Home health vs. home care vs. hospice: what's the difference?

Not clinically reviewed. Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.

Home health is part-time skilled care, such as nursing or therapy, that a doctor or other allowed provider orders; Medicare covers it when you qualify. Home care is non-medical help with daily tasks like bathing and meals, usually paid privately or through state programs. Hospice is comfort care for a terminal illness with a prognosis of six months or less.

Key facts - You pay nothing for covered home health services under Medicare, which covers people who are homebound and need part-time or intermittent skilled care (Medicare.gov, checked Oct. 29, 2026). - Medicare doesn't pay for 24-hour care at home, meal delivery, or personal care when that's the only care you need (Medicare.gov). - Hospice requires a terminal-illness certification with a prognosis of 6 months or less if the illness runs its normal course (CMS, checked Oct. 29, 2026). - Illinois licenses three kinds of in-home agencies: home health, home services and home nursing (77 Ill. Adm. Code 245.80).

The three names sound alike, and families often hear them in the same hospital discharge conversation. They are different services with different rules on who orders them, who provides them and who pays.

What is home health care?

Home health is skilled care delivered at home on a part-time or intermittent basis. Medicare.gov's home health coverage page (checked Oct. 29, 2026) lists skilled nursing, physical and occupational therapy, speech-language pathology, medical social services, and part-time home health aide help, but the aide help counts only when you're also getting skilled nursing or therapy.

To qualify under Medicare, you must be homebound and need part-time or intermittent skilled services. A doctor or other provider, such as a nurse practitioner, must see you in person, confirm you need the care and order it, and a Medicare-certified home health agency must provide it. In most cases, Medicare.gov says, "part-time or intermittent" means skilled nursing and aide services combined up to 8 hours a day and no more than 28 hours a week.

Illinois law uses a similar definition. The state's licensing act, 210 ILCS 55/2.05, defines home health services as care at a person's residence under a plan of treatment prescribed by a physician, physician assistant or advanced practice registered nurse, including part-time and intermittent nursing, therapy, medical social services and home health aide services.

We explain Medicare's homebound and eligibility rules in more detail in Does Medicare cover home health care? For the Nov. 2 change on who can certify home health care, see Medicare reviewers must accept NP and PA home health certifications.

What is home care?

Home care (also called in-home care, personal care or non-medical home care) is help with daily living rather than skilled treatment. The Illinois Department on Aging's in-home care page (checked Oct. 29, 2026) lists the kinds of help it covers: companionship, meal prep, light housekeeping, errands, bathing, dressing, grooming, getting around the home, fall prevention, transportation and medication reminders.

In Illinois, this kind of care comes from home services agencies, which the Illinois Department of Public Health (IDPH) licenses to employ home care aides on a daily or weekly basis for clients of any age.

What is hospice care?

Hospice is comfort-focused care for someone with a terminal illness. Under Medicare, CMS's hospice page (checked Oct. 29, 2026) says a patient with Part A qualifies when they get care from a Medicare-certified hospice, their attending physician (if they have one) and the hospice physician certify a prognosis of 6 months or less if the illness runs its normal course, and they sign an election statement choosing hospice instead of Medicare-covered treatment aimed at curing the terminal illness and related conditions.

Medicare.gov's hospice coverage page says hospice can usually be delivered at home or where you live, including assisted living or a nursing home. Coverage runs in two 90-day benefit periods followed by an unlimited number of 60-day periods, as long as a hospice doctor recertifies that the person is still terminally ill. Medicare still pays for covered care for health problems unrelated to the terminal illness.

For how Medicare sets hospice payments, see our story on FY 2027 hospice payment rates and the cap. For the four kinds of hospice care Medicare pays for, see our guide to the 4 levels of hospice care.

Who pays for each one?

Sources: Medicare.gov home health, Medicare.gov hospice, Illinois Department on Aging, all checked Oct. 29, 2026.

The biggest gap for families is home care. Medicare.gov says Medicare doesn't pay for 24-hour care at home, home meal delivery, homemaker services such as shopping and cleaning that aren't part of the care plan, or custodial and personal care when that's the only care you need. If you're comparing Medicare plans, our guide to Medicare open enrollment for home health and hospice covers what to check. People in a Medicare Advantage plan should check with their plan about home health benefits, Medicare.gov says.

How does Illinois license each type of agency?

Illinois' rules, 77 Ill. Adm. Code 245.80 (checked Oct. 29, 2026), say no one may open or run a home health agency, a home services agency or a home nursing agency without an IDPH license. The home services and home nursing rules also bar advertising those services without a license. Each license lasts one year, can't be transferred to a new owner, and out-of-state agencies serving Illinois clients need one too, along with an Illinois office.

IDoA's in-home care page sums up the split: home services agencies provide personal care through home care aides; home nursing agencies provide skilled nursing as prescribed by a health professional; home health agencies provide skilled nursing and physical, occupational and speech therapy as prescribed. IDPH licenses hospices separately.

Aides are treated differently too. Under 77 Ill. Adm. Code 245.70, home health and home nursing agencies must use aides who are on IDPH's Health Care Worker Registry, finished an approved training program or meet set equivalencies, and the agency must check the registry for findings of abuse, neglect or misappropriation before hiring. More Illinois-specific coverage is on our Illinois page.

What should families ask an agency?

These questions come straight from what the primary sources above require or recommend:

• Is your agency licensed by IDPH, and for which type? Home health, home services and home nursing are separate licenses in Illinois.
• For home health or hospice: are you Medicare-certified (or Medicare-approved for hospice)? Medicare pays only certified home health agencies and Medicare-approved hospices.
• What will Medicare pay, and what won't it? Medicare.gov says a home health agency should tell you, verbally and in writing, what Medicare won't pay for and what you'd owe, and give an Advance Beneficiary Notice before providing uncovered services.
• For hospice: what isn't covered? You can ask for an addendum to the hospice election statement listing items, services and drugs the hospice won't cover because they're unrelated to the terminal illness, Medicare.gov says.
• If you hire a caregiver directly, IDoA recommends checking IDPH's Health Care Worker Registry to make sure the person is eligible to work in in-home care.

Frequently asked questions

Does Medicare pay for home care? Generally no. Medicare.gov says Medicare doesn't pay for homemaker services or for personal care like bathing and dressing when that's the only care you need. It can cover part-time home health aide help when you're also getting skilled nursing or therapy.

Does Medicare pay for 24-hour care at home? No. Medicare.gov lists 24-hour-a-day care at home among the services Medicare doesn't pay for.

Is a home health aide the same as a home care aide? Not under Illinois rules. Home health and home nursing agencies must use aides who are on the IDPH Health Care Worker Registry, finished an approved training program or meet set equivalencies (77 Ill. Adm. Code 245.70). Home services agencies employ home care aides for non-medical help with daily living.

Do home care agencies need a license in Illinois? Yes. Under 77 Ill. Adm. Code 245.80, no one may run or advertise a home health, home services or home nursing agency in Illinois without an IDPH license.

Can you get hospice care at home? Yes. Medicare.gov says you can usually get Medicare-approved hospice care at home or in a facility where you live, such as assisted living or a nursing home. Medicare doesn't cover room and board.

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Sources were opened and checked Oct. 29, 2026. Rules and coverage can change; the linked primary sources control. Home Health Brief corrects errors under its published corrections policy.

This item has not been clinically reviewed. It is general information, not clinical, billing or legal advice.

Drafted with AI assistance from primary sources. Written and edited by the Home Health Brief newsroom under Monsaur Othman's editorial standards. Read how we use AI, our editorial policy and our corrections policy.