Companion Care vs. Medical Home Health: What's the Difference?

Quick answer: The difference is skill, and it determines who pays. Companion care is non-skilled support with daily living, delivered by trained caregivers with no physician's order required. Medical home health is skilled clinical care from licensed nurses and therapists, ordered by a physician. Medicare covers skilled home health when you qualify, but it never covers non-skilled companion care, which families fund through private pay, long-term care insurance, VA benefits or Florida Medicaid waivers.

The Core Difference, Defined

The distinction comes down to a single concept: skill. Does delivering the care require a licensed clinical professional, such as a nurse, physical therapist, or occupational therapist? Or can it be delivered by a trained but non-licensed caregiver?

Non-Skilled Companion Care

• Delivered by trained caregivers or home health aides, not licensed clinical professionals.
• No physician's order required; families can arrange it directly.
• Focuses on daily living support, safety, and quality of life.
• Available hourly, daily, or as live-in, with no limit on scope or duration.
• Funded through private pay, LTC insurance, or Medicaid waivers.
• Regulated by Florida AHCA as a Home Health Agency licensed for non-skilled services only.

Medical Home Health

• Delivered by licensed nurses (RN/LPN), physical therapists, occupational therapists, and speech therapists.
• Requires a physician's order and documented medical necessity.
• Focuses on clinical treatment, rehabilitation, and recovery from specific conditions.
• Provided in episodic visits (typically one to five per week) for a defined treatment period.
• Covered by Medicare Part A/B when eligibility criteria are met.
• Regulated by Florida AHCA under a Home Health Agency (HHA) license.

The most common mistake families make is assuming that the home health aide who comes with the Medicare-covered home health service provides the same daily support as a companion caregiver. They don't.

The Complete Comparison

The two care types differ across nearly every practical factor. Non-skilled companion care is delivered by trained caregivers and home health aides, requires no physician's order, and is not covered by Medicare. It covers core daily-living needs such as bathing, dressing, meal preparation, medication reminders, companionship, transportation, errands, and dementia behavioral support, available from one hour up to 24 hours a day with no duration limits. In Broward County in 2026, it runs about $26 to $35 per hour, with a 4-hour minimum per visit.

Medical home health is delivered by licensed nurses and therapists, requires a physician's order, and is covered by Medicare when eligible. It provides medication administration, wound care, IV therapy and injections, and physical or occupational therapy, but does not provide meal preparation, transportation, or companionship. It is delivered in one-to-two-hour visits, one to five times per week, only for the duration of active medical need, at roughly $100 to $200 per visit when not Medicare-covered.

Who Pays: Insurance Breakdown

• Medicare covers skilled nursing, PT, OT, speech therapy, and limited home health aide services when medically ordered. It provides zero coverage for custodial companion care.
• Long-term care insurance most often covers companion care when the insured cannot perform two or more ADLs; coverage of skilled home health varies. Review the policy for daily benefit, elimination period, and inflation protection.
• Florida Medicaid covers companion care through the SMMC-LTC waiver for income-qualifying seniors needing nursing-home level of care, and the APD iBudget waiver covers companion care for eligible individuals with developmental disabilities.
• Veterans Aid & Attendance provides $1,200 to $2,700 per month for qualifying wartime veterans and surviving spouses who need help with ADLs.
• Private pay is the most flexible option, with no applications, waitlists, or coverage restrictions; companion care averages $26 to $35 per hour in Broward County, with a 4-hour minimum per visit.
• Home equity or a reverse mortgage may let homeowners 62 and older fund care while remaining at home; consult a HUD-approved housing counselor.

Which Type Does Your Loved One Need?

Use this simple framework. If your loved one has an active medical condition requiring clinical treatment, such as wound care, IV therapy, injections, or post-surgical monitoring, they need medical home health; get a physician's referral, and Medicare may cover it.

If they need help with daily living activities, such as bathing, dressing, meals, getting around, or medication reminders, they need non-skilled companion care, with no doctor's order required. If they need physical or occupational therapy, speech therapy, or skilled nursing assessment and monitoring, that is medical home health.

And if they are not safe to be alone and need supervision, companionship, or dementia support, that points to companion care, available hourly or as live-in.

Most patients recovering from illness, surgery, or managing chronic conditions need BOTH types, simultaneously.

Real Scenarios Broward Families Face

• Dad just had hip replacement surgery. He needs wound care monitoring, physical therapy, and nursing assessment, AND help bathing, dressing, getting around, and someone present for safety. Needs both types.
• Mom has mid-stage Alzheimer's and can't be left alone. She needs supervision, personal care, behavioral management, and companionship, with no active medical condition. Companion care only.
• Grandmother had a stroke and needs speech therapy. She needs a licensed SLP and skilled nursing, AND personal care, meal prep, and daily supervision. Needs both types.
• Father has diabetes and needs daily insulin injections he can't self-administer. Insulin administration requires a licensed nurse, which is skilled medical home health, and he may also need companion care for meals and reminders. Medical home health.
• Elderly neighbor lives alone and family worries about safety and meals. She needs companionship, meal prep, light housekeeping, reminders, and supervision. Companion care only.
• Post-hospital discharge with wound dressing changes plus help at home. Dressing changes require a skilled nurse (Medicare may cover), while the remaining hours need a companion caregiver. Needs both types.

Florida Licensing: What to Verify

Florida does not issue a home care organization license; that term belongs to other states. Non-skilled companion care agencies are licensed by AHCA as a Home Health Agency under Chapter 400, Part III, Florida Statutes, carrying a “Non-Skilled Services Only” designation. Agencies that also deliver skilled nursing and therapy hold the same Home Health Agency license without that restriction, and must be Medicare-certified to bill Medicare. Providers offering companionship and homemaking alone may instead register under Chapter 400, Part X, as a Homemaker and Companion Services provider. Nurse registries hold yet another AHCA license type and refer independent nurses and aides rather than employing them, creating different liability and oversight implications for families.

Always verify a Florida home care agency's license at ahca.myflorida.com before engaging their services, regardless of what they tell you.

Unlicensed agencies operate illegally in Florida and leave families without legal protection. DavidStar Home Care holds Florida AHCA Home Health Agency license #299995097, designated for non-skilled services only, and is verifiable on the AHCA public database. Learn more about us or explore our full range of home care services.