Paying privately for home care: what drives the cost and what to ask

Most non-medical home care is paid for privately. Medicare does not pay for long-term custodial care, and Medicaid only helps people who qualify under their state's rules. If you are paying out of pocket, the useful questions are what changes the price and what to ask before you sign.

Carevo is a directory and does not set prices or arrange care. We do not publish a national average hourly price, because we only use figures from primary sources and none we use gives one.

Why families pay privately

Medicare.gov says Medicare does not pay for long-term care, also called custodial care, which is mostly non-medical help with bathing, dressing and using the bathroom. It also lists 24-hour-a-day care at home and custodial or personal care, when that is the only care you need, as not covered. You pay all costs for non-covered services.

Other routes can help some families:

• Medicaid pays for home and community-based services for people who qualify, and each state sets its own program.
• VA pension with Aid and Attendance is a monthly payment added to a VA pension.
• Long-term care insurance pays toward care once the policy's triggers and elimination period are met.

If none of these applies, you pay the agency or caregiver directly.

What can change the cost

We cannot state prices, but these are the points agencies commonly quote differently. Ask each agency how it handles them.

• Hours and visit length. Some agencies set a minimum number of hours per visit.
• Type of help. Companionship, personal care with bathing, and care for dementia at home may be priced differently.
• Time of day. Ask whether nights, weekends and holidays cost more.
• Overnight and round-the-clock care. 24-hour home care and live-in care may be priced per day, per shift or per hour. Ask which and how rest breaks are treated.
• Where you live. Rates in your area are what matter, not a national number.
• Extras. Ask about mileage, supplies, onboarding assessments and any deposit.

To work out what a plan could cost over a week or month, use the home care hours cost calculator with the rate you are quoted. Compare settings with the care cost comparison.

A wage is not a price

The U.S. Bureau of Labor Statistics reports a median hourly wage of $17.21 for home health and personal care aides in May 2025. That is what workers were paid. It is not what an agency charges a family. We do not have a sourced figure for what agencies charge, so we do not estimate one from the wage.

Questions to ask an agency

Ask these before you commit, and keep the answers in writing.

1. What is the hourly rate, and is there a minimum number of hours per visit?
2. Are caregivers your employees, or do I become the employer?
3. What does the rate include, and what costs extra?
4. How do you check and train caregivers, and who supervises them? Ask to see what the agency can show you, since Carevo does not vouch for any provider.
5. What happens if my caregiver is sick or cannot come?
6. How much notice do you need to change or cancel hours, and how much notice do I give to end service?
7. How and when do you bill, and will you give me an itemized invoice?
8. Does your state require a license for your type of agency, and can I see it?
9. Do you accept long-term care insurance or VA payments, and will you help with the paperwork?
10. Who do I call after hours?

Medicare.gov notes that an agency should explain in writing and verbally what Medicare will and will not pay for before care starts. Ask for the same clarity on private fees.

Before you sign

Read the service agreement in full. Check that the rate, minimum hours, notice terms and the list of tasks match what you were told. If the agency says something is covered by Medicare, ask for it in writing, because Medicare.gov says the agency should explain what Medicare will and will not pay for before care starts and give a notice for items that are not covered.

If you plan to rely on long-term care insurance or a VA benefit to reimburse you, check the rules first. Some policies only pay for services that begin after the elimination period, and VA pension is a monthly amount added to a pension, not a refund of invoices. See how a long-term care insurance claim starts.

Paying for care that is partly covered

Some people use more than one source. For example, Medicare can pay for part-time skilled home health after a hospital stay, while a family pays privately for daily personal care. See what Medicare pays for. Keep each payer's rules separate, and ask each provider which services fall under which payer.

Be careful about moving assets to qualify for Medicaid. Speak to your state Medicaid agency or a qualified elder law attorney first. See the Medicaid look-back rule.

Find providers

Browse home care agencies, companion care and respite care, or tell us what you need and we will show providers that serve your area. Carevo reports what regulators and CMS publish and does not rank by payment.