In Colorado, "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.
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
- 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. 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. 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. 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. 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. 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. 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.
One line is worth stating plainly. Medicare does not pay for non-medical personal care. 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.
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.
| 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. 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 home health aide ran about $96,096 a year in 2024, according to the Genworth/CareScout Cost of Care Survey, which works out to roughly $8,008 a month on a basis of 44 hours a week. That runs above the national figure (about $77,792 a year). 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.
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.
Frequently Asked Questions
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. 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.
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. 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.
CDPHE licenses every home care agency in Colorado as Class A or Class B. 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.
The routes are private pay, long-term care insurance, or Health First Colorado for those who qualify. 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.
Yes, and many do. 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.
Learn More
- Assisted Living in Colorado
- Nursing Homes in Colorado
- Memory Care in Colorado
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
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.