"Home care" and "home health" sound interchangeable, but in Vermont 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 state designates through the Vermont Home Health Agency Directory, and it's what Medicare can cover; home care is non-medical daily help that Medicare won't.
This guide draws that line so a Vermont 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
- The Two Services, Defined
- Home Health: What Medicare Covers
- What It Costs and Other Ways to Pay
- How to Choose and Vet an Agency
- Frequently Asked Questions
The Two Services, Defined
The split is skilled versus non-medical, and in Vermont the skilled side carries a state designation and a Medicare certification the non-medical everyday help does not.
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 Vermont, that agency is designated and overseen by the Department of Disabilities, Aging and Independent Living through its Division of Licensing and Protection, which also serves as the state survey agency, and to serve Medicare patients it must also be Medicare-certified.
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." It's a separate kind of service from skilled home health, and Vermont does not regulate it through a separate stand-alone license the way it designates home health agencies, so it sits on a separate payer track.
That separation is what decides the money. Medicare certification, layered on top of the state designation, is the step that lets a home health agency bill Medicare for the skilled care it delivers. Non-medical personal care is care Medicare doesn't pay for at all. So when a Vermont 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 Vermont comes from an agency designated by the DAIL Division of Licensing and Protection, and to bill Medicare that agency must also be Medicare-certified. The agency employs the clinical staff, registered nurses and therapists, who carry out the plan of care a physician has ordered. The state designation 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. 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 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.
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.
Per the 2024 Genworth/CareScout Cost of Care Survey, the most recent state-level data, a home health aide and homemaker services in Vermont each ran about $99,528 a year. Both annual figures are built on a roughly 44-hour week. That matters: a family hiring an aide for only a few hours a day pays a fraction of the annual figure, which assumes a near full-time schedule. At a 44-hour week, each figure works out to roughly $43 an hour, so a few hours of help two or three days a week runs in the hundreds of dollars a month, not the tens of thousands. These are industry survey medians, not government rates and not a ceiling, so what a specific Vermont agency charges can land above or below them. Vermont's in-home care runs well above the national figures in this survey, which makes the cost question sharper here than in many states.
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.
- Vermont Medicaid. For eligible lower-income older Vermonters, Vermont Medicaid funds non-medical personal care through Choices for Care, the state's long-term-services program, for those who meet a nursing-home level of care, and through the Vermont Attendant Services Program, a consumer-directed path run through DAIL's Adult Services Division that lets the person hire and direct their own personal-care help.
- Long-term care insurance. A private policy, if the person holds one, may reimburse personal-care hours.
How Vermont Medicaid sets eligibility is worth understanding before counting on it. Vermont is an SSI-criteria (1634) state and runs its whole Medicaid program under the Global Commitment to Health Section 1115 demonstration, so people approved for SSI are automatically eligible for Medicaid. For long-term-care eligibility, the special income standard is 300 percent of the federal SSI benefit rate, about $2,982 a month for a single applicant in 2026, and an applicant over that line may still qualify through a medically needy or spend-down path. The asset limit is generally $2,000 for a single applicant, or $5,000 if the applicant owns and continues to live in their home, a Vermont wrinkle worth noting. 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.
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 lower-income Vermonters, Vermont Medicaid's Choices for Care program or the Attendant Services Program.
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. 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.
| Home Health (Skilled) | Home Care (Non-Medical) | |
|---|---|---|
| Vermont oversight | Agency designated and overseen by the DAIL Division of Licensing and Protection; bills Medicare only if also Medicare-certified | Personal care and homemaker help, not separately licensed as a stand-alone service in Vermont |
| What it is | Skilled, physician-ordered care: nursing and physical, occupational, or speech therapy under a plan of care, part-time or intermittent | Everyday non-medical help with daily living (bathing, dressing, grooming, meals, homemaking) |
| Who provides it | A designated home health agency, often Medicare-certified, and its clinical staff (nurses and therapists) | A home care or personal-care agency and its aides, or a consumer-directed worker |
| Who pays | Medicare (when homebound + intermittent skilled need) | Private pay, long-term care insurance, or Vermont Medicaid's Choices for Care or the Attendant Services Program for eligible lower-income Vermonters |
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 Vermont Medicaid.
Once you know which service you need, the checks differ by track. For skilled home health, the designation and the certification are the substance, not the marketing:
- Confirm the DAIL designation and Medicare certification. A skilled home health agency must be designated by the Vermont DAIL Division of Licensing and Protection, and for Medicare billing it must also be Medicare-certified. Use the Vermont Home Health Agency Directory to confirm an agency before assuming Medicare will pay.
- 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.
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.
- Check the Medicaid path early if money is tight. If private pay isn't sustainable, contact Vermont Medicaid about Choices for Care and the Attendant Services Program before a crisis, because home and community-based eligibility takes time to establish and Choices for Care requires meeting a nursing-home level of care.
Frequently Asked Questions
Yes, but only skilled care. Medicare's home health benefit covers physician-ordered nursing and physical, occupational, or speech therapy for a person who is homebound and needs that care on a part-time or intermittent basis, delivered by a Medicare-certified agency. It does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides, on its own.
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 Vermont, the skilled home health agency is designated by the DAIL Division of Licensing and Protection and is Medicare-certified to bill Medicare; non-medical personal care is a separate service that Vermont does not license on its own.
Per the 2024 Genworth/CareScout Cost of Care Survey, a home health aide and homemaker services in Vermont each ran about $99,528 a year, each on a roughly 44-hour week, which is well above the national figures. Those annual figures assume a near full-time schedule, which works out to roughly $43 an hour, so a family hiring an aide for only a few hours a day pays far less than the annual number. The figures are survey medians, not fixed rates, so a given agency can charge above or below them.
Yes. For eligible lower-income older Vermonters, Vermont Medicaid funds non-medical personal care through Choices for Care, its long-term-services program for people who meet a nursing-home level of care, and through the Attendant Services Program, a consumer-directed path run through DAIL's Adult Services Division that lets a person hire and direct their own personal-care help. Vermont runs its Medicaid program under the Global Commitment to Health Section 1115 demonstration, and the long-term-care income standard is 300 percent of the federal SSI benefit rate, about $2,982 a month for a single applicant in 2026.
In the 2024 Genworth/CareScout survey, yes. A home health aide and homemaker services each ran about $99,528 a year in Vermont, well above the national figures, and the state's nursing-home costs are among the highest in the country as well. That gap is part of why the home-care payer question matters here: when the hours add up, the annual cost of non-medical help in Vermont can rival facility care.
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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.