Home Care vs. Home Health in Colorado (2026)

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.1,2

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.1 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.1 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.1 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.1,3 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 or allowed practitioner certifies that the person needs skilled nursing or therapy on a part-time or intermittent basis, under a plan of care that practitioner 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.1 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 Community First Choice (CFC), and its Home and Community-Based Services (HCBS) waivers cover long-term supports at home.1,4 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 care at home, and they work differently. Community First Choice (CFC) is an optional Medicaid State Plan benefit, also known as 1915(k), that offers home and community-based attendant services. A CFC member can receive Personal Care and Homemaker services through an agency, which must hold a Class A or Class B license for personal care, or can self-direct Personal Care, Homemaker and Health Maintenance Activities through In-Home Support Services (IHSS) or Consumer Directed Attendant Support Services (CDASS). To qualify, a person must meet the financial rules for full Health First Colorado benefits and an institutional level of care set by the state's assessment.1 The HCBS waiver for the Elderly, Blind, and Disabled (HCBS-EBD) is the main waiver for older adults: it serves people who need long-term supports and services to remain in a community setting, and it carries a nursing-facility level-of-care test on top of the financial rules.4

Both run through Medicaid's financial rules. For the EBD waiver, HCPF states the test as countable income less than three times the current federal Supplemental Security Income (SSI) limit per month, which is under roughly $2,982 in 2026 because SSA sets the monthly maximum federal SSI amount at $994 for an eligible individual, and countable resources under $2,000 for a single person or under $3,000 for a couple, with spousal-impoverishment protections when one spouse is in an institution. A 60-month look-back applies to assets disposed of for less than fair market value on or after February 8, 2006.4 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.4

One line is worth stating plainly. Medicare does not pay for non-medical personal care when that is the only care a person needs.1,3 Medicare home health can include aide help with bathing, grooming or walking while a nurse or therapist is also visiting, but a family expecting Medicare to cover an aide for daily help with no skilled care attached 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.1

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, generally costs the beneficiary nothing for the covered services; durable medical equipment is the exception, where the beneficiary pays 20 percent of the Medicare-approved amount after the Part B deductible.1,3 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 (a median of $42 an hour).2 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.2

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.2 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.4

For low-income Coloradans who qualify, that private cost can be covered instead through Health First Colorado's Community First Choice personal care, delivered by an agency or self-directed through In-Home Support Services.1

Learn More

Find personalized help arranging care at home in Colorado at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.