Home health vs. hospice vs. private home care
Three different in-home care options. Three different sets of rules. Three different payers. A plain-English comparison for Florida families trying to understand which one fits — and how to combine them when no single option covers everything.
Three in-home care options serve three different needs. Medicare home health covers intermittent skilled care (nursing, therapy) for homebound patients — $0 out of pocket, but limited to medical needs. Medicare hospice covers comprehensive comfort care for patients with a terminal prognosis — $0 out of pocket. Private home care (sometimes called custodial care or non-medical home care) covers daily personal assistance with bathing, meals, supervision, and companionship — paid out of pocket, by long-term care insurance, or in some cases by Medicaid waivers. Many families use them in combination.
Five terms that split the options
- Skilled care vs. custodial care
- The dividing line between Medicare-covered services and private-pay services. Skilled care requires a licensed clinician (nurse, therapist) and addresses a medical need. Custodial care is non-medical personal assistance — bathing, dressing, meals, supervision — that doesn’t require clinical training. Medicare pays for skilled; Medicare does not pay for stand-alone custodial care.
- Medicare home health benefit
- Skilled medical care delivered intermittently in the patient’s home by a Medicare-certified agency. Requires homebound status and a skilled need (nursing, PT, OT, SLP). $0 copay for covered services. See what Medicare covers.
- Medicare hospice benefit
- Comprehensive comfort-focused care for patients certified by two physicians as having a life expectancy of six months or less if the disease runs its expected course. Provided at home, in a nursing facility, in a hospital, or in a dedicated hospice facility. Covers nursing, aide, social work, chaplain, bereavement support, medications related to the terminal condition, DME. $0 copay (small copays for outpatient drugs and respite). 3
- Private home care (non-medical / custodial)
- Paid personal assistance with activities of daily living — bathing, dressing, meals, light housekeeping, supervision, companionship, transportation. Provided by home care agencies or independently contracted caregivers. Typically $25–35/hour in Florida. Paid out of pocket, by long-term care insurance, by Medicaid Long-Term Care waivers (income-eligible), or by Veterans Aid & Attendance.
- Florida Long-Term Care Medicaid waiver (SMMC LTC)
- The Statewide Medicaid Managed Care Long-Term Care program provides in-home and community-based care for income- and asset-eligible older adults in Florida. May cover personal care, homemaker services, respite, adult day health, and case management. Eligibility includes clinical criteria. Administered by the Florida Department of Elder Affairs and AHCA. 5
The three options compared
Most family decisions come down to these dimensions. Use the three columns below as the single reference for the family-meeting conversation.
Medicare Home Health
Skilled medical care at home
Medicare Hospice
Comfort care for terminal illness
Private Home Care
Daily personal assistance
How to decide — and how to combine
Identify the type of help needed
Medical/skilled care (nursing, therapy, wound care) — Medicare home health if patient is homebound and skilled need exists. Personal/custodial care (bathing, meals, supervision) — private home care, Medicaid waiver, or some Medicare Advantage supplemental benefits. End-of-life comfort care for terminal illness — Medicare hospice.
Determine prognosis and goals of care
Is the prognosis terminal (life expectancy ≤6 months if disease runs its expected course) and do you and the patient prioritize comfort over curative treatment? Hospice. If goals include continued curative or restorative treatment, home health or private care.
Assess homebound status for Medicare home health
If the patient is homebound (leaving home requires considerable and taxing effort) and needs intermittent skilled care, Medicare home health is available at $0 out-of-pocket. If not homebound, Medicare home health is not eligible.
Assess hours per week of care needed
Medicare home health is intermittent — typically 1–5 nursing or therapy visits per week. If the patient needs 24-hour supervision or daily extended assistance with activities of daily living, you’ll need private home care (paid out of pocket, by long-term care insurance, or by Medicaid waiver) on top of or instead of Medicare home health.
Check insurance and payment options
Medicare covers home health and hospice for eligible patients. Medicaid (Florida Long-Term Care waiver) may cover personal care services for income-eligible patients. Long-term care insurance covers private home care per the policy terms. Some Medicare Advantage plans offer supplemental in-home support benefits.
Consider combining services
Many families use multiple services together: Medicare home health for the skilled medical care, private home care for the daily personal care and supervision. Medicare hospice with private aide services for daily personal care. The medical social worker on the home health team can map a combined plan.
Long-term care funding options in Florida
Florida has one of the largest Medicare-age populations in the country — and one of the highest rates of long-term care needs. The funding landscape is more complex than most families realize. Medicare pays for skilled medical care (home health) and end-of-life care (hospice) but does not pay for ongoing custodial care. Medicaid (specifically the Florida Statewide Medicaid Managed Care Long-Term Care program) covers personal care for income-eligible older adults but has waiting lists in some areas. Long-term care insurance is a private product that covers custodial care, but only if purchased before the need arose (typically in your 50s or 60s, in good health). Veterans benefits (Aid & Attendance) provide a monthly stipend wartime veterans and surviving spouses can use for any caregiving cost. Out of pocket remains the default for many middle-income families.
The medical social worker on the home health team is the right person to map a combined plan: which services Medicare covers now, which services Medicaid or VA might cover with application, where private pay fills the gaps, and how to apply for the benefits the family qualifies for. This is the single most underused resource on the home health team — ask for an MSW visit.
Kassy Health refers families across all three categories — we serve the home health piece, and we coordinate with private home care agencies, hospice providers, and the Florida Long-Term Care waiver intake when a family’s situation calls for a combination. Most of the families we serve in Central Florida end up using two or three of the options below, not just one.
Questions families ask about the three options
Yes. These are completely different benefits with different rules. Medicare home health covers intermittent skilled medical care; private home care covers daily personal/custodial care (bathing, meals, supervision, companionship). They are commonly used together when a patient needs both medical management and significant personal assistance. The home health agency and the private caregiver coordinate care; the medical social worker can help map the combined plan.
Medicare home health covers home health aide services for bathing and personal care, but ONLY when the patient also has a skilled need (nursing or therapy) in the plan of care. The aide service is intermittent (typically 2–3 times per week) — not daily and not all-day. For 24-hour supervision or extensive daily personal care, Medicare does not cover it; you would need private home care, Medicaid waiver, or some Medicare Advantage supplemental benefits.
In Florida (2024–2025), private non-medical home care typically costs $25–35 per hour for a home health aide, with most agencies requiring a 4-hour minimum per visit. Live-in care runs $200–400 per 24-hour period. Costs vary by agency, region, and required skill level. Long-term care insurance, Medicaid Long-Term Care waivers (income-eligible), and Veterans Aid & Attendance benefits may cover some or all of private home care for qualifying patients.
Functionally similar — both provide bathing, dressing, grooming, and personal care assistance. The differences are payer (Medicare vs. private/out-of-pocket), frequency (Medicare HHAs are intermittent, private aides can work daily or 24-hour), and scope (private aides may do light housekeeping, meal prep, transportation; Medicare HHAs typically do not). Many families use Medicare HHA service for medical-related bathing visits and supplement with private care for daily personal needs.
Yes, when the patient elects the Medicare hospice benefit for a terminal condition. Hospice provides comprehensive care for the terminal diagnosis — nursing, aide service, social work, chaplain, medications related to the terminal condition, DME, and bereavement support. Medicare home health and hospice cannot be billed simultaneously for the same diagnosis. Some patients on hospice continue to receive home health for an unrelated condition (e.g., wound care for a non-terminal wound).
Generally no. Medigap (Medicare Supplement insurance) covers cost-sharing for services that Original Medicare covers — copays, coinsurance, deductibles. It does not cover services Medicare does not cover, which includes most private/custodial home care. Long-term care insurance is the specific product designed to cover ongoing personal care; it is a separate policy you would have purchased earlier, typically before the need arose.
Florida’s Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program provides in-home and community-based care for eligible older adults and individuals with disabilities. Services may include personal care, homemaker, respite, adult day health, and case management. Eligibility is income- and asset-based, with specific clinical criteria. The Florida Department of Elder Affairs and the Florida Agency for Health Care Administration administer the program; the medical social worker on the home health team can help families apply.
Aid & Attendance is a VA pension benefit for wartime veterans (and surviving spouses) who need help with daily activities. It pays a monthly tax-free benefit that families can use for in-home care, assisted living, or nursing facility costs. Income and asset limits apply; the benefit is paid in addition to basic VA pension. Many eligible veterans do not know about it. The Veterans Service Officer in your county can help with the application.
Sources cited in this guide
Drawn from CMS, the Florida Agency for Health Care Administration, the Florida Department of Elder Affairs, and Veterans Affairs benefits guidance. Verified May 2026.
- Medicare.gov. Home Health Services Coverage. medicare.gov →
- Centers for Medicare & Medicaid Services (CMS). Medicare Benefit Policy Manual, Chapter 7: Home Health Services. Publication 100-02. cms.gov →
- Centers for Medicare & Medicaid Services (CMS). Medicare Benefit Policy Manual, Chapter 9: Coverage of Hospice Services. Publication 100-02. cms.gov →
- Medicare.gov. Long-Term Care: Paying for Long-Term Care. medicare.gov →
- Florida Agency for Health Care Administration (AHCA). Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Program. ahca.myflorida.com →
- Florida Department of Elder Affairs. Long-Term Care Resources. elderaffairs.org →
- U.S. Department of Veterans Affairs. VA Aid and Attendance Benefits. va.gov →
- Genworth Financial. Cost of Care Survey — Florida. Annual data on home care, assisted living, and nursing home costs. genworth.com →
Not sure which combination of services fits?
Our intake team can map a combined plan in one call — what Medicare covers now, what private care fills the gap, and how to apply for the Florida Medicaid LTC waiver or Veterans Aid & Attendance if you qualify. Most families combine two or three services; the medical social worker is the right guide.
(407) 875-1801Mon–Fri 8 am–5 pm · Bilingual (English · Español) Read: What Medicare coversKassy Health · Medicare-certified home health agency founded by Sandra Morales, RN in 2006. Serving Orange, Seminole, Osceola, Lake, and Volusia counties. CHAP-accredited · 4-star CMS Quality of Patient Care.
