"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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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
- Home Care vs. Home Health in Vermont: The Two Services
- Home Health: What Medicare Covers
- What It Costs and Other Ways to Pay
- Choosing Home Care or Home Health in Vermont: How to Vet an Agency
- Frequently Asked Questions
Home Care vs. Home Health in Vermont: The Two Services
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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. Under the federal rule, "part-time or intermittent" generally means combined skilled nursing and home health aide care of fewer than 8 hours a day and 28 or fewer hours a week (up to 35 hours on case-by-case review).U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualification requirements, home health (govinfo.gov). govinfo.gov. Retrieved Jun 23, 2026, from https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol2/xml/CFR-2023-title42-vol2-sec409-42.xml
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. For those covered home health services, a beneficiary generally pays $0; the one ordinary out-of-pocket cost is a 20 percent coinsurance on any durable medical equipment.U.S. Government Publishing Office. (n.d.). 42 CFR 409.42 — Beneficiary qualification requirements, home health (govinfo.gov). govinfo.gov. Retrieved Jun 23, 2026, from https://www.govinfo.gov/content/pkg/CFR-2023-title42-vol2/xml/CFR-2023-title42-vol2-sec409-42.xml 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
Per the CareScout 2025 Cost of Care Survey (released March 2026, the most recent state-level data), Vermont's non-medical caregiver rate ran about $8,580 a month.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Jun 25, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results Beginning with the 2025 survey, CareScout merged its former "homemaker" and "home health aide" categories into a single "non-medical caregiver" rate, so that one figure now covers both personal-care and homemaking help. The national median is $35 an hour, or about $80,080 a year assuming roughly 44 hours of care a week. That assumption matters: a family hiring an aide for only a few hours a day pays a fraction of the full-time figure, so a few hours of help two or three days a week runs in the hundreds of dollars a month, not the 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 ranks among the ten most expensive states in every care category in this survey, which makes the cost question sharper here than in many states.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Jun 25, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
- 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services,Centers for Medicare & Medicaid Services. (2026). CMS - 2026 SSI and Spousal Impoverishment Standards (CIB, Dec 2025): community spouse resource allowance maximum $162,660. medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
- 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 a Supplemental Security Income (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.Centers for Medicare & Medicaid Services. (2026). CMS - 2026 SSI and Spousal Impoverishment Standards (CIB, Dec 2025): community spouse resource allowance maximum $162,660. medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf For long-term-care eligibility, the special income standard is 300 percent of the federal SSI benefit rate; the Department of Vermont Health Access sets the monthly long-term-care income limit at about $2,982 for a single applicant in 2026, and an applicant over that line may still qualify through a medically needy or spend-down path. The countable-asset limit is generally $2,000 for a single applicant, with the home exempt up to a $730,000 equity limit when the applicant intends to return or a spouse lives there. 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.Centers for Medicare & Medicaid Services. (2026). CMS - 2026 SSI and Spousal Impoverishment Standards (CIB, Dec 2025): community spouse resource allowance maximum $162,660. medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
One line is worth stating plainly. Medicare does not pay for non-medical personal care.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.
Choosing Home Care or Home Health in Vermont: How to 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
| 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services
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.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Jun 25, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results
- 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.Centers for Medicare & Medicaid Services. (2026). CMS - 2026 SSI and Spousal Impoverishment Standards (CIB, Dec 2025): community spouse resource allowance maximum $162,660. medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Frequently Asked Questions
Does Medicare cover home health in Vermont?
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services It does not pay for non-medical personal care, the help with bathing, dressing, meals, and everyday support an aide provides, on its own.
What is the difference between home care and home health in Vermont?
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services 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.
How much does home care cost in Vermont?
Per the CareScout 2025 Cost of Care Survey (released March 2026), Vermont's non-medical caregiver rate ran about $8,580 a month, with the state among the ten most expensive in the country for every care category.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Jun 25, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results The national median is $35 an hour, or about $80,080 a year assuming roughly 44 hours of care a week, so a family hiring an aide for only a few hours a day pays far less than the full-time number. Beginning with the 2025 survey, CareScout combined the former homemaker and home-health-aide categories into one "non-medical caregiver" rate. The figures are survey medians, not fixed rates, so a given agency can charge above or below them.
Does Vermont Medicaid cover personal care?
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.Centers for Medicare & Medicaid Services. (n.d.). Medicare.gov - Home health services coverage (doctor-certified plan of care, homebound, intermittent skilled care, Medicare-certified agency; no coverage for personal care alone). medicare.gov. Retrieved Jun 25, 2026, from https://www.medicare.gov/coverage/home-health-services Vermont runs its Medicaid program under the Global Commitment to Health Section 1115 demonstration, and the Department of Vermont Health Access sets the long-term-care income limit at about $2,982 a month for a single applicant in 2026, with a medically needy or spend-down path for applicants over that line.Centers for Medicare & Medicaid Services. (2026). CMS - 2026 SSI and Spousal Impoverishment Standards (CIB, Dec 2025): community spouse resource allowance maximum $162,660. medicaid.gov. Retrieved Jun 25, 2026, from https://www.medicaid.gov/federal-policy-guidance/downloads/cib12092025.pdf
Is home care more expensive in Vermont than elsewhere?
In the CareScout 2025 survey, yes. Vermont's non-medical caregiver rate ran about $8,580 a month, well above the national median, and the state ranks among the ten most expensive in the country in every care category, including nursing-home care.Genworth Financial. (2025). CareScout Releases 2025 Cost of Care Survey Results. investor.genworth.com. Retrieved Jun 25, 2026, from https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results That gap is part of why the home-care payer question matters here: when the hours add up, the cost of non-medical help in Vermont can rival facility care.
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