Quick Answer
In Texas, in-home care is paid for through four main routes: private pay, long-term care insurance, Medicaid via the STAR+PLUS waiver, and VA benefits for eligible veterans. Medicare does not cover ongoing personal care or companion care. Most families pay privately — but understanding every option before you need care can make a significant difference in how long those resources last.
Why We Wrote This
Payment is the question our Care Concierge team hears most — and the one with the most misinformation. We wrote this guide because too many families assume Medicare will cover their parent's care and are blindsided when it doesn't. Every option here is real, verified, and specific to Texas.
Figuring out how to pay for in-home care is one of the most stressful parts of a situation that's already difficult. The good news: there are more options than most families realize. The hard part: understanding what each one actually covers — and what it doesn't — before you need it.
What Are the Main Ways Families Pay for In-Home Care in Texas?
Most Texas families rely on one or more of these five sources to fund in-home care:
- Private pay — paying out of pocket, from savings, retirement income, or family contributions. This is the most common path for personal care and companion care.
- Long-term care insurance — a policy specifically designed to cover custodial care costs. The earlier it was purchased, the more coverage it typically provides.
- Medicaid — STAR+PLUS waiver — Texas Medicaid's managed care program for low-income adults 65+ or adults with disabilities who need long-term services at home.
- VA benefits — eligible veterans and surviving spouses can access the Aid and Attendance pension benefit, which provides additional monthly income for care costs.
- Medicare — limited and often misunderstood. Covers short-term skilled nursing visits after hospitalization only. Does not cover ongoing personal or companion care.
Below is a quick reference before we go deeper into each:
| Payment Source | Covers Personal / Companion Care? | Income / Asset Requirements? | Application Required? |
|---|---|---|---|
| Private Pay | Yes | No | No |
| Long-Term Care Insurance | Yes (policy-dependent) | No | File a claim with insurer |
| Medicaid (STAR+PLUS) | Yes | Yes — income & asset limits apply | Yes — apply through Texas HHSC |
| VA Aid & Attendance | Yes | Yes — wartime veteran, income limits | Yes — VA Form 21-2680 |
| Medicare | No (skilled nursing only, short-term) | No | Through Medicare provider |
Does Medicare Cover In-Home Care in Texas?
This is the most common misconception in senior care — and it catches families completely off guard. Medicare does cover home health care, but only in a very specific and limited way: skilled nursing visits, physical therapy, or occupational therapy ordered by a physician after a qualifying hospitalization or medical event. That coverage ends when the skilled need ends.
What Medicare does not cover is custodial care — the everyday help with bathing, dressing, meals, medication reminders, and companionship that most families need a caregiver for. This type of care is considered non-medical, and Medicare explicitly excludes it from coverage.
If your parent needs help getting dressed in the morning, preparing meals, or simply having someone present for safety — Medicare will not pay for it, regardless of how medically necessary it feels. This is the gap that private pay, long-term care insurance, and Medicaid waivers are designed to fill.
Does Medicaid Cover In-Home Care in Texas — and What Is the STAR+PLUS Waiver?
Yes — but eligibility is strict, and the process takes time. Texas Medicaid covers in-home personal attendant services through a program called STAR+PLUS, which is the state's managed care program for adults 65 and older or adults with disabilities who have low income and assets.
Under STAR+PLUS, qualified individuals can receive Personal Attendant Services (PAS) — help with Activities of Daily Living (ADLs) like bathing, dressing, and mobility — provided by a caregiver in their home. The program is administered through managed care organizations (MCOs) and funded jointly by the state and federal government.
Who qualifies for STAR+PLUS in Texas?
- Age 65 or older, or have a disability that meets Social Security criteria
- Texas resident with U.S. citizenship or qualifying immigration status
- Income at or below 300% of the Federal Benefit Rate (approximately $2,742/month in 2026)
- Asset limit of $2,000 for an individual (certain assets are exempt, including a primary home and one vehicle)
- Require a nursing facility level of care — meaning daily assistance with multiple ADLs
If your parent might qualify, apply as early as possible. STAR+PLUS waitlists are real, and the application and assessment process can take several months. Contact your local Texas HHSC office or call 2-1-1 to start.
Not sure which payment options apply to your family's situation?
Talk to a Care ConciergeCan Veterans Use VA Benefits to Pay for In-Home Care in Texas?
Yes — and this benefit is significantly underutilized. The VA Aid and Attendance benefit is a pension supplement available to wartime veterans and their surviving spouses who need help with daily activities. It provides additional monthly income on top of the base VA pension, which can be used to pay for in-home care.
Who qualifies for Aid and Attendance?
- Veteran who served at least 90 days of active duty, with at least one day during a wartime period (WWII, Korea, Vietnam, Gulf War)
- Discharged under conditions other than dishonorable
- Meets VA pension income and asset requirements (net worth limit is approximately $155,000 in 2026)
- Requires assistance with at least two ADLs, or is housebound, or is a patient in a nursing home
In 2026, the maximum monthly Aid and Attendance benefit is approximately $2,300 for a veteran with a dependent spouse. Applications are filed using VA Form 21-2680 along with a physician's statement. The process typically takes 6–12 months, so applying well before care begins is strongly recommended. A VA-accredited claims agent or elder law attorney can help navigate the process.
How Does Long-Term Care Insurance Work for In-Home Care?
Long-term care (LTC) insurance is the most straightforward private-pay supplement for families who have it — but the details vary significantly by policy. Most LTC policies cover custodial care, including personal care and companion care in the home, once the policyholder meets the benefit trigger (typically needing help with 2 or more ADLs, or cognitive impairment).
Key policy terms to review:
- Elimination period — most policies have a 30–90 day elimination period during which the family pays out of pocket before benefits begin. This functions like an insurance deductible, measured in days.
- Daily or monthly benefit — the maximum the policy will pay per day or per month. Older policies may have lower limits that don't fully cover current care costs.
- Inflation protection — policies purchased with inflation riders will have higher benefit limits over time. Policies without this feature may cover less than families expect.
- Qualified caregiver requirements — some policies require care to be provided by a licensed agency; others allow independent caregiver arrangements. Review your policy language carefully if you're using BubbieCare, and contact your insurer to confirm.
If your parent has a policy, file a claim as soon as care begins — don't wait until the elimination period is over to start the paperwork.
What Other Financial Assistance Options Are Available in Texas?
Beyond the four main options, Texas families have access to a few additional programs worth knowing about:
- Area Agencies on Aging (AAAs) — federally funded organizations that provide information, referrals, and some direct services for seniors. Your local AAA can help identify programs your parent may qualify for. Find yours at eldercare.acl.gov.
- Community Care for Aged and Disabled (CCAD) — a Texas state program that provides in-home services to seniors and people with disabilities who don't qualify for Medicaid but need some support. Services include personal care, housekeeping, and emergency response. Income-based eligibility.
- PACE (Program of All-Inclusive Care for the Elderly) — available in some Texas metro areas, PACE provides comprehensive medical and social services for seniors who qualify for nursing home care but choose to remain in the community. It functions as both a care coordinator and a payer.
- Life insurance accelerated death benefits — some life insurance policies allow policyholders with terminal or chronic illness to access a portion of the death benefit early to pay for care costs. Check the policy terms or contact the insurer.
- Reverse mortgage — for homeowners 62 and older, a reverse mortgage converts home equity into cash that can be used for care costs. This is a significant financial decision with long-term implications and should be approached with independent financial and legal counsel.
How Does Paying for Care Through BubbieCare Work?
BubbieCare families pay two things: the caregiver's wage, which the family sets directly, and BubbieCare's service fee, which covers the care concierge support, payroll administration, background check coordination, and workers' compensation coverage.
The total is comparable to what traditional home care agencies charge in Texas — but the caregiver can earn significantly more per hour, because there is no agency margin extracted from their wage. Families using long-term care insurance can typically use BubbieCare's care arrangement, though you should verify coverage terms with your insurer. VA Aid and Attendance benefits, once approved, can be applied directly toward caregiver wages.
Your Care Concierge can walk you through exactly what care will cost for your parent's specific needs and schedule — including what questions to ask your insurer or VA benefits coordinator — before you commit to anything.
Want to understand exactly what care will cost for your situation?
See How Pricing WorksFrequently Asked Questions
Does Medicare pay for in-home care in Texas?
Medicare covers limited skilled nursing or therapy-related home health visits after a qualifying hospitalization — but it does not cover ongoing personal care or companion care. If your parent needs help bathing, dressing, meals, or companionship, Medicare will not pay for it. Most families pay for this type of care privately or through long-term care insurance.
What is the Texas STAR+PLUS waiver and how do I apply?
STAR+PLUS is Texas Medicaid's managed care program for adults 65 and older or adults with disabilities who need long-term services. It can cover personal attendant services (PAS) in the home. To apply, contact your local Texas HHSC office or call 2-1-1. Eligibility is income- and asset-based, and there are often waitlists — applying early is strongly recommended.
Can I use long-term care insurance to pay for a caregiver hired through BubbieCare?
In most cases, yes — but it depends on your policy. Most long-term care insurance policies cover custodial care (help with ADLs) provided by a licensed home care agency or a qualified independent caregiver. Because BubbieCare families are the legal employer of their caregiver, you should review your policy language and contact your insurer to confirm coverage. Your Care Concierge can help document the care arrangement for insurance purposes.
What is the VA Aid and Attendance benefit for veterans needing in-home care?
The VA Aid and Attendance benefit is a pension supplement for wartime veterans (and surviving spouses) who need help with daily activities. It provides additional monthly income that can be used to pay for in-home care. In 2026, the maximum monthly benefit is approximately $2,300 for a veteran with a spouse. Applying requires filing VA Form 21-2680 along with medical documentation. The process can take 6–12 months, so applying early is critical.
Related Resources From BubbieCare
These guides from our Family Resource Center can help you think through the broader care picture:
- The Complete Guide to In-Home Senior Care in Texas (2026)
- What Does In-Home Care Actually Cost in Texas?
- Home Care vs. Nursing Home: What Texas Families Need to Know
- Why the Direct-Hire Model Creates Better Caregiving Relationships
Sources & Citations
This article is for informational purposes only and does not constitute financial, legal, or benefits counseling. Program eligibility, benefit amounts, and waitlist status change frequently. Consult a licensed elder law attorney, a VA-accredited claims agent, or your local Area Agency on Aging for guidance specific to your situation. BubbieCare is a care concierge service and does not administer or advise on government benefit programs.