Non-medical home care is custodial help — bathing, meals, companionship, 24-hour aides — and Medicare does not pay for it. Skilled home health from a Medicare-certified agency is covered. CMS lists 12,392 certified home health agencies.
What non-medical home care is
Non-medical home care — often called custodial or personal care — is help with the activities of daily living, not clinical treatment. A caregiver or home aide assists with bathing, dressing, toileting, meals, light housekeeping, errands, transportation, and companionship. It keeps people safe and independent at home, but it is support, not medicine.
That distinction is the whole story for how it gets paid. Because non-medical care does not require a doctor’s order or a licensed clinician, it falls outside the skilled services Medicare was built to cover.
Non-medical home care vs. Medicare home health
- Custodial help with daily living
- Delivered by aides, not nurses or therapists
- No doctor’s order required
- Not covered by Original Medicare
- Skilled nursing or therapy
- From a Medicare-certified agency
- Doctor-ordered, for a homebound patient
- Intermittent — not 24-hour or custodial
For the full Medicare home health rules, see the home health explainer linked below.
Who pays for non-medical home care
Because Medicare excludes it, families fund non-medical care another way. Most is paid out of pocket. The main alternatives are:
- Medicaid waivers — home- and community-based services programs that pay for personal care for people who qualify; rules and benefits vary by state.
- Long-term care insurance — private policies bought in advance that reimburse custodial care.
- Veterans’ benefits — the VA Aid and Attendance benefit for eligible veterans and surviving spouses.
- Medicare Advantage supplements — some plans offer limited in-home support; Original Medicare does not.
24-hour and live-in care
Around-the-clock care comes in two shapes: 24-hour care, where aides work in shifts and stay awake all night, and live-in care, where a caregiver sleeps in the home and is available across the day. Both are custodial and both fall outside Medicare. Even the Medicare home health benefit pays only for intermittent skilled visits, never continuous personal care — so 24-hour coverage is funded privately or through Medicaid long-term-care programs where a person qualifies.
Medicare home health by the numbers
Find a home health agency
Browse loaded Medicare-certified home health agencies by state with available CMS Quality of Patient Care star ratings. Supported fields display available CMS source and snapshot metadata.
Home health compare →Frequently asked questions
- What is non-medical home care?
- Non-medical home care — also called custodial or personal care — is help with daily activities rather than clinical treatment: bathing, dressing, toileting, meal preparation, light housekeeping, transportation, and companionship. It is delivered by aides or caregivers, not by nurses or therapists, and does not require a doctor's order.
- Does Medicare pay for non-medical home care?
- No. Medicare does not cover non-medical or custodial home care when that is the only care needed. Medicare home health covers skilled, intermittent care — nursing or therapy — ordered by a doctor for a homebound patient. Help with daily living alone is paid for privately, through Medicaid waivers, long-term care insurance, or veterans' programs.
- What is the difference between home care and home health?
- "Home care" usually means non-medical custodial help; "home health" means skilled clinical care from a Medicare-certified agency. The CMS Care Compare home health file lists 12,392 certified agencies; non-medical caregivers are not in that file because they do not provide skilled clinical services.
- Will Medicare pay for 24-hour home care?
- No. Medicare does not pay for around-the-clock or live-in custodial care. Even under the Medicare home health benefit, covered care is intermittent and skilled, not continuous personal care. Families pay for 24-hour aides privately or through Medicaid long-term-care programs where they qualify.
- Who pays for non-medical home care?
- Most non-medical home care is paid out of pocket. Other sources include Medicaid home- and community-based services waivers (which vary by state), long-term care insurance policies, and the VA's Aid and Attendance benefit for eligible veterans. Some Medicare Advantage plans offer limited supplemental in-home support, but Original Medicare does not.
- How can I check a home health agency's record?
- Fonteum's home health compare pages list loaded Medicare-certified agencies by state with available CMS Quality of Patient Care star ratings and published services. Supported fields display the available CMS source and snapshot date. You can also screen an agency's NPI against the OIG exclusion list.
Related
- Medicare home health care: what’s covered — the skilled benefit, the homebound rule, and what it excludes.
- Home health agency quality data — per-agency CMS star ratings and services by state.
- Medicare vs. Medicaid — which program pays for long-term and custodial care.
- What is hospice care? — another in-home Medicare benefit, for terminal illness.
- Compare loaded CMS Care Compare facilities — home health, hospice, nursing homes, dialysis, and more.
- Look up an agency by NPI — search any provider or organization and check its federal records.