The most common confusion families run into when they first start looking for help at home is treating Medicare home health and private home careas the same thing. They aren't. Mixing them up wastes weeks — sometimes thousands of dollars — before the right service shows up at the door.
Here's the difference, in the order it usually matters.
The fundamental split: medical vs non-medical
The line between these two services isn't blurry. It runs through a single question: does someone need a clinician (nurse, therapist) coming to the house, or do they need a person to help with daily life?
- Medical → home health. Skilled nursing, wound care, IV antibiotics, post-stroke physical therapy, post-surgery occupational therapy. Ordered by a physician.
- Non-medical → home care. Bathing, dressing, meals, light housekeeping, supervision. No medical orders involved.
A single agency may offer both, but they bill separately and the eligibility rules don't overlap.
Medicare home health (clinical, intermittent, time-limited in spirit)
Who pays.Original Medicare Part A or B, in full, when criteria are met. There's no copay for the home health benefit itself.
Who qualifies. Three things must be true:
- A physician has ordered home health and signed off on a face-to-face encounter (in person or telehealth, in the 90 days before or 30 days after services start).
- You're considered "homebound" — leaving home requires considerable effort and isn't medically advised except for short trips.
- The care needed is "skilled" — meaning it requires a licensed nurse or therapist, not just an aide.
What you get. Visits, not hours. A typical schedule might be 3 visits a week for nursing, 2 for PT, dropping as recovery progresses. Visits run 30–90 minutes. Aides may also visit briefly to help with bathing — but only as a side service to the skilled care, not as a primary purpose.
How long.As long as you continue to meet the criteria. Care is reviewed every 60 days (a "certification period"). Many people are on home health for 4–8 weeks post-discharge; some are on it for months for chronic management.
The trap. When Medicare home health ends, families often expect the same caregiver to keep coming. The agency cannot send anyone for free once the skilled need ends — but they often offer to continue privately at $25–$32/hour. This is the moment families realize they actually need a separate private home care service.
Private home care (non-medical, hourly, indefinite)
Who pays.
- Out of pocket is the default in Texas: ~$25–$32 /hour in Houston in 2026, with most agencies requiring a 4-hour minimum shift.
- Long-term care insurance, if the policy is in force. Read the elimination period (often 90 days) and daily benefit cap before assuming you're covered.
- Texas Medicaid (STAR+PLUS waiver) for qualifying members, after enrollment — wait time in Harris County typically runs from a few weeks to several months.
- VA Aid and Attendance for qualifying wartime veterans and surviving spouses.
- Medicare does not cover this on its own.
Who qualifies. Anyone, at any time. No physician order, no homebound requirement, no skilled-need test.
What you get. Hours, not visits. A caregiver arrives, stays for the booked shift (4 / 6 / 8 / 12 / 24 hours), and helps with whatever falls inside their training: bathing, dressing, meal prep, light housekeeping, errands, medication reminders (not administration), companionship, and supervision for safety and dementia.
How long. Indefinitely. Some families use it for a few weeks to bridge a recovery; others keep a caregiver for years.
The trap.Quality varies enormously. Caregiver turnover at low-end agencies can be weekly. The cheapest agency on Google is rarely the right one — what you're really paying for is reliable scheduling, supervision, and a backup plan when the assigned caregiver calls out.
Side by side
| Medicare home health | Private home care | |
|---|---|---|
| Type of service | Medical (nurse, therapist) | Non-medical (aide, companion) |
| Who pays | Medicare | You / LTC insurance / Medicaid waiver / VA |
| Order required | Physician | None |
| Homebound required | Yes | No |
| Billing | Per visit | Per hour |
| Visit length | 30–90 min | 4–24 hours |
| Time limit | While criteria met | Indefinite |
| Houston rate (2026) | $0 to family | $25–$32/hr |
| Best for | Recovery, wound care, post-stroke | Daily living, supervision, dementia |
Common scenarios
"Mom is being discharged tomorrow with a wound vac and needs PT."
Medicare home health. The hospital's discharge planner will usually arrange it directly with an in-network agency.
"Dad can't shower safely anymore but is otherwise stable."
Private home care. Two visits a week, an hour each, for personal care. No Medicare path here.
"Mom has dementia and shouldn't be alone."
Private home care, often 8–12 hour shifts. If she also needs medication management or has another chronic condition, a hybrid arrangement may apply — Medicare home health for the medical piece, private care for supervision.
"Dad has a six-month prognosis and we want him at home."
Hospice — a third category, also Medicare-covered, comfort-focused. Most major Houston home health agencies have a hospice arm.
"Mom finished her Medicare home health and wants the same caregiver to keep coming."
This is the most common transition point. Ask the same agency about their private duty service — same building, often the same caregiver pool, but now billed at $25–$32/hour out of pocket.
The order to think about it
In practice, families tend to figure this out in roughly this sequence:
- What's the immediate need? A clinical task (post-discharge, wound, therapy) → home health. A daily-living task (bathing, meals, supervision) → home care.
- What's the funding source?If it's covered by Medicare, the path is short (physician order → agency intake). If it's private pay, you have time to compare agencies on rate and reliability.
- What's the timeline? Discharge tomorrow → call the planner now. Stable situation → spend 2–3 days picking carefully. Our decision guide walks through that path.
- Will both be needed? Often yes — especially for post-stroke, post-fall, or dementia situations. Lining them up early avoids gaps.
Houston-specific notes
- Same agency, different products.Many of the top Houston agencies offer both Medicare home health and private duty. Asking up front "do you do both?" is reasonable and useful — continuity matters when transitioning between the two.
- Private duty pricing. $25–$32/hour for personal care is the 2026 Houston market, slightly lower than Dallas or Austin. 4-hour minimum shift is near-universal.
- STAR+PLUS waiver waitlist.Harris County's enrollment volume is high; expect the waitlist for personal attendant services to be measured in months rather than weeks. Apply as soon as need is established, even if you're paying privately in the meantime.
- Language clusters. Vietnamese, Spanish, and Chinese-speaking caregiver pools are concentrated in Sharpstown, Alief, and southwest Houston. Both Medicare home health and private agencies that serve those neighborhoods well typically have multilingual intake staff, not just multilingual caregivers.
Where to start
WeCarely lists every Medicare-certified home health agency andevery state-licensed private home care agency in Houston, ranked by CMS clinical stars combined with Google review weight. The same agency's two products (when they have both) are noted on its detail page. We don't sell leads, we don't take referral fees.
Start with the Houston directory, or jump to a neighborhood: Sharpstown, Galleria, Cypress, Memorial / Energy Corridor.
If you're earlier in the decision and still figuring out what to look for, our guide on how to choose a home care agency in Houston is the next read.
Sources.Medicare home health benefit ( medicare.gov/coverage/home-health-services), CMS face-to-face encounter rule (cms.gov), Texas STAR+PLUS waiver (hhs.texas.gov), VA Aid & Attendance (va.gov/pension). Rates reflect 2026 Houston market data; confirm current pricing with each agency.