One of the most important first steps in a long-term care plan is establishing how to pay for in-home care. Fortunately, there are various ways to pay for in-home care, including some insurance policies.
Knowing what insurance covers in-home care, what services are covered, and what’s required to access insurance coverage is essential to keeping costs as affordable as possible.
Scheduling free, in-home assessments with licensed, local home care agencies is the best way to learn more about home care costs and what insurance covers in-home care.
Key Takeaways
- No single insurance covers everything — most families use a combination of Medicare, Medi-Cal, VA benefits, private insurance, and supplemental funding.
- In-home care can be a cost-effective alternative to facility-based care — especially for seniors who only need part-time assistance and want to remain safely in their own homes. Because home care is typically billed by the hour, families can tailor services to their needs and budget.
- California residents have robust state-specific options — including IHSS, CalAIM Medi-Cal expansion, and one of the nation’s largest PACE networks.
- Medicare covers skilled, short-term care — not long-term custodial or companion care. Knowing this distinction helps set realistic expectations.
- Long-term care insurance and life insurance policies may offer more flexibility than many seniors realize — always call the insurer to review your options.
- Free in-home assessments are your best first step — they’re no-obligation, comprehensive, and will help map out a personalized funding strategy.
Table of Contents
Understanding Home Care Costs & Insurance Coverage
Insurance for Home Care in California
Medicare vs. Private Insurance: Side-by-Side Comparison
What Insurance Covers In-Home Care
Medicare Part A (Hospital) & Part B (Medical Insurance)
Long-Term and Life Insurance Policies
Roadmap to Accessing Insurance Benefits
Learn About the Many Options Available to Pay for In-Home Care
Understanding Home Care Costs, Insurance, & Senior Care Coverage
Home care costs vary according to the type of care required, geographic location (home care costs fluctuate with living costs), and how many hours of care the client needs.
Unlike assisted living communities and nursing homes, which typically charge a monthly fee, in-home care is generally billed by the hour. In the Inland Empire and surrounding communities served by Families Choice Home Care, non-medical home care typically ranges from approximately $36 to $41 per hour, depending on the level of care, schedule, and provider.
The comparison below illustrates how hourly home care pricing compares with the typical monthly costs of residential senior care options. Because families only pay for the hours of care they need, in-home care offers flexibility that allows costs to be tailored to each individual’s care plan.
| Typical Senior Care Costs (Inland Empire) | Estimated Cost |
| In-Home Care | $36–$41/hour |
| Assisted Living Facility | $4,635/month* |
| Nursing Home (Semi-Private Room) | $8,145/month* |
| Nursing Home (Private Room) | $9,305/month* |
*Facility care is typically priced as a monthly residential fee. In contrast, in-home care is billed by the hour, so total monthly costs depend on the number of care hours scheduled each week. Actual costs vary based on location, level of care, and services provided.
Unlike assisted living communities, which often advertise a base monthly rate and charge additional fees for services such as meals, laundry, transportation, personal care, or medication assistance, in-home care allows families to pay only for the hours and services they need. This flexibility makes it easier to build a care plan that fits both a loved one’s needs and the family’s budget.
In most cases, clients use a variety of sources to fund aging-in-place, many of which include insurance of one type or another. The following are some of the most common insurance providers that cover some aspects of home care costs, depending on the client’s diagnosis, medical needs, prescriptions, etc.
Insurance for Home Care in California
California residents have access to several state-specific programs and protections that can significantly reduce out-of-pocket home care costs. Before diving into individual coverage types, here are the California-specific options to be aware of:
- Medi-Cal Home & Community-Based Services (HCBS): California’s Medicaid program has expanded HCBS waivers under the CalAIM initiative, offering broader in-home support than many other states.
- IHSS (In-Home Supportive Services): California’s IHSS program is one of the most robust in the nation. Administered by counties, it can pay a family member or friend to provide care. Eligibility is income- and need-based.
- PACE Programs in California: California has one of the largest PACE networks in the country, with programs across Los Angeles, San Bernardino, Riverside, and other counties.
- California Department of Aging: Provides a network of resources, referrals, and coordination services for seniors. Visit aging.ca.gov.
- SCAN Health Plan & Other Medicare Advantage Plans: California seniors may be eligible for Medicare Advantage plans that include expanded home care benefits not available through Original Medicare.
Medicare vs. Private Insurance: Side-by-Side Comparison
One of the most common questions families face is whether to rely on Medicare, private insurance, or both to fund in-home care. The answer is usually a strategic combination. Here’s how they compare:
| Factor | Medicare | Private Health Insurance |
| Eligibility | Age 65+ or qualifying disability | Varies by plan |
| Non-medical home care | Not covered | Rarely covered; plan-dependent |
| Skilled nursing (short-term) | Covered if homebound + physician order | Often covered with prior authorization |
| Long-term custodial care | Not covered | Not covered (requires LTC policy) |
| Cost to enrollee | Premiums + copays | Premiums + deductibles + copays |
| Can be combined? | Yes, use Medicare first, then private | Yes, coordinate benefits |
Speaking with both your insurance representative and your loved one’s physician together often reveals coverage combinations that neither party would have surfaced alone. A home care agency’s intake coordinator can also help navigate this process.
Have questions about what your plan covers? Call Families Choice Home Care for a free consultation.
What Insurance Covers In-Home Care
We can’t emphasize enough how much free assessments with local home care agencies help with understanding which situations qualify for insurance support and which do not. These assessments are 100% free of charge and carry no obligation. They provide a wealth of information about what’s required for loved ones to age in place with dignity, independence, and a high quality of life.
Here is a general overview of which types of insurance cover in-home care services:
| Insurance Type | Covers Home Care? | Income-Based? | Best For |
| Medicare Part A & B | Yes – limited, medical only | No | Post-hospital skilled care |
| Medicaid / Medi-Cal | Yes – limited, medical only | Yes | Low-income seniors |
| Medigap | No | No | Filling Medicare cost gaps |
| PACE Program | Yes – broader services | Yes | Comprehensive, team-based care |
| VA Benefits | Yes – varies by program | No (service-based) | Veterans & surviving spouses |
| Private Health Insurance | Partial – varies by plan | No | Supplementing Medicare |
| Long-Term Care Insurance | Yes – typically robust | No | Ongoing custodial care |
| Life Insurance Policy Loan | Indirect – loan on principal | No | Seniors with existing policies |
Medicare Part A (Hospital) & Part B (Medical Insurance)
Medicare insurance policies can be used to cover some aspects of home care, but only those that are:
- Medically-related
- Ordered by a physician
- Considered short-term or temporary
In these cases, Medicare works with healthcare providers, covering medical-oriented care, which may include home care from a Medicare-certified home care agency.
In most cases, Medicare pays for things like:
- Home health assistance
- Durable medical equipment
- Home health care that supports skilled nursing, PT or OT, and other services ordered by the doctor
- Personal care that supports hygiene and daily living activities (bathing/showering, bathroom care, dressing, etc.)
- Other services (as long as your doctor certifies that you are homebound)
In most cases, Medicare does not cover the costs for basic housekeeping, full-time care, meal preparation, or other services not covered by your medical care plan. That said, there are cases where post-operative patients may have some of these services covered for a short time to support a healthy recovery, and insurance pays for what the doctor orders. Your general physician or specialist, and a conversation with Medicare, will highlight what services will or won’t be covered.
Medicare home care coverage is not unlimited. Once a physician determines care is no longer “medically necessary,” or that you are no longer homebound, coverage stops, even if your loved one still needs assistance. This is one of the most common points of confusion for families, and one of the main reasons a combination of funding sources is so important.
Contact Medicare directly: 1-800-MEDICARE (1-800-633-4227) | TTY: 1-877-486-2048 | medicare.gov
Medicaid/Medi-Cal
Medicaid and Medi-Cal follow almost identical coverage guidelines as Medicare. The difference is that, unlike Medicare, which is available to all adults 65 years old or more, regardless of financial stability, Medicaid and Medi-Cal provide additional healthcare for seniors living below a certain economic level.
If applicants qualify for Medicaid or Medi-Cal, the requirements for temporary or part-time home care support mimic those of Medicare. Part of these programs may include the ability for a spouse, child, or family caregiver to receive financial support for their role as caregiver. This also alleviates home care costs.
Key eligibility factors for Medi-Cal in California:
- Income limit: Varies by household size; generally at or below 138% of the Federal Poverty Level for most adults
- Age 65+ or disabled: May qualify under the Aged & Disabled Federal Poverty Level program
- Asset test: California eliminated the asset test for most Medi-Cal applicants effective January 2024 — meaning savings and property are no longer counted against eligibility for most people
- Application: Apply through your county social services office or at coveredca.com
Medigap Insurance
Medigap insurance is a supplemental plan paid for out-of-pocket. While designed to help cover gaps in standard Medicare plans (co-payments, deductibles, and co-insurance), it does not cover home health services or items that are not covered by Medicare, such as hearing aids, routine vision care, and long-term care.
We recommend downloading the Medicare & Home Health Care guide for more details about Medicare, Medicaid/Medi-Cal, and Medigap insurance, and what they do and do not cover regarding home health. You can also call their helpline at 1-800-MEDICARE (1-800-633-4227) for the most current information. TTY users can call 1-877-486-2048.
PACE Programs
PACE (Program of All-Inclusive Care for the Elderly) programs are another potential option. PACE is available in 30 states, including California. Qualification for PACE depends on your income. So, like Medicaid/Medi-Cal, most qualifying participants have some financial need.
The program relies on guidelines similar to Medicare and Medi-Cal when it comes to home care coverage, although individuals qualifying for PACE have a team of interdisciplinary medical and social services professionals overseeing their care.
This often provides the advantage of connecting clients/patients with home-care-oriented community services and support that might not be provided or advertised via Medicare/Medi-Cal.
Another benefit of PACE is that, depending on an individual’s qualifications, it may cover co-payments and deductibles not covered by Medicare, in return for a minimal monthly premium.
What PACE covers that Medicare often doesn’t:
- Dental, vision, and hearing care
- Transportation to and from medical appointments
- Adult day health center services
- Prescription drug coverage
- Coordination across all your providers, one team manages everything
Find a PACE program near you: npaonline.org/pace-locator
Veteran’s Benefits
If your loved one was a veteran, look into VA benefits and pension offerings. The VA is dedicated to keeping veterans out of nursing homes and supporting home and community-based care through various programs. In some cases, the veteran’s pension may also be leveraged to pay for home care costs.
Key VA Programs for In-Home Care:
- Aid & Attendance Benefit: Additional pension for veterans or surviving spouses who need help with daily activities, one of the most underutilized benefits available
- Homemaker & Home Health Aide Program: Provides in-home personal care services through the VA
- VA Home-Based Primary Care (HBPC): Brings a VA medical team directly to the veteran’s home
- Veteran-Directed Care (VDC): Allows veterans to hire and manage their own caregivers, including family members
- Caregiver Support Program: Financial and psychological support for family caregivers of eligible veterans
VA Resources: va.gov/health-care | Caregiver Support: caregiver.va.gov
Private Health Insurance
As you can imagine, private health insurance coverage for home health is as varied as the number of policies available. In addition, most private insurance companies do not pay for non-medical home care services.
However, it’s always worth speaking to insurance representatives and the loved one’s physician to see how a combination of Medicare and private health insurance can be used in tandem, or back-to-back, to make home care as affordable as possible.
Questions to Ask Your Private Insurance Provider:
- Does my plan cover any home health services, even short-term skilled nursing?
- Does my plan offer a Medicare Advantage (Part C) option that includes expanded home care benefits?
- Is there a case management or care coordination benefit that covers home assessments?
- Can I coordinate benefits between my private plan and Medicare to reduce out-of-pocket costs?
- Does my plan cover durable medical equipment (DME) for use at home?
Long-Term and Life Insurance Policies
Does your loved one have long-term insurance or a life insurance policy? If so, call the representatives as soon as possible to learn more about policy terms. Many seniors are unaware that they can take a loan back on the principal amount to reduce or cover in-home care costs.
What they initially took out to support loved ones in the case of a traumatic injury or death may be used instead to maintain their quality of life via high-quality in-home care.
If you or a loved one already has a long-term care (LTC) policy, here’s what to review:
- Benefit triggers: Most policies activate when the individual needs help with 2 of 6 Activities of Daily Living (ADLs): bathing, dressing, eating, toileting, transferring, and continence
- Elimination period: Similar to a deductible — a waiting period (typically 30–90 days) before benefits kick in
- Benefit period: How long coverage lasts (e.g., 2 years, 5 years, or lifetime)
- Inflation protection: Critical for policies purchased years ago — check if benefits have kept pace with rising care costs
- Home care coverage: Confirm the policy covers in-home care specifically, not just nursing facilities
- Life insurance with a long-term care rider: Some life insurance policies include LTC riders, or allow accelerated death benefits, that can be used for home care
Roadmap to Accessing Insurance Benefits
- Start by identifying which types of insurance apply to your situation. Your loved one’s diagnosis, income level, and veteran status will all affect eligibility.
- Gather insurance documents, such as Medicare card, Medi-Cal ID (if applicable), private insurance policy, VA ID, and any LTC insurance policy paperwork.
Speak with your loved one’s physician to obtain the necessary orders, documentation of homebound status, and certifications required by Medicare/Medi-Cal.- Contact each insurer, Medicare, Medi-Cal, VA, and private plans, to confirm coverage, get pre-authorization if required, and understand coordination of benefits.
- Request a written care plan from the home care agency, which insurers will typically require to process claims.
- Explore supplemental funding options, including IHSS, PACE, VA programs, and life insurance loans, to fill any coverage gaps.
Learn About the Many Options Available to Pay for In-Home Care
Do you feel that insurance coverage for in-home care isn’t enough? Don’t worry! Insurance is just the tip of the iceberg. Schedule an assessment with Families Choice Home Care to learn more about all the many ways clients creatively fund in-home care services without breaking the bank.
Additional Resources
| Resource | Description | Contact / Link |
| Medicare.gov | Official Medicare coverage info and home health guide | medicare.gov | 1-800-633-4227 |
| California Dept. of Aging | State aging services, senior referrals, county resources | aging.ca.gov |
| DHCS – Medi-Cal | California Medicaid eligibility and benefits | dhcs.ca.gov |
| CDSS – IHSS | In-Home Supportive Services program info | cdss.ca.gov/ihss |
| VA Caregiver Support | VA programs for veterans and their caregivers | caregiver.va.gov |
| PACE Association | Find PACE programs by state and county | npaonline.org |
| Eldercare Locator | National resource finder for senior services | 1-800-677-1116 |
