How to Pay for In-Home Care: Medicare, Medicaid & Other Options

Reviewed by the care team at A Graceful Touch Healthcare | Last updated July 2026

This is one of the most important questions families ask us, and one of the most misunderstood. Many families assume Medicare will cover in-home care the way it covers a hospital stay. In most cases, it won’t. Here’s a clear, accurate breakdown of every real way Texas families pay for in-home care, so you can plan with facts instead of assumptions.

This article is for general educational purposes and isn’t a substitute for personalized financial or benefits advice. Eligibility rules change, and your specific situation matters, so we’d always encourage confirming details directly with Medicare, Medicaid, or a qualified benefits counselor.

What Medicare Actually Covers

This is the biggest misconception families run into. Original Medicare covers home health care, skilled nursing visits, physical therapy, and similar services, but only when it’s medically necessary, ordered by a doctor, and provided on a part-time or intermittent basis. Medicare generally covers up to 28 hours per week of these skilled services, and in some circumstances up to 35 hours.

What Medicare does not cover: non-medical home care, help with bathing, dressing, meal preparation, companionship, light housekeeping, is generally excluded unless it’s a minor part of a broader skilled care plan. This is the type of support most families are actually looking for when they contact us, and it’s important to understand upfront that Medicare typically will not pay for it on its own.

What Medicaid Covers, and Texas’s STAR+PLUS Program

Unlike Medicare, Medicaid does cover long-term, non-medical custodial care in many states, including Texas, through Home and Community-Based Services (HCBS) waiver programs. In Texas, the primary program for this is STAR+PLUS, administered by the Texas Health and Human Services Commission (HHSC).

A few important things to know about STAR+PLUS:

It’s designed specifically to help Medicaid-eligible seniors and adults with disabilities receive care at home instead of in a nursing facility.
Eligibility is based on both financial need (income and asset limits) and a functional/medical need for assistance.
Many areas of Texas maintain an interest list for HCBS waiver slots, meaning there can be a wait even after you qualify. This is one of the most important reasons to start the application process early rather than waiting until care is urgently needed.

Because Medicaid rules and income limits are detailed and change periodically, we’d always recommend confirming current numbers directly through Texas HHSC or a Medicaid planning professional rather than relying on any single article, including this one.

VA Aid & Attendance for Veterans and Surviving Spouses

This is one of the most underused benefits we come across, many veteran families simply don’t know it exists. VA Aid & Attendance is a tax-free monthly pension benefit, separate from VA health care, available to eligible wartime veterans and surviving spouses who need help with daily activities.

For the current benefit period (December 2025 through November 2026), maximum monthly amounts are approximately:

$2,874/month for a married veteran
$2,424/month for a single veteran
$1,558/month for a surviving spouse

To qualify, a veteran generally needs at least 90 days of active duty service with at least one day during a designated wartime period, a need for help with daily activities like bathing, dressing, or mobility, and net worth under the VA’s current limit (approximately $163,699 in 2026, not counting a primary residence or one vehicle). The funds can be used flexibly, including to pay for in-home care from an agency like ours. Applications go through the VA directly, we’re happy to point families in the right direction if this applies to your situation.

Long-Term Care Insurance

If your parent purchased a long-term care insurance policy years ago, it’s worth digging up and reviewing carefully. Many policies cover in-home care, not just nursing facility care, but benefits, waiting periods, and daily/monthly payout limits vary significantly by policy. Contact the insurance company directly to understand exactly what’s covered before assuming either way.

Private Pay

Most families, even those using one or more of the resources above, end up paying at least partially out of pocket for in-home care. This is by far the most common funding source nationally, in part because it offers the most flexibility: no waiting lists, no approval processes, and a care plan built entirely around your family’s actual needs rather than what a program covers. We break down what private-pay care actually costs in the DFW area in our companion article on home care costs.

Combining Multiple Sources

Most families don’t rely on just one option. A common pattern is using Medicare for short-term skilled care after a hospital stay, VA Aid & Attendance or long-term care insurance to offset ongoing costs, and private pay to cover the remaining gap. There’s no single “right” combination, it depends entirely on your family’s specific eligibility and needs.

Frequently Asked Questions

Does Medicare cover 24-hour home care?

No. Medicare explicitly excludes 24-hour-a-day care at home, regardless of medical necessity. It’s structured around part-time, intermittent skilled care only.

Can my parent have both Medicare and Medicaid?

Yes, this is called dual eligibility, and it’s common among lower-income seniors. When someone is dual-eligible, Medicare typically pays for covered services first, with Medicaid stepping in to cover additional costs and services Medicare doesn’t.

How do I start the Medicaid waiver application process in Texas?

Applications for STAR+PLUS and related HCBS waiver programs go through Texas Health and Human Services. Given potential interest lists, we generally recommend starting this process as early as possible, even before care feels urgently needed.

Let’s Talk Through Your Specific Situation

Every family’s payment picture looks a little different. We’re happy to have an honest conversation about what might apply to yours, and connect you with the right resources for anything outside our scope, like formal Medicaid or VA benefits counseling.

Call us at 682-267-0724 or reach out here to schedule a free consultation. We serve Arlington, Mansfield, Dallas, and the surrounding DFW area.

Sources: Medicare.gov, Home Health Services coverage guidelines; Texas Health and Human Services Commission (HHSC), STAR+PLUS program; U.S. Department of Veterans Affairs, Aid and Attendance / Housebound benefit rates (effective December 1, 2025 through November 30, 2026).