Medicare Home Health vs Non-Medical Home Care in Indiana

Two different products, often confused

When families search “home care,” they may mean a nurse after surgery or a caregiver who helps Dad bathe every morning. Medicare, Medicaid, and private agencies use overlapping words for very different benefits. Getting the labels straight saves weeks of frustration.

Medicare home health is a medical benefit for people who need intermittent skilled care and meet homebound and physician-order rules. Non-medical (personal) home care is help with activities of daily living and household tasks—often for months or years—and is usually not paid by Medicare alone.

What Medicare home health can cover

According to Medicare.gov, covered home health services can include medically necessary part-time or intermittent skilled nursing care; physical, occupational, and speech therapy; and home health aide services when they are part of a skilled plan of care. A Medicare-certified home health agency must provide the care, and a doctor or certain other practitioners must order and oversee it after an in-person encounter (rules apply).

You generally pay nothing for covered Medicare home health services under Original Medicare, though durable medical equipment can have cost sharing after the Part B deductible. Always verify with Medicare or your plan for your situation—especially if you have a Medicare Advantage plan, which must cover at least Original Medicare home health benefits but may use different networks and prior authorization.

What Medicare generally does not pay for

Medicare’s public coverage page states that Medicare does not pay for 24-hour-a-day care at home, meals delivered to your home, homemaker services like shopping and cleaning when unrelated to the skilled plan, or custodial care when that is the only care you need (help with bathing, dressing, and using the bathroom without a skilled need).

If the main need is long-term personal care or homemaker help, plan on Medicaid HCBS waivers (PathWays or Health & Wellness), VA Aid & Attendance or other VA programs, long-term care insurance, or private pay.

Homebound and “intermittent” rules (plain English)

To qualify for Medicare home health, you typically must need skilled services on a part-time or intermittent basis and be considered homebound. Homebound does not mean you can never leave home—it means leaving requires considerable effort, and absences are mainly for medical care or short, infrequent non-medical trips. Adult day care attendance can still be compatible with home health in many cases.

If someone needs more than intermittent skilled care, they may not qualify for Medicare home health and may need other settings or payers. Confirm eligibility with the ordering clinician and the home health agency.

Non-medical home care in Indiana

Non-medical agencies (often regulated as personal services agencies in Indiana) help with bathing, dressing, grooming, toileting, transferring, meals, light housekeeping, errands, companionship, and respite. Under Medicaid waivers, similar help may appear as attendant care or home and community assistance (HCA). Official HCA descriptions include cleaning, laundry, meal prep, and errands—and note that HCA does not cover ADLs or skilled needs; attendant care covers personal care ADLs.

Licensing, training, and background-check expectations differ between Medicare-certified home health agencies and personal services / waiver providers. Ask each agency what license they hold and which payers they accept.

How Indiana families often combine both

A common pattern: after a hospital stay, Medicare home health provides nursing and therapy for a limited period. Meanwhile, the family applies for a Medicaid waiver or pays privately for ongoing personal care. When Medicare home health ends, non-medical care may continue under another payer.

Another pattern: someone already on a PathWays or Health & Wellness waiver also qualifies for Medicaid State Plan home health when medically necessary. Indiana materials note that waiver services generally come after other available supports are considered—ask the case manager how home health and waiver services interact so hours are not duplicated incorrectly.

Questions to ask any agency

Whether you are using Medicare, Medicaid, or private pay, ask:

• Are you Medicare-certified, Medicaid/waiver-certified, or both?
• Which counties do you serve, and do you have caregivers available now?
• What is included in a visit vs. billed as an extra?
• How do you handle call-offs and after-hours needs?
• Can you coordinate with our hospital discharge planner or waiver case manager?

Frequently asked questions