.pdf In 2026, Health First Colorado long-term care covers a single applicant with countable income at or below about $2,982 a month and countable assets at or below $2,000, with protections for a married applicant's spouse. The HCBS waiver for the Elderly, Blind, and Disabled also requires a nursing-facility level-of-care assessment. Because the determination can take weeks, start the application early, and the HCPF long-term services and supports page shows where to begin.
Can someone get both home health and personal care at the same time?
Yes, and many do.Centers for Medicare & Medicaid Services. (n.d.). Medicare - Home Health Services Coverage. medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services A person recovering from surgery might receive Medicare-covered home health (a nurse and a therapist for a set period) while also needing ongoing personal care (an aide for bathing and meals). A single Class A agency can deliver both, but the skilled care and the personal care still run on separate payer tracks, so arranging one does not arrange or pay for the other.
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