Home health care vs home care: why the cost question has two answers
When people ask about home health care cost, they usually mean one of two very different services.
Skilled home health care is medical care ordered by a doctor or allowed practitioner and provided by nurses, therapists and aides from a licensed, often Medicare-certified agency. For eligible patients, Medicare covers it in full.
Non-medical home care is help with bathing, dressing, meals, housekeeping, companionship and supervision. Medicare does not cover this when it is the only care needed, so most families pay privately or use Medicaid, long-term care insurance or veterans benefits.
The price of each, and who pays, is completely different. This guide covers both.
The national picture: 2025 cost of care medians
CareScout, a Genworth company, surveys providers nationwide each year. Its 2025 survey, collected July through November 2025, found these national medians:
Type of care | National median cost |
|---|---|
Non-medical in-home caregiver (homemaker or home health aide) | $35 per hour, about $6,673 per month at 44 hours a week |
Private duty nurse | $90 per hour, or $160 per visit |
Adult day health care | $2,058 per month |
Assisted living community | $6,200 per month |
Nursing home, semi-private room | $9,581 per month |
Nursing home, private room | $10,798 per month |
The in-home caregiver rate rose about 3% from $34 an hour the year before. CareScout now reports homemaker services and home health aides as a single non-medical caregiver category because the two prices have converged.
What full-time and 24-hour care cost
Hourly rates add up fast. At the $35 national median:
Schedule | Approximate cost |
|---|---|
20 hours a week | About $3,030 a month |
44 hours a week | About $6,673 a month, or $80,080 a year |
24 hours a day, 7 days a week (hourly shifts) | Roughly $25,500 a month |
Round-the-clock care is often cheaper through a live-in arrangement, where one caregiver stays in the home with scheduled sleep and break periods. Live-in pricing varies by agency and state labor rules, so get written quotes.
For many families, part-time in-home care costs much less than assisted living or a nursing home. Once needs reach full-time or 24-hour supervision, facility care can become the less expensive option.
Home care cost by state
Location changes the price significantly. Here are 2025 CareScout medians for three large states:
State | Non-medical caregiver (hourly) | Monthly at 44 hours a week | Private duty nurse (hourly) |
|---|---|---|---|
California | $40 | $7,627 | $110 |
New York | $35 | $6,673 | $120 |
Texas | $30 | $5,720 | $90 |
United States | $35 | $6,673 | $90 |
Across all states, the non-medical caregiver median ranged from $24 an hour in Mississippi to $46 an hour in Wyoming. Within a state, metro areas and resort communities often cost more than rural counties.
What drives the cost of home care
Level of care. Companionship and housekeeping cost less than hands-on personal care. Skilled nursing costs the most.
Hours and schedule. Many agencies require a minimum shift of three or four hours. Nights, weekends and holidays often cost more.
Agency vs independent caregiver. Agencies charge more, but handle background checks, training, payroll taxes, insurance and backup coverage.
Location. Wages and living costs vary widely by region.
Special needs. Dementia care, two-person transfers or complex conditions can raise the rate.
What Medicare pays for skilled home health care
For patients who qualify for the Medicare home health benefit, the cost to the patient for covered visits is $0. Patients pay 20% of the Medicare-approved amount for durable medical equipment after the Part B deductible.
The agency, however, is paid by Medicare. Under the Patient-Driven Groupings Model (PDGM), Medicare pays a set amount for each 30-day period of care. For 2026, the national standardized 30-day rate is $2,038.22, adjusted up or down for the patient's clinical group, functional level, comorbidities and local wages. If a period has very few visits, Medicare pays per visit instead, at 2026 national rates such as $176.96 for a skilled nursing visit and $80.12 for a home health aide visit.
CMS has proposed raising the 30-day rate to $2,092.27 for 2027. That proposal was still under review at the time of writing.
Other ways to pay for home care
Medicaid. State Medicaid programs and home and community-based services (HCBS) waivers can cover personal care for people who meet financial and functional criteria.
Medicare Advantage. Plans must cover the Medicare home health benefit and may offer limited extra in-home support.
Long-term care insurance. Many policies pay a daily or monthly benefit for in-home custodial care.
Veterans benefits. The Department of Veterans Affairs offers programs such as Homemaker and Home Health Aide care and the Aid and Attendance pension benefit.
Private pay, including savings, home equity or family contributions.
Tax considerations. Some home care expenses may qualify as medical expense deductions. Consult a tax professional for your situation.
How to estimate your family's cost
List the tasks your loved one needs help with each day.
Estimate the hours per week required.
Ask your doctor whether skilled needs could qualify for Medicare home health.
Get quotes from at least three local agencies.
Check Medicaid, long-term care insurance and VA eligibility.
Revisit the plan every few months as needs change.
Why cost pressure matters to agencies too
Agencies face their own cost squeeze. Caregiver wages are rising while Medicare's 2026 base rate fell slightly after CMS applied behavioral and temporary adjustments. Medicaid rates in many states lag behind labor costs. Agencies that lose revenue to denials or slow payments have less room to keep private-pay rates affordable.
That is one reason more agencies outsource revenue cycle work. A dedicated Trucare Home health billing Company can reduce denials and speed up Medicare, Medicare Advantage and Medicaid payments, which helps agencies keep rates stable. Families comparing agencies rarely see this, but agencies backed by strong billing partners are often more financially stable.
Providers comparing home health billing companies in USA should look at local expertise as well. In California, where the caregiver median is $40 an hour, agencies seeking home health billing in Palm Springs balance high labor costs with Medi-Cal and Medicare Advantage billing. In Texas, where costs are lower, agencies using home health billing services in the Houston area manage heavy Medicaid managed care volume. In New York, agencies relying on home health billing services in NYC navigate one of the largest Medicaid-funded home care markets in the country.
If margin pressure is squeezing your agency, the Trucare Home health billing service team can review your payer mix and A/R to find revenue you may be leaving on the table.
FAQs
How much does a home health aide cost per hour? The 2025 CareScout national median for a non-medical caregiver, including home health aides, was $35 an hour.
How much does home care cost per month? About $6,673 a month at 44 hours a week, based on the 2025 national median.
Does Medicare pay for home health care? Yes, for eligible patients who need skilled care and are homebound. Patients pay nothing for covered visits.
Is home care cheaper than a nursing home? Part-time home care usually is. Full-time or 24-hour home care can cost more than a nursing home, which had a 2025 national median of $9,581 a month for a semi-private room.
Sources: CareScout Cost of Care Survey 2025 median cost data tables (PDF); Caring Village summary of CareScout 2025 results; Medicare.gov: Home health services; IHA CY 2026 HH PPS final rule summary; CMS CY 2027 proposed rule fact sheet.
