Paying for care3 min read
Paying for care at home: Medicare, Medicaid, private pay, and insurance
Who pays for which kind of help at home, in general terms. The short version: Medicare pays for skilled care for a while, not for aides for the long haul.
Written and reviewed by Cardinal Care Advisors, Buffalo, New York. Published September 26, 2026.
Paying for careAt home
The one thing to know first
Medicare and Medicaid sound alike and pay for very different things. Medicare is health insurance for people 65 and over. Medicaid is the state and federal program for people with limited income and assets, and it is the main public payer for long-term help at home. This page is general information, not financial or legal advice; the programs have detailed rules, and the offices linked below can answer for your situation.
Medicare
Medicare can pay for home health: part-time skilled nursing and therapy, ordered by a doctor, for someone who has trouble leaving home, from a Medicare-certified agency. It can include some aide help while skilled care is going on. It does not pay for round-the-clock care, for meals, or for an aide when help with daily activities is the only need. Durable medical equipment such as a walker or hospital bed may be covered with a doctor's order.
Medicare and Medicaid sound alike and pay for very different things.
Medicaid in New York
Medicaid can pay for ongoing help at home: personal care aides, or the Consumer Directed Personal Assistance Program, where the person hires their own aide. Eligibility depends on income and assets, and the need for help is set by an assessment the state arranges. Most people who need Medicaid help at home for more than a few months receive it through a managed long-term care plan. There is never a fee from Cardinal on care Medicaid pays for.
Private pay
Agencies bill by the hour, and rates vary by agency and by the kind of help. Ask for the rate in writing, the minimum visit, and what changes on weekends and holidays. Knowing how many months savings will cover helps you decide when to look into Medicaid, and our runway tool can help you do the arithmetic.
Long-term care insurance
If there is a policy, read the home care section. Most policies pay a daily or monthly amount after a waiting period, and many require a licensed agency. Call the insurer early; claims take time to start.
Veterans
The VA has home care programs for enrolled veterans, and the Aid and Attendance pension can help pay for help at home for eligible veterans and surviving spouses. A VA-accredited representative can help with the claim at no charge.
County programs
Every county Office for the Aging runs programs for people who do not qualify for Medicaid, including New York's EISEP program for in-home help, with a cost share based on income. Waitlists are common, so call early.
Official sources
These open another website. We link only to government agencies and established nonprofits.
- Medicare: what is covered (opens another site) · Search a service to see if Medicare pays.
- New York State Medicaid (opens another site) · Eligibility, applying, and local offices.
- NY Connects (opens another site) · Free help finding long-term care services and how they are paid for.
- New York State Office for the Aging (opens another site) · State programs, including EISEP and HIICAP insurance counseling.
- VA Aid and Attendance (opens another site) · Eligibility and how to apply.
Was this helpful?
General information for families in Western New York, written by Cardinal Care Advisors. Not medical or legal advice; a physician, an elder law attorney, or a licensed assessor decides the things that need deciding. Tell us if something here is wrong or out of date: hello@thecardinalgroup.org.