"Home care" and "home health" sound like the same thing, but in Oregon they're two different services, and the difference decides who pays. In a twist worth knowing, both come from agencies licensed by the Oregon Health Authority, not the state agency that licenses facilities. Home health is skilled, doctor-ordered care that Medicare can cover; home care is non-medical daily help it won't.
This guide draws that line so an Oregon family doesn't pay out of pocket for care a program would have covered, or wait on Medicare coverage that was never coming. The label that matters isn't the agency's name. It's whether the care is skilled or non-medical, and which program pays the bill.
In This Guide
- Key Takeaways
- The Core Difference
- Home Health: The Home Health Agency
- Home Care: The In-Home Care Agency and Who Pays
- Which One Do You Need?
- What It Costs
- Frequently Asked Questions
The Core Difference
The split is skilled versus non-medical, and in Oregon it's written into two different licenses, both held by the same regulator. The Oregon Health Authority (OHA) doesn't run in-home care under one rulebook. It licenses a Home Health Agency to deliver skilled care under OAR 333-027, and it licenses an In-Home Care Agency, under the separate OAR 333-536, to deliver non-medical help.
That OHA detail is more than trivia. In most people's mental model, in-home care belongs with nursing homes and assisted living. In Oregon it doesn't: the facilities go through the Department of Human Services, while both kinds of in-home agency go through OHA. So when you check a provider's license, you're looking at OHA records either way, and the division number, 027 or 536, tells you which service you're actually getting.
A Home Health Agency provides skilled, intermittent care: nursing and physical, occupational, or speech therapy that a physician orders because the person has a medical need only a licensed professional can meet. Wound care after surgery, an injection 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.
An In-Home Care Agency provides non-medical support: help with daily living and personal care that keeps someone safe at home. The person can be medically stable and still need this help every day.
That separation is what decides the money. A Home Health Agency may also be Medicare-certified, which is the step that lets it bill Medicare for the skilled care it's licensed to deliver. An In-Home Care Agency provides care Medicare doesn't pay for at all.
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 for months. Those come from different agencies under different OHA licenses, and they run on separate payment tracks.
Home Health: The Home Health Agency
Skilled home health in Oregon comes from a Home Health Agency licensed by OHA under OAR 333-027, often one that has also earned Medicare certification. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The OHA 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 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: The In-Home Care Agency and Who Pays
Non-medical home care in Oregon comes from an In-Home Care Agency, licensed by OHA under OAR 333-536 to provide help with daily living and personal care. Because it isn't skilled medical care, the payer picture looks nothing like home health.
Who pays for in-home 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.
- The Oregon Health Plan. For low-income Oregonians, the state's Medicaid program funds non-medical in-home care, including through the K Plan (Community First Choice) and the Aged and People with Disabilities waiver, so a person can stay at home rather than enter a facility.
- 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 are private funds, long-term care insurance, or, for eligible low-income Oregonians, the Oregon Health Plan.
Which One Do You Need?
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. The license is your first clue: a Home Health Agency under OAR 333-027 delivers skilled care, while an In-Home Care Agency under OAR 333-536 delivers the non-medical help.
| Home Health Agency (Skilled, OAR 333-027) | In-Home Care Agency (Non-Medical, OAR 333-536) | |
|---|---|---|
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, on a part-time or intermittent basis | Everyday non-medical help with daily living (bathing, dressing, eating, mobility) and the personal-care support that keeps someone safe at home |
| Who provides it | An OHA-licensed Home Health Agency, often Medicare-certified, and its clinical staff (nurses and therapists) | An OHA-licensed In-Home Care Agency and its aides |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or the Oregon Health Plan (K Plan and the APD waiver) for eligible low-income Oregonians |
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 an In-Home Care Agency, and the question becomes whether to pay privately or qualify through the Oregon Health Plan. Both can be in play at once, and plenty of Oregon families arrange both.
What It Costs
Home health, when Medicare covers it, costs the beneficiary nothing for the covered skilled services. The cost question really lives on the non-medical side, where families pay out of pocket unless the Oregon Health Plan covers it.
For non-medical home care in Oregon, a home health aide ran about $91,520 a year in 2024, according to the CareScout/Genworth Cost of Care Survey, on a basis of 44 hours a week. Oregon's long-term care costs run among the highest in the nation, so that figure sits well above many states' medians. These are industry survey medians, not government rates and not a maximum, so what a specific Oregon agency charges can land above or below them, and the Portland metro tends to run higher than rural parts of the state. A family using fewer hours than the full-week assumption will pay less than the annual figure suggests.
For low-income Oregonians who qualify, that private cost can be covered instead through the Oregon Health Plan, including the K Plan and the APD waiver.
Frequently Asked Questions
No. Medicare does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support that an aide provides. Medicare's home health benefit covers skilled, physician-ordered care (nursing and therapy) for people who are homebound and need it on an intermittent basis. For non-medical home care, the options are private pay, long-term care insurance, or, for eligible low-income Oregonians, the Oregon Health Plan.
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 help with daily living that Medicare does not cover. In Oregon, the Oregon Health Authority licenses the two separately: a Home Health Agency under OAR 333-027 for the skilled care, an In-Home Care Agency under OAR 333-536 for the non-medical help.
The Oregon Health Authority licenses both kinds of in-home agency, the Home Health Agency under OAR 333-027 and the In-Home Care Agency under OAR 333-536. This is a point Oregon families miss, because facilities such as nursing homes and assisted living are licensed by the Department of Human Services instead. For in-home care, the license you check is an OHA license either way.
Yes. For eligible low-income Oregonians, the Oregon Health Plan funds non-medical in-home care, including through the K Plan (Community First Choice) and the Aged and People with Disabilities waiver, so a person can stay at home rather than enter a facility. Eligibility and enrollment run 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). The two run on separate payment tracks, Medicare for the skilled care and private pay or the Oregon Health Plan for the personal care, so arranging one does not arrange or pay for the other.
Learn More
- Assisted Living in Oregon
- Nursing Homes in Oregon
- Memory Care in Oregon
- Medicaid Planning Strategies
- Caregiver Burnout: Signs and Support
Find personalized help arranging care at home in Oregon 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.