The Home Health Agency
A skilled home health agency sends nurses, therapists and aides into patients' homes after a hospital stay, a surgery or a decline at home, and bills a payer for the care. Demand is steady and aging in your favor, and a Medicare-certified agency is a real, sellable asset. But the payer decides the price, Medicare cannot be billed until a 12 to 18 month certification is finished, and the work that decides the margin is billing, compliance and keeping nurses, not nursing.
Read the launch plan: every step from deciding to opening, free →The Snapshot
Is this worth your attention?
Estimated Typical bands for this kind of business, estimated from adjacent public data where no direct benchmark exists; treat them as rough. Estimates, not forecasts; a specific business varies with its location, lease, equipment and owner. Last reviewed 2026-10-29. smbnest is a self-assessment tool, not individualized advice.
A fit if you…
- Are a registered nurse, or will hire a director of nursing you trust with your license to operate
- Can walk into hospital discharge offices and physician practices and ask for referrals every week
- Treat documentation, coding and compliance as the product, not paperwork
- Can fund 12 to 18 months of operations before the first Medicare dollar arrives
- Will recruit and keep nurses in a market where everyone is short of them
Probably not if you…
- Expect to set your own prices; Medicare, Medicaid and the plans set them
- Want revenue in the first quarter; certification alone takes a year or more
- Dislike being audited, surveyed and asked for records
- Cannot carry an office payroll while the visit count is still small
Step Inside the Layout
A live look at one tool inside
This is the actual 3D floor from the full model. Drag to explore it. Inside, you configure the space yourself and watch the economics move with every choice.
Sources and method16 public sources, with the year and a link where the source gives one. The benchmark bands on this page are estimated from adjacent data and labeled as estimates.
Sources & Method
Figures are estimated from the public sources below and from adjacent data; the bands are labeled as estimates
How these numbers were built: agency counts, Medicare spending, visits per period and margins come from MedPAC's March 2026 report (Medicare FFS margin 21.2% and all-payer margin 5.0% for freestanding agencies in 2024); the 30-day period rate, the per-visit LUPA amounts and the 2026 rate reductions come from the CY 2026 home health final rule; clinician wages come from the U.S. Bureau of Labor Statistics industry table for home health care services (May 2023), loaded by about 25% for taxes and benefits; the capitalization, 36-month and certification steps come from 42 CFR 489.28, 42 CFR 424.550 and ACHC's published process; resale figures come from BizBuySell's 2021 to 2025 sales; and the opening kit is priced line by line from a franchise disclosure, state fee schedules and supplier pages. The blended per-visit rate from non-Medicare payers ($125) and the office payroll are estimates that vary by state and contract; the margin band of 8 to 18% is our synthesis of the MedPAC all-payer average and BizBuySell owner earnings for the typical agency sold, and is labeled as an estimate. The moment you enter a real agency's payer mix, visits per clinician, pay rates and LUPA rate, your numbers should replace ours. Figures are current as of 2025-2026 and refreshed as the sources update.
Margins blend MedPAC's 2024 all-payer and Medicare margins for freestanding agencies with BizBuySell owner earnings for the typical agency sold; clinician pay is anchored to BLS May 2023 wages for home health care services plus taxes and benefits; the Medicare period rate and per-visit amounts follow the CY 2026 final rule. The blended non-Medicare rate per visit, visits per clinician per day, LUPA rate and days in receivables are directional industry patterns rather than a single cited study.
This is just the surface
The full model is the complete, interactive deep-dive, and every business here is built to the same standard: a live economics simulator you tune to your own numbers, an interactive 3D walkthrough, a location scorecard, an owner-fit assessment, a buy-versus-build comparison, and the full breakdown of how it makes money and what quietly kills margin.
then $29 a month
Time to choose and start, then month to month.
$99 today for your first 3 months, then $29 a month until you cancel.
about $17 a month
The best price: a year to decide, open and run it.
$199 today, then $199 each year until you cancel.
Renews until you cancel. Cancel any time from your account; you keep access to the end of the period you paid for, and your saved plans stay in your account. What membership opens
smbnest is a self-assessment tool. It does not give individualized financial, investment, legal or tax advice. Figures are estimates and benchmarks, not forecasts. Speak with a qualified financial adviser and a licensed attorney before you start, buy, finance or sign anything.