Getting home health care for an elderly family member starts with understanding what type of care they need, then matching that to the right funding source. The process differs depending on whether your loved one needs medical services like wound care and physical therapy or non-medical help with bathing, meals, and household tasks. Most families use a combination of Medicare, Medicaid, veterans benefits, or private pay to cover costs.
Medical Home Health vs. Non-Medical Home Care
These two categories look similar from the outside, but insurance treats them very differently. Medical home health means a nurse, physical therapist, or other licensed clinician comes to the home to provide skilled care: changing wound dressings, administering injections, monitoring an unstable condition, or running a rehabilitation program after surgery. Medicare and most insurance plans cover this type of care.
Non-medical home care covers the daily living tasks that become harder with age: bathing, dressing, grooming, cooking, light housekeeping, and companionship. Medicare does not cover this kind of help on its own. It only pays for a home health aide if the person is also receiving skilled nursing or therapy at the same time, and even then, only on a part-time basis. If your family member primarily needs help getting through the day safely, you’ll need to look beyond Medicare to pay for it.
How to Start Medicare Home Health Services
If your loved one has Medicare and needs skilled medical care at home, the process begins with a face-to-face assessment from a health care provider, such as their primary care doctor or a nurse practitioner. That provider must certify two things: the person is “homebound” (meaning leaving home requires considerable effort) and they need skilled nursing, physical therapy, speech therapy, or occupational therapy on a part-time or intermittent basis.
Once the provider writes a home health order, you choose a Medicare-certified home health agency to deliver the care. The agency sends a nurse or therapist to the home for an initial evaluation, builds a care plan, and begins visits. Medicare covers 100% of approved home health services with no copay, which makes this one of the most valuable benefits available. However, it will not pay for 24-hour care, meal delivery, or housekeeping unrelated to the medical plan.
If your family member is being discharged from a hospital or rehabilitation facility, the discharge planner will typically coordinate the home health referral before they leave. If the need develops at home, call your loved one’s doctor and ask specifically for a home health evaluation and order.
Medicaid and State Waiver Programs
For elderly adults with limited income and assets, Medicaid is the primary source of funding for long-term home care, including the non-medical help Medicare won’t cover. Every state runs Home and Community-Based Services (HCBS) waiver programs designed to keep people out of nursing homes by providing services like personal care aides, homemaker assistance, adult day programs, and care coordination.
Eligibility rules vary by state but generally require that the person be Medicaid-eligible (meeting income and asset thresholds) and functionally eligible, meaning they need a level of care that would otherwise qualify them for a nursing facility. Many states have waiting lists for these waiver programs, so applying early matters. Contact your state’s Medicaid office or your local Area Agency on Aging to find out which programs are available and how to apply. The federal Eldercare Locator (eldercare.acl.gov or 1-800-677-1116) can connect you to the right local office.
Veterans Benefits for Home Care
Veterans and surviving spouses who receive a VA pension may qualify for Aid and Attendance, a monthly payment specifically designed to help cover the cost of in-home care. To be eligible, at least one of the following must apply: the veteran needs help with daily activities like bathing, feeding, or dressing; they are largely confined to bed due to illness; they are in a nursing home due to disability-related loss of function; or they have severely limited eyesight.
Aid and Attendance is added on top of the existing VA pension, and the extra monthly payment can be put toward hiring a home care aide. The application goes through the VA, and processing can take several months, so families should apply as soon as the need becomes clear. The VA also offers its own home health programs through VA medical centers for enrolled veterans.
Long-Term Care Insurance
If your family member purchased a long-term care insurance policy, it may cover home care services once specific conditions are met. Most policies use “benefit triggers” to determine when payouts begin. The standard trigger is needing help with two or more of six basic activities of daily living: bathing, dressing, eating, toileting, transferring (moving from bed to chair), and continence. Cognitive impairment, such as dementia, is also a qualifying trigger in most policies.
The insurance company will send a nurse or social worker to assess your loved one’s condition before approving benefits. Pull out the policy and review its terms, or call the insurer directly to start the claims process. Policies vary widely in what they cover, how much they pay per day, and how long benefits last.
The PACE Program
The Program of All-Inclusive Care for the Elderly (PACE) is a lesser-known option that combines medical care, home care, and social services into a single program. PACE is available to people who are 55 or older, live in the service area of a PACE organization, and are eligible for nursing-home-level care but able to live safely in the community. For those who qualify for both Medicare and Medicaid, PACE typically costs nothing out of pocket. Others may pay a monthly premium.
PACE organizations operate day centers where participants receive medical visits, therapy, meals, and social activities, while also coordinating home care services. The program is not available everywhere, but it operates in more than 30 states. Check with your local Area Agency on Aging or search for PACE programs at medicare.gov.
What Home Care Costs Out of Pocket
When insurance or government programs don’t cover the full picture, families pay privately. The national median rate for a home health aide is about $34 per hour, while homemaker services (non-medical help like cooking and cleaning) average around $30 per hour. Rates range from $21 to $50 per hour depending on location, the level of care needed, and whether you hire through an agency or independently.
For a family hiring a home health aide seven hours per week, expect to pay roughly $950 per month. Full-time care, at 40 or more hours per week, can easily reach $5,000 to $8,000 monthly. Some families reduce costs by combining a few hours of paid help with unpaid family caregiving, or by using adult day programs to cover daytime hours.
How to Find and Evaluate an Agency
Start with Medicare’s Care Compare tool (medicare.gov/care-compare), which lets you search for Medicare-certified home health agencies by zip code and compare their quality ratings. Agencies receive star ratings based on seven performance measures, including how quickly they begin care after a referral, whether patients improve in walking and bathing ability, how well patients manage their medications, and how often patients end up in the hospital during care.
Look for agencies with four or five stars, and pay attention to the hospitalization rate in particular, since a low rate suggests the agency catches problems before they become emergencies. Beyond the ratings, ask practical questions when you call:
- Staffing: Will the same aide or nurse visit consistently, or will it rotate?
- Availability: Can they provide care on weekends or evenings if needed?
- Supervision: How often does a registered nurse oversee the aide’s work?
- Backup plan: What happens if your regular caregiver calls in sick?
- Communication: How will they keep the family updated on changes in condition?
Your Local Area Agency on Aging
If you’re unsure where to begin, your local Area Agency on Aging (AAA) is the single best starting point. These federally funded offices exist in every part of the country and specialize in helping older adults and their families navigate exactly this process. They can assess what services your loved one needs, explain which programs they qualify for, connect you with vetted local providers, and help with applications for Medicaid waivers and other assistance. AAAs also coordinate services like home-delivered meals and homemaker assistance that can fill gaps between what insurance covers and what your family member actually needs day to day. Find yours through the Eldercare Locator at 1-800-677-1116.