Financial

  • How to Pay for In-Home Care for an Aging Parent

    ByOwner

    You want your parent to stay home. That is usually what they want too. But in-home care is expensive — and figuring out how to pay for it is one of the most stressful parts of caregiving.

    The good news: there are more options than most families realize. The hard part is that finding and accessing them takes time and persistence. Let’s walk through what is available.

    Please note: This page provides general information for family caregivers — not financial or legal advice. Benefit rules change often. Always verify current details with the relevant agency or a benefits counselor.

    What Does In-Home Care Actually Cost?

    Home health aides (help with bathing, dressing, meals, mobility) typically cost $20 to $35 per hour. Full-time care can easily run $4,000 to $8,000 per month or more.

    Skilled nursing visits (a nurse or therapist who comes to the home) are typically covered by Medicare when medically necessary.

    Adult day programs — where your parent goes to a center during the day — are significantly less expensive and often a good middle option.

    Medicare — Limited but Important

    Medicare does cover some home health care, but only under specific conditions. Your parent must be homebound, must need skilled care (nursing, physical therapy, or speech therapy), and the care must be ordered by a doctor.

    Medicare does NOT cover ongoing custodial care — meaning a home health aide who comes every day to help with bathing and meals. This surprises many families who assume Medicare covers home care broadly. It does not.

    If Medicare does cover home health, it pays 100% of approved services. Ask the doctor specifically whether your parent qualifies.

    Medicaid — The Biggest Payer for Long-Term Home Care

    For families with limited income and assets, Medicaid is often the most important resource. Many states have Medicaid waiver programs specifically designed to pay for in-home care and keep people out of nursing homes.

    These programs pay for home health aides, personal care attendants, adult day services, and sometimes home modifications. The catch: most have waiting lists, sometimes years long.

    Apply as early as possible. Do not wait for a crisis. Search for “[your state] Medicaid home and community-based services waiver” to find your state’s program.

    Veterans Benefits

    If your parent is a veteran, the VA offers significant benefits that many families never claim. The Aid and Attendance benefit is especially important — it provides monthly payments to veterans and surviving spouses who need help with daily activities.

    This benefit can pay $700 to $2,300 per month or more depending on the veteran’s status and situation. Many eligible veterans and their families never apply because they do not know it exists.

    Contact your local VA office or a Veterans Service Organization (VSO) to learn more. There is no cost to apply with help from a VSO.

    Long-Term Care Insurance

    If your parent purchased long-term care insurance before they needed it, now is the time to use it. Review the policy carefully — it will specify what types of care are covered, what the daily benefit is, and how long benefits last.

    Filing a claim often requires documentation from a doctor. If the policy seems to be delaying or denying a valid claim, an elder law attorney can help.

    Private Pay — Making It Last Longer

    Start with fewer hours and increase as needed. Many families over-hire initially.

    Use adult day programs during the week and family caregivers in the evenings and on weekends.

    A geriatric care manager (also called an aging life care professional) can help create a care plan that uses resources efficiently.

    Other Resources Worth Exploring

    Area Agency on Aging — every community has one, and they know local resources better than anyone. Find yours at eldercare.acl.gov.

    Volunteer programs — many communities have volunteer services for transportation, meal delivery, and companionship that reduce paid care needs.

    Questions to Ask

    “Does my parent qualify for Medicare home health benefits right now?” “Has my parent applied for Medicaid home care programs in our state?” “Is my parent a veteran or a surviving spouse of a veteran?” “Does my parent have a long-term care insurance policy?” “Have I contacted our local Area Agency on Aging about available programs?”

    Helpful Resources

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    Medicare vs. Medicaid: What Family Caregivers Need to Know

    ByOwner

    Medicare and Medicaid. They sound almost the same. But they are very different programs — and knowing the difference could save your family thousands of dollars and a lot of confusion.

    You are not the only caregiver who gets these mixed up. Most people do, until they suddenly need to figure it out in a hurry. Let’s fix that right now.

    Please note: This page provides general information for family caregivers — not legal or financial advice. Rules change often. Always verify current details with Medicare.gov, your state Medicaid office, or a benefits counselor.

    What Is Medicare?

    Medicare is federal health insurance. It is run by the U.S. government and available to almost everyone who is 65 or older — regardless of income.

    Your parent likely already has Medicare if they are 65 or older. It covers:

    Hospital stays (Part A). This includes inpatient hospital care, skilled nursing facility care (short-term), hospice, and some home health care. Most people do not pay a premium for Part A if they worked and paid Medicare taxes.

    Doctor visits and outpatient care (Part B). This includes doctor visits, preventive care, lab tests, medical equipment, and outpatient procedures. There is a monthly premium for Part B.

    Prescription drugs (Part D). A separate plan you choose and pay for to help cover the cost of medications.

    Medicare Advantage (Part C). A private insurance alternative to original Medicare that bundles Parts A, B, and usually D together.

    What Medicare does NOT cover is critical to understand: it does not pay for long-term custodial care. This means it will not pay for an assisted living facility, a nursing home (beyond a short skilled nursing stay), or someone to help your parent bathe and dress at home long-term. This surprises many families.

    What Is Medicaid?

    Medicaid is a joint federal and state program. Unlike Medicare, Medicaid is based on financial need. Your parent must have low income and limited assets to qualify.

    Each state runs its own Medicaid program with its own rules, so what Medicaid covers — and who qualifies — varies significantly by state.

    What Medicaid CAN cover that Medicare does not:

    Long-term care in a nursing home is the big one. Medicaid is the primary payer for nursing home care in the United States. If your parent has spent down their assets and meets income requirements, Medicaid can cover the full cost of a nursing facility.

    Many states also offer Medicaid waiver programs that pay for in-home care, adult day programs, and assisted living — keeping people out of nursing homes. These programs often have waiting lists.

    Can a Parent Have Both?

    Yes — and many do. When someone has both Medicare and Medicaid, they are called “dual eligible.” In this case, Medicare pays first, and Medicaid pays some or all of the remaining costs. This combination can dramatically reduce out-of-pocket costs for your parent.

    The Key Differences

    Medicare: Federal program. Available at 65 regardless of income. Covers hospital, doctors, short-term skilled nursing, prescriptions. Does NOT cover long-term custodial care.

    Medicaid: Federal/state program. Based on financial need. Covers long-term nursing home care and, in many states, in-home care. Rules vary by state.

    What Should You Do Now?

    Find out exactly what Medicare plan your parent has. Look at their Medicare card and any supplemental insurance they carry.

    If your parent has limited income and assets, look into Medicaid eligibility in your state. Search for “[your state] Medicaid long-term care” to find the right office.

    Consider a free benefits counseling appointment. Every state has a SHIP (State Health Insurance Assistance Program) that offers free help understanding Medicare. Search “SHIP near me” to find your local office.

    If your parent has significant assets, talk to an elder law attorney before a crisis hits. Medicaid planning can legally protect some assets, but it must be done well in advance.

    Questions to Ask the Doctor or Benefits Counselor

    “Does my parent’s current Medicare plan cover the care they need?” “Does my parent qualify for Medicaid based on their income and assets?” “Does our state have a Medicaid waiver program for in-home care?” “Should we meet with an elder law attorney about Medicaid planning?” “Is there a SHIP counselor in our area who can help us understand our options?”

    Helpful Resources