How much does insurance cost for a home health or home care agency?

What a home care agency has to carry, and why

Three things shape this trade’s insurance: aides work alone in other people’s homes, they drive between clients, and the license often names the policy. The agency’s own risk is mostly not a building. It is the people it sends.

Federal Medicare bond

A home health agency that bills Medicare must hold a surety bond. Under 42 CFR 489.65 the amount is $50,000 or 15 percent of Medicare payments, whichever is greater, but for bonds submitted on or after June 1, 2005 the 15 percent leg no longer applies: the amount is $50,000 or whatever CMS sets after an overpayment finding, whichever is greater⁠⁵. If an agency’s overpayment in its latest accepted cost report exceeds 15 percent of annual payments, CMS may require a bond up to the overpayment⁠⁵. The surety must hold a Treasury certificate of authority⁠⁵. Agencies run by federal, state, local or tribal governments are deemed to have a comparable bond if they have no unpaid claims and no referrals to the Department of Justice in the prior five years⁠⁵. The surety bonds page explains how bond premiums are priced.

State license rules we confirmed

Scroll the table sideways to see every column.

• California. The list applies to home care organizations licensed under the Health and Safety Code. We did not check California’s separate licensing of home health agencies.
• Florida. The $250,000 floor is lower than the $1 million that Illinois and California name, and Florida lists malpractice and liability as two separate policies⁠⁷.
• Illinois. The rule covers home services and placement agencies as well as nursing agencies⁠⁸; a non-medical agency is not exempt.
• Washington. The rule asks for general liability, not professional liability⁠⁹.

Where the license sets no number, your contracts, referral sources or the agency’s own insurer will. These are floors: check each state’s current rule before applying.

Workers’ comp: class and cost

Home care is mostly lifting, transferring and driving. Ohio, Washington and Wyoming publish their rates:

Base rates set by the state fund before experience modification. Ohio and Wyoming charge per $100 of payroll; Washington charges per hour worked, and part is withheld from wages. Other states’ insurers file their own rates; see where rates are published.

In context:

• Ohio. Class 8835, “Home, Public and Traveling Healthcare – All Employees”, is $1.2567 per $100. That is 27 times clerical class 8810 ($0.0466) and 3.0 times hospital professional employees, class 8833 ($0.4137); group homes (8842) are $1.4654 (our calculations from the July 1, 2026 schedule)⁠¹. The class is “all employees”, so we found no rule here that lets you split office staff out; ask the bureau.
• Washington. Home health services and nursing care NOC (6110) is $1.2569 per hour in 2026. Home care services under the Consumer Directed Employer Program (6512) is $0.4331; assisted living and adult family homes (6509) is $0.8789⁠². Class 6512 is titled for the Consumer Directed Employer Program, so ask L&I whether it can apply to a private-pay agency⁠². Of the $1.2569, $0.2318 an hour is the part that may be taken from the worker⁠².
• Wyoming. Wyoming’s NAICS-based schedule has no home health line. Home health care services (NAICS 621610) would fall under 621000, Ambulatory Health Care Services, at $0.48 per $100; non-medical care for the elderly (NAICS 624120) under 624000, Social Assistance, at $1.85⁠³. That mapping is ours; confirm your class with the Department of Workforce Services.

Our worked examples, not quotes:

1. Ohio, $400,000 of aide payroll

   $400,000 ÷ 100 × $1.2567 = $5,026.80 a year at the base rate, before experience rating⁠¹.

2. Washington, eight aides at 1,500 hours each

   12,000 hours × $1.2569 = $15,082.80, of which 12,000 × $0.2318 = $2,781.60 may come from workers, leaving $12,301.20 for the employer⁠².

3. Wyoming, $400,000 of payroll

   $4,000 × $0.48 = $1,920 if you are in 621000; $4,000 × $1.85 = $7,400 if you are in 624000⁠³.

The BLS survey measures comp cost per hour, not per class:

Average employer cost per employee hour worked for workers' compensation and for health insurance, averaged across all workers in the group, plus workers' compensation as a percent of total compensation. Group averages mix high- and low-risk jobs, so they are not a premium rate for any single business. U.S. Bureau of Labor Statistics (BLS), National Compensation Survey, June 2026 (2026 Q2), private industry workers, released 9 Sep 2026.

Education and health services employers spent $0.30 per hour worked on workers’ comp in June 2026, 0.6% of compensation, against $0.43 for all private industry. That sector includes schools and clinics, so a home care agency’s rate runs above it (our inference from the class rates)⁠⁴. The workers’ comp page explains experience modification; the calculator runs the arithmetic.

What Insureon publishes

No insurer in our data set publishes a figure for this trade except Insureon, and its pages are from early 2025:

Both pages call these “average” costs in the text but say the figures are the median cost of policies for people who requested quotes with Insureon⁠¹⁰⁠¹¹. The pages state no payroll or headcount behind them. Professional liability is $56 for the medical group against $12 for the non-medical one. Without payroll, the $154 workers’ comp figure cannot be set against the state-fund rates, so we would not use it in a budget.

Aides who drive, and abuse claims

Non-owned auto. Insureon’s page says commercial auto covers vehicles the business owns, and points to hired and non-owned auto for personal, rented and leased vehicles used for work⁠¹⁰. For agencies whose aides use their own cars, that is the gap to check. We found no published HNOA price for this trade; see hired and non-owned auto for how it is rated.

Abuse and molestation. Liability policies can carry an exclusion for it. The ISO businessowners form BP 04 39 07 02 removes liability for injury “arising out of” actual or threatened abuse or molestation of anyone in the insured’s care, custody or control, and for negligent employment, investigation, supervision, reporting or retention of the person responsible⁠¹². An agency’s clients are in its care. Ask whether your policy carries it, and whether abuse coverage is available by endorsement or separate policy. California also makes the licensee report suspected elder and dependent adult abuse⁠⁶.

Budgeting

No published figure gives an agency’s total insurance cost. To build one:

1. Split payroll by class

   Use hours worked in Washington and payroll in Ohio and Wyoming (where the class or industry code applies).

2. Apply your state’s comp rate

   , or get the class code and rate from your insurer.

3. Set liability limits from the license

   , then check what referral contracts require.

4. Add non-owned auto, abuse coverage and the fidelity bond

   separately.

5. If Medicare-certified, add the $50,000 minimum bond

   ⁠⁵.

The premium guide explains each step. State hubs: California, Florida, Illinois, Washington, Ohio, Wyoming.

Sources

1. 1
   Ohio Bureau of Workers' Compensation / Ohio Administrative Code, OAC 4123-17-06, Appendix A: base rates effective July 1, 2026 (private employers) Checked 13 Oct 2026 · Back to text ↑
2. 2
   Washington State Department of Labor & Industries, 2026 hourly rates by risk classification Checked 13 Oct 2026 · Back to text ↑
3. 3
   Wyoming Department of Workforce Services, Workers' compensation 2026 industry base rates by classification Checked 13 Oct 2026 · Back to text ↑
4. 4
   U.S. Bureau of Labor Statistics, Employer Costs for Employee Compensation, June 2026 (released Sept. 9, 2026) Checked 13 Oct 2026 · Back to text ↑
5. 5
   Centers for Medicare & Medicaid Services / eCFR, 42 CFR 489.60 to 489.65, Surety bond requirements for home health agencies (eCFR text as of Oct. 1, 2026) Checked 13 Oct 2026 · Back to text ↑
6. 6
   California Legislative Information, California Health and Safety Code 1796.42, Home care organization operating requirements Checked 13 Oct 2026 · Back to text ↑
7. 7
   Florida Legislature, Florida Statutes 400.471, Application for license; fees; provisional license; temporary permit Checked 13 Oct 2026 · Back to text ↑
8. 8
   Illinois General Assembly, Joint Committee on Administrative Rules, 77 Ill. Adm. Code 245, Home Health, Home Services, and Home Nursing Agency Code (section 245.90) Checked 13 Oct 2026 · Back to text ↑
9. 9
   Washington State Department of Health / Code Reviser, WAC 246-335-320, Initial application (in-home services agencies) Checked 13 Oct 2026 · Back to text ↑
10. 10
    Insureon, Home healthcare providers insurance cost (page updated January 23, 2025) Checked 13 Oct 2026 · Back to text ↑
11. 11
    Insureon, Non-medical home care and personal care aides insurance cost (page updated February 4, 2025) Checked 13 Oct 2026 · Back to text ↑
12. 12
    ISO Properties, Inc. (form as filed by a mutual insurer), Businessowners abuse or molestation exclusion, form BP 04 39 07 02 Checked 13 Oct 2026 · Back to text ↑

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