Home Care vs. Home Health in Massachusetts: The Difference

"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

• Home care vs. home health in Massachusetts: the core difference
• Home care: what it is and who pays
• Home health: what it is and who pays
• Home care vs. home health in Massachusetts: which one do you need?
• Paying for ongoing home care in Massachusetts
• MassHealth home care: who it's for and how to start

Home Care vs. Home Health 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 or another allowed practitioner and delivered by a Medicare-certified agency. Home care is non-medical help with everyday life, bathing, dressing, meals, reminders, companionship, a ride to an appointment.1 Many people need both, but they're billed and paid for differently, and that difference is where families get caught off guard.

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 when that's the only care you need.1 Families pay privately (in Massachusetts, the median non-medical rate is $40/hour in CareScout's 2025 survey, against $35 nationally), 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 health care provider 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 $0 to you when you're homebound, under a plan of care from a physician or allowed practitioner, and need skilled nursing or therapy; after the Part B deductible, you pay 20% of the Medicare-approved amount for covered medical equipment.2

There's a concrete limit behind the words "part-time or intermittent": Medicare generally means combined skilled-nursing and home-health-aide care of less than 8 hours a day and 28 or fewer hours a week (up to 35 hours a week on a case-by-case review), and a home health aide is covered only while you also need the skilled care.2 So home health is for skilled needs, not help with daily activities alone, and it isn't a solution for ongoing custodial care.

Home Care vs. Home Health in Massachusetts: 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 or other provider 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 Ongoing Home Care in Massachusetts

For ongoing home care, the main payers in Massachusetts are private funds and MassHealth. MassHealth (the state's Medicaid program) funds in-home personal care for eligible members through two main vehicles.

The Personal Care Attendant (PCA) program is self-directed: the member is the employer who recruits, hires, trains, schedules, and supervises their own attendants, who are paid by MassHealth to help with activities of daily living.3 Many family members can be hired and paid as a PCA, though the member's spouse, the parent of a minor member, and any legally responsible relative cannot.3

Adult Foster Care (AFC) instead pays a live-in caregiver who shares a home with the member to provide daily personal care, with nursing oversight from an AFC provider agency.4 The caregiver may be a relative, but not the member's spouse or a legally responsible relative, and MassHealth's AFC fact sheet also excludes legal guardians. The AFC provider pays the caregiver a stipend, and MassHealth's AFC rates include nothing for room and board, so confirm the current stipend with the AFC agency before you count on it.4

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.

MassHealth Home Care in Massachusetts: Who It's For and How to Start

Both MassHealth paths turn on the same two things: you must be a MassHealth member (which depends on MassHealth's income and asset limits), and you must have a clinical or functional need, meaning help with activities of daily living such as bathing, dressing, and mobility.3 If you're not sure whether you'd qualify financially, that's the first thing to check; MassHealth income and asset thresholds, and how it counts a married couple's resources, are detailed in MassHealth eligibility and income limits in Massachusetts.

The starting move is different for each program:

• For PCA: you, as the member, become the employer who recruits, hires, and schedules your attendant, and each attendant must hold a PCA provider number and sign a PCA provider agreement before they can be paid.3
• For AFC: your primary care provider must order it, and an AFC provider agency gets MassHealth's prior authorization before services start and provides the nursing oversight and care management.4

Learn More

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.