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Private pay is one of the most common ways to cover the cost of home care. This option allows families to pay for services directly without relying on insurance or government assistance. According to research from the National Institute on Aging-funded Health and Retirement Study, paid caregivers play a significant role in meeting the care needs of older adults living at home with functional impairments, with approximately 27% of community-dwelling older adults receiving some form of paid care support.
Private pay gives you the flexibility to choose the exact care your loved one needs, whether it’s a few hours of assistance each week or full-time support. This option can be ideal if you don’t qualify for Medicaid or other financial assistance programs, or if you need care that falls outside of what Medicaid or insurance covers.
Here is what families should know about private pay home care:
Greater Flexibility and Control: Private pay arrangements are not restricted by the coverage limitations of insurance plans or government programs. This means more freedom to design a care schedule that fits your life and needs, without being bound by what a third party will approve .
Personalized, Customized Care: Private pay allows for truly individualized attention. Care plans can be tailored based on specific health conditions, preferences, lifestyle routines, and cultural considerations, ensuring your loved one receives care that feels natural and comfortable .
Immediate Start of Services: Unlike Medicaid programs that may involve application processes, eligibility determinations, and waiting periods, private pay services can begin immediately. There is no need to wait for plan approvals or assessments when care is needed right away .
No Eligibility Requirements: Private pay does not require you to meet specific income, asset, or medical criteria. This makes it an ideal option for families who don’t qualify for public assistance programs but still need support for their loved one .
Ideal for Temporary or Transitional Care: Private pay works well for short-term needs such as post-surgery recovery, rehabilitation support, or as a bridge while waiting for Medicaid approval or other funding to begin .
Supplementing Other Funding Sources: Even families who receive Medicaid or other assistance may choose to use private pay to “top up” their care, adding extra hours or services beyond what their funding covers .
Transparent Pricing: Reputable home care agencies provide clear, detailed budget breakdowns with no hidden fees, allowing families to plan with confidence and know exactly what services they are receiving and what they will cost.
Considerations for Long-Term Planning: While private pay offers many advantages, families should consider long-term affordability.
According to a recent scoping review published by the National Institute of Health, the United States operates a “means-tested, safety-net system” for long-term care, where public funding, such as Medicaid, becomes available for individuals who cannot afford to pay for their own care . This underscores the importance of financial planning, as many families begin by paying out-of-pocket but may transition to programs like IHSS when personal resources are depleted and care needs persist.
At First Hope Home Care, we are happy to discuss all payment options with you, including private pay, Medicaid, and other resources, and help you build a care plan that fits both your loved one’s needs and your family’s budget.
For families who meet income and other eligibility criteria, Medicaid provides an invaluable option for covering home care services. Medicaid home care in Denver is available through Health First Colorado (Colorado’s Medicaid program) and offers various waivers and programs that cover a wide range of services, including personal care, homemaking, and respite care. At First Hope Home Care, we specialize in helping families access Medicaid home care, guiding you through the application process, and ensuring you receive the full benefits available. This option is particularly helpful for those who require long-term care but need financial assistance to cover the costs.
Understanding Medicaid Home Care in Denver
Medicaid is a joint federal and state program that serves as the primary payer for long-term care services in the United States, helping individuals who might otherwise face the depletion of their life savings due to care costs . In Colorado, Medicaid is known as Health First Colorado, and it offers several pathways to receive home-based care .
Here is what Denver families should know about accessing Medicaid home care through programs like IHSS:
What Medicaid Home Care Offers: Through Home and Community-Based Services (HCBS) waivers and the Community First Choice (CFC) program, Medicaid helps cover essential non-medical services including personal care assistance, homemaker services, health maintenance activities, and respite care, all designed to help individuals remain safely in their homes rather than moving to institutional settings.
Eligibility Criteria: To qualify for Medicaid-funded home care, individuals must meet both functional and financial requirements. Functionally, they must have an assessed need for personal care, homemaker, or health maintenance services and meet an institutional level of care, typically requiring assistance with daily living activities. Financially, eligibility is determined by income and asset limits, with spousal protections in place to help ensure the spouse living at home can maintain their financial stability.
Self-Direction Options: One of the most valuable aspects of Colorado’s IHSS program is that it allows members to direct and manage their own care, including the ability to select and supervise their own attendants. Family members can be hired as paid caregivers, recognizing the critical role families already play in providing support.
Services Covered: Under the Community First Choice program, IHSS covers three main categories of service: Personal Care (assistance with bathing, dressing, grooming, eating), Homemaker services (light house cleaning, meal preparation, shopping, money management), and Health Maintenance Activities (skilled tasks that can be performed by non-licensed individuals under professional oversight) .
Application Assistance Available: Denver residents can apply for Health First Colorado through the Colorado PEAK online portal or in person at Denver Human Services locations. For those who need help navigating the process, Denver Benefits in Action provides navigators who can offer free support throughout the application process. Once enrolled in Medicaid, individuals work with a Case Management Agency to complete a needs assessment and determine their eligibility for home-based services.
Research-Backed Benefits: A recent study using data from the NIH-funded Health and Retirement Study found that state-level Medicaid initiatives focused on expanding home and community-based services were associated with a significant reduction in long-term nursing home stays for individuals living alone, while also increasing paid support for family caregivers in multi-person households. This confirms that programs like IHSS effectively help families stay together while reducing institutionalization.
A Critical Safety Net: Research published by the National Institutes of Health highlights that the vast majority of families have not planned financially for long-term care needs and are quickly overwhelmed by costs. Medicaid serves as an essential safety net, ensuring that when personal resources are exhausted, quality care does not have to end.
Long-Term Sustainability: Unlike some waiver programs with enrollment caps, the Community First Choice program through which IHSS is now available is an entitlement program. This means that everyone who meets the eligibility criteria is guaranteed to receive benefits, providing families with long-term certainty and peace of mind.
At First Hope Home Care, we are here to help you navigate every step of accessing Medicaid home care benefits, from understanding eligibility to completing applications and connecting with the right caregivers for your loved one.
While Medicare generally covers only short-term, medically necessary care, it can be helpful for specific in-home services. Medicare might cover skilled nursing care, physical therapy, or other medically necessary services when prescribed by a doctor. However, it does not typically cover non-medical services like personal care, homemaking, or companionship. If your loved one qualifies for Medicare, it can complement other payment options, but you may need to explore additional financial assistance to cover non-medical services.
Here is what Denver families should know about Medicare coverage for home-based care:
What Medicare Covers
According to the official Medicare.gov website, Medicare covers certain home health services if you meet specific eligibility requirements and the care is provided by a Medicare-certified home health agency. Covered services include :
Skilled Nursing Care: Medically necessary part-time or intermittent skilled nursing care, including wound care for pressure sores or surgical wounds, patient and caregiver education, intravenous or nutrition therapy, injections, and monitoring of serious illness and unstable health status .
Therapy Services: Physical therapy, occupational therapy, and speech-language pathology services when ordered by a doctor and provided by certified therapists .
Home Health Aide Services: Part-time or intermittent home health aide care, but only if you are also receiving skilled nursing care, physical therapy, speech-language pathology services, or occupational therapy at the same time. This may include help with walking, bathing or grooming, changing bed linens, and feeding .
Medical Social Services: Part-time or intermittent services provided by a social worker to help with social and emotional concerns related to your medical condition .
Medical Supplies and Equipment: Durable medical equipment and medical supplies for use at home .
Medicare explicitly excludes several types of home care services :
24-Hour Care: Round-the-clock care at home is not covered.
Custodial or Personal Care: Help with daily living activities such as bathing, dressing, or using the bathroom when this is the only care needed. As the Center for Medicare Advocacy confirms, custodial care alone does not qualify for Medicare coverage.
Homemaker Services: Services like shopping, cleaning, and laundry that are unrelated to a specific care plan are not covered.
Meal Delivery: Home-delivered meals are excluded from coverage.
Long-Term Care: Medicare does not cover long-term care when that is the only needed service.
To qualify for Medicare-covered home health services, several conditions must be met :
Homebound Status: The patient must be considered “homebound,” meaning they have trouble leaving home without assistance (using a cane, wheelchair, walker, or help from another person), leaving home is not recommended due to their condition, or leaving home requires considerable and taxing effort .
Physician Certification: A doctor or allowed practitioner must certify that the patient needs intermittent skilled nursing care, physical therapy, or speech-language pathology services, and establish a plan of care that is reviewed periodically .
Medicare-Certified Agency: Services must be provided by a Medicare-certified home health agency .
Face-to-Face Encounter: The patient must have a face-to-face encounter with a physician or allowed practitioner related to the primary reason for home health services, occurring no more than 90 days before or within 30 days of the start of care .
In most cases, “part-time or intermittent” care means up to 8 hours per day and a maximum of 28 hours per week of combined skilled nursing and home health aide services. In certain cases, this may extend to 35 hours per week if the provider determines it is necessary .
Per the Medicare Benefit Policy Manual, coverage of skilled nursing or therapy services does not depend on the patient’s potential for improvement. Skilled care may be necessary to maintain the patient’s current condition, prevent or slow further deterioration, or perform a maintenance program safely and effectively. This clarification from the Jimmo settlement is important for patients with chronic conditions who need ongoing skilled care to maintain function .
For covered home health services, Medicare pays 100% for the services themselves. However, after meeting the Part B deductible, beneficiaries pay 20% of the Medicare-approved amount for durable medical equipment .
For families receiving care through First Hope Home Care, Medicare can serve as a valuable complement to other funding sources :
Short-Term Skilled Needs: If your loved one requires skilled nursing or therapy after a hospitalization or injury, Medicare may cover these services temporarily while you arrange for longer-term support through IHSS or private pay.
Medicare Advantage Plans: Some Medicare Advantage (Part C) plans may offer additional benefits beyond Original Medicare, though coverage rules and costs vary by plan .
Medigap Policies: Medicare Supplement Insurance (Medigap) policies can help cover some out-of-pocket costs like copayments and deductibles, but they do not expand the scope of covered services .
Coordinating with IHSS: Since Medicare does not cover ongoing non-medical personal care, IHSS or other Medicaid-funded programs can fill this gap for eligible individuals, while Medicare covers qualifying skilled needs that arise.
At First Hope Home Care, we help families understand how Medicare fits into their overall care plan and coordinate with other payment options to ensure comprehensive, affordable support for their loved ones.
Long-term care insurance is another option that can help cover home care costs, including personal care services, home health aides, and respite care. According to the National Association of Insurance Commissioners (NAIC), long-term care insurance is different from traditional medical insurance, it generally helps you live as you are living now rather than improving or correcting medical problems, and it typically covers services in your own home, an assisted living facility, a nursing home, or an adult day care center.
If you or your loved one have long-term care insurance, it’s essential to understand the specific policies and benefits offered. Many insurance plans cover in-home care, but the extent of coverage varies, and you’ll need to check with your provider to see if First Hope Home Care is included in your plan.
Here is what Denver families should know about using long-term care insurance for home care services:
Long-term care insurance policies generally cover a wide array of both medical and non-medical care in the home . Covered services may include:
Personal Care Assistance: Help with activities of daily living (ADLs) such as bathing, dressing, toileting, eating, and transferring
Skilled Nursing Care: In-home nursing services when prescribed
Therapy Services: Physical, occupational, and speech therapy
Homemaker Services: Meal preparation, light housekeeping, and shopping (depending on the policy)
Respite Care: Temporary relief for primary caregivers, providing care at home, adult day care, or other settings
Hospice Care: Some policies may cover short-term hospice care, though Medicare typically covers this
To qualify for benefits under most long-term care insurance policies, specific criteria must be met:
Certification as Chronically Ill: You must typically be certified as unable to perform at least two of the six standard activities of daily living (eating, bathing, dressing, transferring, toileting, and continence) without substantial assistance, or require substantial supervision due to severe cognitive impairment
Health Care Practitioner Certification: A licensed health care practitioner must certify that you meet the definition of “chronically ill,” and this certification must be renewed every 12 months
Plan of Care: A written plan of care must be developed describing your needs and specifying the type, frequency, and providers of required services
Elimination Period (Waiting Period): Most policies have a waiting period, typically 30 to 90 days, before benefits begin. During this time, you pay for care out-of-pocket. This is essentially your deductible, and you must satisfy this period before the insurance company starts paying
Daily or Monthly Benefit Limits: Policies specify maximum daily or monthly benefit amounts. If your care costs exceed this limit, you pay the difference out-of-pocket. For context, visit this site for understanding your policy’s daily maximum to ensure your coverage aligns with the cost of care in your area.
Benefit Period and Maximums: Policies have set benefit periods (ranging from a few years to lifetime) and overall benefit caps. For context, visit this site for understanding your policy’s benefit limits and what happens when coverage is exhausted.
Inflation Protection: Some policies include inflation protection, which allows benefit amounts to increase over time to keep pace with rising care costs
Reimbursement vs. Indemnity: Most policies operate on a reimbursement basis, you pay for services first, then submit invoices for reimbursement . Some “cash indemnity” policies provide a fixed daily amount regardless of actual expenses
When it’s time to file a claim, understanding the process helps avoid delays :
Benefit Eligibility Review: After filing a claim, a care coordinator will contact you to review information, discuss past and current providers, and order required documentation such as physician records, care provider records, and potentially an onsite assessment
Provider Approval: Before contracting services, your provider must be approved and verified as having licensure and credentials that meet your policy requirements. Failure to do so may lead to services not being reimbursed
Documentation Requirements: When submitting invoices, you’ll need documentation including your name, provider name on company letterhead, dates and types of service provided, and fees charged per day or visit . For independent or informal caregivers, detailed timesheets with signatures and cancelled checks may be required
Regular Updates: During the claim review process, the insurance company typically provides written updates every 30 days
Provider Network: Some policies may require caregivers to be licensed or come from approved agencies . Check with your insurance provider to confirm whether First Hope Home Care is included in your plan
Family Caregivers: Traditional long-term care insurance policies may not cover care provided by family members . Review your policy’s specific provisions regarding who can be paid for providing care
Pre-Existing Conditions: Policies may have limitations for pre-existing conditions, meaning benefits for care related to certain conditions may not be paid for a period after the policy goes into effect, typically six months
Partnership Programs: Colorado participates in the Long-Term Care Partnership Program, which allows you to protect additional assets while still qualifying for Medicaid if your policy benefits are exhausted . This program lets you shelter an amount of assets equal to the dollar value of your policy
Tax-Qualified Policies: If you have a tax-qualified long-term care insurance policy, benefits received are generally not taxable as income, and a portion of premiums may be tax-deductible
It’s equally important to understand exclusions :
Rent or room and board at assisted living facilities unless you have a qualifying medical need
Care provided by family members (under most traditional policies)
Expenses covered by Medicare or other health insurance
Services not meeting the policy’s eligibility criteria
For veterans or their surviving spouses, the VA (Veterans Affairs) offers benefits that can help cover the cost of home care. The VA provides a range of services, including assistance with daily activities, in-home nursing care, and home modification services. These benefits can be an excellent way for qualifying veterans to get the care they need in the comfort of their own home. Here are some key programs to consider:
Aid and Attendance (A&A): This is a monthly pension benefit added to the VA pension for eligible veterans and survivors who need help with daily activities, are bedridden, or have limited eyesight . It can significantly offset the costs of in-home care, assisted living, or nursing home care.
Program of Comprehensive Assistance for Family Caregivers (PCAFC): This program offers clinical support, training, counseling, and a financial stipend to eligible family caregivers of qualifying post-9/11 veterans.
Respite Care: The VA provides respite care services to offer temporary relief for primary caregivers. This can include up to 30 days of in-home care per year, giving family caregivers a much-needed break.
Veteran Directed Care (VDC): This program allows veterans to manage their own flexible budget for personal care services and supports, giving them control over who provides their care and how it is delivered.
Getting Help: To determine eligibility and apply, contact a local Veteran Service Officer (VSO) who provides free, accredited assistance with navigating these benefits.
If you’re struggling with the upfront costs of home care, we can work with you to find a solution. We offer flexible payment plans and can assist in identifying other financial assistance programs that may be available to help your loved one receive the care they deserve. By discussing your options with us, we’ll help you explore the best financial resources for your family’s situation, making sure home care is both affordable and accessible.
Personalized Payment Plans: We can structure a private-pay plan that aligns with your budget, offering flexibility in scheduling and service intensity to manage costs effectively.
Guidance with Applications: Our team can help you understand and complete applications for programs like Medicaid and VA benefits, connecting you with the appropriate agencies and resources.
Local Assistance Resources: We can refer you to free, professional resources such as Benefits in Action or your local Area Agency on Aging, which offer navigators to support Denver families through the complexities of applications for financial assistance .
No-Cost Consultation: We are committed to transparency and will sit down with you to review all available options without pressure, ensuring you find a path that provides peace of mind for your entire family.
At First Hope Home Care, we’re committed to helping families access quality home care at an affordable price. We work closely with you to navigate the complexities of home care payments and ensure that your loved one receives the best care possible. Whether you choose private pay, Medicaid, or another financial solution, we are here to support you every step of the way.
If you’re exploring home care payment options in Denver for your loved one, we’re here to help. At First Hope Home Care, we offer flexible payment solutions tailored to your family’s needs. Whether you’re looking into private pay options, Medicaid assistance, or other financial support, we’ll work with you to create a plan that ensures your loved one receives the care they deserve.
Contact us at 303-222-0063 or email us at support@firsthopecare.com to get started today!
We believe in working alongside you—not taking charge. You’re the decision-maker in your care, and we’re here as your supportive partner every step of the way.