"Home care" and "home health" sound interchangeable, but in Massachusetts they're two different services paid for in two different ways, and confusing them is an expensive mistake. In short: home care is non-medical help, home health is skilled medical care.
This guide explains the difference plainly, shows what Medicare does and doesn't pay for, gives the Massachusetts cost, and explains how MassHealth can fund ongoing care at home.
In This Guide
- The core difference
- Home care: what it is and who pays
- Home health: what it is and who pays
- Which one do you need?
- Paying for in-home care in Massachusetts
The Core Difference
It comes down to one word: medical. Home health is skilled medical care, a nurse managing a wound, a physical therapist rebuilding strength after a hospital stay, ordered by a doctor and delivered by a licensed agency. Home care is non-medical help with everyday life, bathing, dressing, meals, reminders, companionship, a ride to an appointment. Many people need both, but they're billed and paid for differently, and that difference is where families get caught off guard.
| Home care (non-medical) | Home health (skilled) | |
|---|---|---|
| What it is | Help with daily activities, companionship, housekeeping | Skilled nursing, physical/occupational/speech therapy |
| Who provides it | Home care aides, personal-care attendants | Nurses and therapists from a certified agency |
| Who orders it | The family arranges it | A physician orders it |
| Who pays | Private pay or MassHealth; NOT Medicare | Medicare (short-term, if homebound), or MassHealth |
| How long | Ongoing, as long as needed | Short-term and intermittent |
Home Care: What It Is and Who Pays
Home care keeps someone safe and comfortable at home without medical treatment: an aide who helps your father bathe and dress, makes meals, tidies up, and keeps him company. It's the help most older adults need first and longest. On payment, the key fact is that Medicare does not cover non-medical home care. Families pay privately (in Massachusetts, home care runs around $38/hour in 2026, lower for companion-level help and higher for skilled aides), use long-term-care insurance, or, if eligible, have it funded by MassHealth.
Home Health: What It Is and Who Pays
Home health is skilled, medically necessary care a doctor orders, usually after a hospital stay, a fall, surgery, or a change in a chronic condition. It comes from a Medicare-certified home health agency and is time-limited and intermittent, not around-the-clock. Medicare Part A and Part B cover home health at no separate cost when you're homebound and need skilled nursing or therapy. The limits matter: it's for skilled needs (not help with daily activities alone), and it's short-term, so it isn't a solution for ongoing custodial care.
Which One Do You Need?
Start with what the person actually needs. If it's help with the rhythms of daily life, bathing, meals, supervision, company, that's home care, paid privately or through MassHealth. If a doctor has ordered skilled care to recover from or manage a medical event, that's home health, and Medicare may cover it for a while. Many families use Medicare home health briefly after a hospitalization, then move to ongoing home care, and that handoff is the moment to plan for, because the bill shifts from Medicare to you (or to MassHealth).
Paying for In-Home Care in Massachusetts
For ongoing home care, the main payers in Massachusetts are private funds and MassHealth. MassHealth funds in-home personal care for eligible members through the Personal Care Attendant (PCA) program, where the member hires and directs their own attendants, and through Adult Foster Care for a live-in caregiver. Veterans may use VA benefits, and some families have long-term-care insurance. For more, see how to get paid to care for a family member in Massachusetts and how to pay for senior care in Massachusetts.
Frequently Asked Questions
Home care is non-medical help with daily activities (bathing, meals, companionship, housekeeping). Home health is skilled medical care (nursing, therapy) ordered by a doctor. The same person may need both, but they're paid for differently.
Medicare does not pay for non-medical home care. It covers home health, skilled, short-term, intermittent care when you're homebound and a doctor orders it. Ongoing non-medical help is paid privately, through MassHealth, or with long-term-care insurance.
Non-medical home care runs around $38 an hour on average in Massachusetts in 2026, with companion-level care lower and skilled aides higher. Massachusetts is one of the pricier states for in-home care.
Yes. MassHealth funds in-home personal care for eligible members through the Personal Care Attendant program (you hire and direct your own attendants) and Adult Foster Care (a live-in caregiver). These are separate from Medicare.
Yes, and many do, especially after a hospital stay: Medicare-covered home health for skilled recovery, plus home care for daily help. Plan for the point when the home health benefit ends and ongoing home care becomes your responsibility.
Learn More
- Assisted Living in Massachusetts
- Nursing Homes in Massachusetts
- How to Get Paid to Care for a Family Member in Massachusetts
- How to Pay for Senior Care in Massachusetts
Find personalized help deciding between home care and home health in Massachusetts 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.