What does home care cost when Medicare does not pay?

Since Medicare does not cover non-medical home care, the cost question is about agency rates, hour bands, and which private funding source applies. Southeast Michigan 2026 agency pricing runs three tiers: Companion ($27–$32/hr) for non-hands-on support, Personal ($29–$37/hr) for hands-on ADL help, and Specialized ($35–$42/hr) for dementia, Parkinson\u2019s, stroke, and other higher-acuity cases.

A typical starting configuration is a 4-hour daytime block, 5 days a week — roughly $540–$740/week for most Personal Care cases. Hours scale up as need grows. At around 12 daily one-on-one hours, live-in care ($400–$500/day, requires a private bedroom and a compliant sleep window) becomes the more economical model.

The rate includes caregiver wages, payroll tax, workers compensation, liability insurance, training, Registered Nurse oversight of the care plan, and access to a vetted backup roster. Private-hire ranges ($18–$28/hr) exclude all of that — those responsibilities shift to the family, who effectively becomes the household employer.

Funding sources most Southeast Michigan families use, in order of frequency: private pay, long-term care insurance (once ADL or cognitive triggers are met and paid receipts submitted), VA Aid & Attendance (eligible wartime veterans and surviving spouses), and the MI Choice Medicaid waiver (income-tested).

For the full breakdown, see the cornerstone: Home Health vs. Home Care guide.