Help Paying for Senior Home Care
Most people pay for senior care using a variety of payment methods, such as Medicare, private insurance, and savings.
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If you're like most seniors, you want to stay in your home as long as possible. Home care allows you to do this. It's less expensive than institutional care, such as assisted living and nursing homes. This type of care includes home health care and non-medical care, such as assistance with activities of daily living and domestic chores. Below, you'll find information on how to pay for elderly home care through Medicare, Medicaid, and other federal, state, and local programs.
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A Rise in Home Care
The market for home care is exploding thanks to the wave of baby boomers reaching their golden years and the need for lower-priced alternatives to institutional care. According to the Bureau of Labor Statistics, the number of home health and care aides will expand to more than 1.3 million by 2020, a 70 percent increase from 2010.
Home health care employees are typically RNs, LPNs, physical therapists, home care aides, occupational therapists, and social workers. Home care aides help with activities of daily living (ADLs) such as bathing, dressing, toileting, and grooming. They assist with instrumental ADLs, such as housekeeping, meal prep, laundry, and transportation.
Home Care Costs
It's no wonder seniors choose home health care over stays in a hospital if they can. The average daily cost of a hospital stay is thousands of dollars, while the median cost of home health aide care is just $213 per day in 2024.1
The estimated national median for a one-bedroom in an assisted living facility is $5,511 a month, according to Genworth Financial's Cost of Care Survey. A semiprivate room in a nursing home has an estimated median cost of $294 per day in 2024. On average, a home health aide costs about $33.99 an hour.
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How We Pay for Home Health Care
The following is how recipients of home health care pay for services, according to the Centers for Medicare and Medicaid Services:
- Medicare 41%
- Medicaid 24%
- State/local governments 15%
- Out-of-pocket 10%
- Private insurance 8%
- Other 2%
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Qualifying for Medicare Home Health Care
If you are enrolled in Original Medicare, you may be eligible for home health benefits. All of the following conditions must be met:
- You must be under the care of a doctor and get services under a plan of care established and reviewed regularly by your doctor
- Your doctor must certify that you need one or more of the following: skilled nursing care, physical therapy, speech-language pathology, and/or occupational therapy
- The home health agency must be Medicare-certified
- A doctor must certify that you are homebound, i.e. your condition keeps you from leaving home without help (wheelchair, walker, help from another person), leaving home takes a “considerable and taxing effort”
In addition, you can only receive benefits for a part-time skilled nurse, defined as providing care on fewer than 7 days/week or less than 8 hours each day over a period of 21 days or less. Those needing full-time care (beyond the above)
What Medicare Covers
- Skilled nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN). Skilled nursing includes services such as shots, tube feedings, giving IV drugs, changing dressings, prescription drugs, diabetes care teaching, etc.
- Physical therapy, occupational therapy, and speech-language services
- Medical social services, including counseling and help finding community services
- Medical supplies used in your care. Can also include durable medical equipment
What Medicare Does Not Cover
- Personal care (home health aides) such as bathing, dressing, and other activities of daily living.
- Homemaker services such as cleaning, laundry, shopping, and preparing meals
- 24-hour-a-day care
- Home-delivered meals
- Medical alert devices
Medicaid and Home Care
Because Medicaid administration falls under individual states, the coverage and eligibility will vary. According to federal Medicaid guidelines, home health coverage must include part-time nursing, medical supplies, and HCA services. Other services may include physical and occupational/ speech therapies.
Home Care for Veterans
If you are a Veteran and eligible for a VA pension, you may be entitled to the Housebound benefit. It is a payment to those receiving care in-home or in a family member’s home.
Veterans may be eligible for the Housebound benefits if:
- The Veteran has a single permanent disability evaluated as 100-percent disabling AND due to such disability, they are permanently and substantially confined to their immediate premises, OR,
- The Veteran has a single permanent disability evaluated as 100 percent disabling AND another disability or disabilities evaluated as 60 percent or more disabling.
In addition, your income must be less than $14,978 without dependents or $18,773 with dependents. To apply for the Housebound benefit, call your regional VA office. For a listing by state, go here. You can also apply online using the VA's VONAPP (Veterans On Line Application) website.
Another Veteran's benefit is the Homemaker and Home Health Aide Care. These are services such as case management, assistance with activities of daily living, and other home-related care services. It is part of the VA Standard Medical Benefits Package for enrolled Veterans who meet the clinical needs for the service.
Other Veterans benefits include Skilled Home Health Care (nursing, physical/occupational/speech therapy, social work), Telehealth Care (phone/video care to track blood pressure, blood sugar, pulse, blood oxygen levels, heart/lung sounds), and Home Based Primary Care.
To apply for these Veterans benefits, contact your VA social worker/case manager and complete the Application for Extended Care Benefits (VA Form 10-10EC). You can also call VA toll-free at 877-222-VETS (8387).
Program of All-inclusive Care for the Elderly (PACE)
PACE is a Medicare and Medicaid program that provides care to seniors in the home. The program provides services such as home care, counseling, meals, transportation, and many other care services.
To be eligible, you must be:
- 55 or older
- live in the service area of PACE
- need nursing home-level of care
- be able to live safely in the community with help from PACE
If you have Medicaid, there is no monthly premium for the long-term care portion of the benefit. If you have Medicare, you'll pay a monthly premium to cover the long-term care benefit and a premium for Medicare Part D drugs. There is no deductible or copay for drugs, services, or PACE-provided care. For more information, go to Medicare's PACE page.
State and Local Services
In addition to the above federal resources, each state has an elder affairs/aging department with programs to support seniors, including home health and home care. For example, New Hampshire's ServiceLink is a comprehensive community-based resource for seniors looking for home care, housing, financial support, food assistance, and many more services.
To find home health and home care in your area, click on your state's link below.
Alabama – Department of Senior Services
Alaska – Division of Senior and Disabilities Services
Arizona – Aging and Adult Administration
Arkansas – Division of Aging and Adult Services
California – Department of Aging
Colorado – Division of Aging and Adult Services
Connecticut – Aging Services Division
Delaware – Division of Services for Aging and Adults with Physical Disabilities
District of Columbia – Office on Aging
Florida – Department of Elder Affairs
Georgia – Division of Aging Services
Hawaii – Executive Office on Aging
Illinois – Department on Aging
Iowa – Department of Elder Affairs
Kansas – Department for Aging and Disability Services
Kentucky – Department For Aging & Independent Living
Louisiana – Governor's Office of Elderly Affairs
Maine – Office of Elder Services
Maryland – Department of Aging
Massachusetts – Executive Office of Elder Affairs
Michigan – Office of Services to the Aging
Mississippi – Council on Aging
Missouri – Division of Health and Senior Services
Nebraska – Health and Human Services – State Unit on Aging
Nevada – Division for Aging Services
New Hampshire – Bureau of Elderly and Adult Services
New Jersey – Department of Health and Senior Services
New Mexico – Aging Network Division
New York – Office for the Aging
North Carolina – Division of Aging and Adult Services
North Dakota – Aging Services Division
Oklahoma – Department of Human Services
Oregon – Seniors and People With Disabilities
Pennsylvania – Department of Aging
Rhode Island – Department of Elderly Affairs
South Carolina – Lieutenant Governor's Office on Aging
South Dakota – Office of Adult Services & Aging
Tennessee – Commission on Aging and Disability
Texas – Department of Aging and Disability Services
Utah – Division of Aging & Adult Services
Vermont Department of Disabilities, Aging and Independent Living
Virginia – Department for the Aging
Washington – Aging and Disability Services
West Virginia – Bureau of Senior Services
Health Care.gov. (2024). Why health insurance is important.
