Home Care vs. Home Health in Delaware (2026)

"Home care" and "home health" sound interchangeable, but in Delaware they're two different services, and the difference decides who pays. Home health is the skilled nursing and therapy a doctor orders from an agency the Delaware Division of Health Care Quality licenses under regulation 3350, and it's what Medicare can cover; home care is non-medical daily help that Medicare won't.1

This guide draws that line so a Delaware family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. What matters isn't the word on the agency's sign, it's whether the care is skilled or non-medical, and which program pays the bill.

In This Guide

• Key Takeaways
• Home Care vs. Home Health in Delaware: The Difference That Decides Who Pays
• Home Health: What Medicare Covers
• What It Costs and Other Ways to Pay
• How to Choose and Vet an Agency
• Frequently Asked Questions

Home Care vs. Home Health in Delaware: The Difference That Decides Who Pays

The split is skilled versus non-medical, and in Delaware the skilled side carries a state license and a Medicare certification the non-medical everyday help does not.1

A home health agency provides skilled, physician-ordered care: nursing and physical, occupational, or speech therapy ordered because the person has a medical need only a licensed professional can meet. Wound care after surgery, IV medication, injections a patient can't manage alone, therapy to rebuild strength after a stroke or a fall. The care is part-time and intermittent, not round-the-clock. In Delaware, that agency must be licensed by the Department of Health and Social Services through its Division of Health Care Quality under regulation 3350, the state's rule for skilled home health agencies, and to serve Medicare patients it must also be Medicare-certified.1

Non-medical home care is everyday help with bathing, dressing, grooming, meals, and homemaking, the tasks that keep someone safe at home. The person can be medically stable and still need this help every day. This is the work most people mean when they say "home care." In Delaware it's a separate kind of service from skilled home health, regulated separately rather than under the skilled-agency license, with a separate payer picture.1

That separation is what decides the money. Medicare certification, layered on top of the state license, is the step that lets a home health agency bill Medicare for the skilled care it delivers.1 Non-medical personal care is care Medicare doesn't pay for at all. So when a Delaware family hears "home health," that points to the skilled, often Medicare-certified track, and "personal care" or "homemaker" points to the non-medical one.

The same person often needs both at once. Someone discharged after a hip replacement might need home health, a nurse and a physical therapist for a few weeks, and also personal care, an aide for bathing and meals over the months that follow. Those run on separate payment tracks: Medicare pays for the skilled piece, and something else pays for the personal-care piece.

Home Health: What Medicare Covers

Skilled home health in Delaware comes from an agency licensed by the Division of Health Care Quality under regulation 3350, and to bill Medicare that agency must also be Medicare-certified.1 The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The state license is the floor; Medicare certification is the additional step that lets the agency bill Medicare for those services.

Medicare's home health benefit covers this care only when a beneficiary meets every condition.1,4 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, a beneficiary generally pays $0 for the covered skilled services: the nursing visits, the therapy, and the home health aide help attached to that skilled care (durable medical equipment is the exception, at 20 percent coinsurance).4 "Part-time or intermittent" is a real limit here: combined skilled-nursing and aide services generally run fewer than 8 hours a day and 28 or fewer hours a week. 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.

If Medicare denies coverage for home health a family expected it to pay, that decision can be appealed. Medicare beneficiaries can challenge a home health termination or denial through the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), the contractor that reviews these disputes; the agency's notice of non-coverage explains how and by when to request that review.1

What It Costs and Other Ways to Pay

Non-medical home care covers help with bathing, dressing, grooming, meals, and homemaking. Because it isn't skilled medical care, the payer picture looks nothing like home health, and the cost question lives almost entirely on this side.1

The most recent benchmark is the CareScout 2025 Cost of Care Survey, released in March 2026. It combined what used to be the separate "homemaker" and "home health aide" lines into one "non-medical caregiver" category, and put the national median at about $35 an hour.2 The survey did not publish a confirmed Delaware-specific non-medical caregiver rate, but it placed Delaware above the national lines across the board, so a Delaware family should plan for in-home care at or above the national hourly figure rather than below it. How that hourly rate adds up depends entirely on the schedule: a family hiring an aide for only a few hours a day pays a fraction of what a near full-time schedule would cost, with a few hours of help two or three days a week running in the hundreds of dollars a month, while round-the-clock or daily coverage runs into the tens of thousands a year. These are industry-survey medians, not government rates and not a ceiling, so what a specific Delaware agency charges can land above or below them.2

How expensive Delaware runs shows up most clearly in facility care: in the same 2025 survey, a private nursing-home room in Delaware ran about $181,588 a year, among the highest in the nation.2 That is part of why the home-care payer question matters here, because when in-home hours add up, the cost climbs fast.

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.1
• Delaware Medicaid. For eligible lower-income older Delawareans, Delaware Medicaid funds non-medical personal care through its Diamond State Health Plan-Plus program, the managed long-term-care path that helps a person stay out of a nursing home.3
• Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.

How Delaware Medicaid sets eligibility is worth understanding before counting on it. Delaware sets its long-term-care income standard at 250 percent of the Supplemental Security Income (SSI) standard, about $2,485 a month for a single applicant in 2026, rather than the 300 percent of the federal benefit rate that most states use.3 An applicant whose gross monthly income runs above that limit can still qualify by establishing a qualified income trust, often called a Miller trust, so income over the cap doesn't automatically end the path. The asset limit is generally $2,000 for a single applicant. When one spouse needs care, federal spousal-impoverishment rules let the at-home spouse keep a community spouse resource allowance of up to $162,660 in 2026.3

One line is worth stating plainly. Medicare does not pay for non-medical personal care.1 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 are private funds, long-term care insurance, or, for eligible lower-income older Delawareans, Delaware Medicaid's Diamond State Health Plan-Plus.

How to Choose and Vet an Agency

Start with the need, not the brochure. The table maps the two services across the dimensions that decide what the care is and who pays.1 Whether the care is skilled is your first clue: skilled, physician-ordered care points to home health, and everyday non-medical help points to personal care.

A quick way to place a situation: if a physician has ordered skilled care and the person is homebound, you're looking at home health, and Medicare is the payer to check first. If the need is ongoing help with everyday tasks and there's no skilled medical component, you're looking at personal care, and the question becomes whether to pay privately or qualify through Delaware Medicaid.

Once you know which service you need, the checks differ by track. For skilled home health, the license and the certification are the substance, not the marketing:

• Confirm the Division of Health Care Quality license and Medicare certification. A skilled home health agency must hold a license from the Delaware Division of Health Care Quality under regulation 3350, and for Medicare billing it must also be Medicare-certified.1 Ask to see the license and confirm the agency is Medicare-certified before assuming Medicare will pay.
• Compare Medicare-certified agencies on Care Compare. Medicare's Care Compare tool at medicare.gov/care-compare lists the Medicare-certified home health agencies serving Delaware and shows their quality ratings, so you can shortlist agencies before you call.1
• Match the agency to the doctor's order. Medicare coverage hinges on a physician's plan of care and the homebound and intermittent-skilled tests, so confirm the agency will work from your doctor's order and bill Medicare directly.1

For non-medical home care, the money question drives the diligence: most families pay privately, so the written terms matter, and the Medicaid path takes time to set up. A few steps are worth taking before you hire:

• Ask how caregivers are screened. Confirm the agency runs criminal background checks and verifies credentials on the aides it sends, and ask whether caregivers are employees the agency covers for liability and workers' compensation or independent contractors you'd be responsible for.
• Check references. Ask for references from current clients and follow up on them.
• Get a written care plan and rate. Insist on a written plan that lists the specific tasks, the hours, the hourly rate, and any minimums, so expectations and cost are clear before care starts.2
• Check the Medicaid path early if money is tight. If private pay isn't sustainable, contact the Delaware Division of Medicaid and Medical Assistance (DMMA) about Diamond State Health Plan-Plus before a crisis, because managed long-term-care eligibility takes time to establish under Delaware's income and asset rules. You can start at the Delaware Long-Term Care Medicaid page, or call DMMA at 1-800-372-2022.3

Learn More

Find personalized help matching the right in-home service to the need and payer in Delaware 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.