Private-pay vs. insurance-covered home care

Paying out of pocket gives the most choice of provider and schedule, and care can usually start quickly. It is the most common way to pay for non-medical help like companionship and personal care when no program applies.

Medicare covers part-time skilled home health care for homebound people with a doctor’s order, through a Medicare-certified agency. It does not cover ongoing personal care when that is the only need, or 24-hour care.

New York Medicaid can cover personal care at home for people who meet both financial and care-needs requirements, including through consumer-directed care, where the person chooses their own aide. An independent assessment decides whether care is approved and how much.

If the person has a long-term care policy, read it for the home care benefit, the daily or monthly maximum, the waiting period before benefits start, and which agencies or caregivers qualify. Call the insurer before services start to begin a claim.

Veterans enrolled in VA health care may qualify for VA Homemaker and Home Health Aide care. Ask the VA care team.

New Yorkers 60 and older who need help with daily activities but don’t qualify for Medicaid may be eligible for EISEP, which shares costs on a sliding scale based on income. In Erie County, start with NY Connects at (716) 858-8526.