Does Medicare pay for a caregiver to come to the house? For the kind of help most St. Louis families are looking for, no. Original Medicare does not pay for ongoing non-medical care at home: someone to help with bathing, dressing, meals, light housekeeping, companionship or getting through the day safely. Medicare calls that custodial care, and when it is the only care your parent needs, Medicare does not cover it.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
What Medicare does cover is home health: skilled, part-time or intermittent care for a person who is homebound, ordered under a plan of care by a doctor or other approved practitioner. Home health can include visits from a home health aide, but only alongside the skilled care, and only for as long as the skilled need lasts. It is not a caregiver who stays for a shift. If your parent is in a Medicare Advantage plan, some plans offer limited in-home support as a supplemental benefit. Call the number on the plan card and ask; do not assume.
So for most families the real question is not "will Medicare pay" but "who pays, and what drives the amount." This sheet is about the second part.
Step 1: Check the payers that might apply
Run down this list and write yes, no or unknown next to each one.
1. Medicare home health. Is there a skilled need right now, such as after a hospital stay, and is your parent homebound? If yes, ask the doctor about a home health referral. It will not replace a caregiver, but it may cover part of the week.
2. Medicare Advantage supplemental benefit. Does the plan list any in-home support? Ask how many hours, who provides it, and whether it needs approval first.
3. MO HealthNet (Missouri Medicaid). Missouri has in-home programs with their own financial and care-need eligibility rules. If your parent may qualify, the application comes before the help, so start early.
4. Long-term care insurance. Find the policy. Some pay for home care depending on the policy terms, often after a waiting period and only through certain kinds of providers.
5. Veterans benefits. If your parent or a late spouse served, ask the VA what in-home or pension benefits might apply.
6. Private pay. Your parent's income and savings, or the family's. For most households this is the payer for at least some of the hours.
The Sources page lists the public pages behind each of these.
Step 2: Know what pushes a private-pay bill up
When you are paying privately, the number of hours matters most, but it is not the only lever. Write down how each of these applies to your parent.
What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).
Shift length and minimums. Many providers have a minimum visit length. A short daily need can bill as a longer shift.
Time of day and week. Nights, weekends and holidays may carry a different rate.
Amount of hands-on help. A parent who needs help standing, bathing or toileting may require a more experienced caregiver, or two people for some tasks.
Consistency. Asking for the same caregiver every visit is reasonable, but long consecutive hours for one worker can create overtime.
Driving and errands. Taking your parent to appointments or picking up a prescription may add mileage or a separate charge.
Agency or direct hire. An agency rate includes things you would otherwise do yourself: screening, payroll, backup coverage. A direct hire can cost less per hour but makes you the employer. The agency or direct page walks through that trade.
Step 3: Know what can bring it down
Cut hours you do not need, not hours you do. Families often lower the bill by covering one predictable block themselves, grouping tasks into fewer, fuller visits instead of many short ones, using adult day programs for part of the week, and letting Medicare home health cover the skilled piece when it applies. Ask each provider: "If I change the schedule this way, what happens to the total?"
Step 4: Questions for the first phone call
1. Do you accept any payer besides private pay? Which ones, and what do you need from me to bill them?
2. What is your minimum visit, and what is your minimum number of hours per week?
3. Are nights, weekends or holidays billed differently?
4. What tasks are included, and which ones cost extra?
5. How often do you send an invoice, and what does it show?
Write the answers down next to the provider's name. A provider that tells you Medicare will cover an ongoing caregiver with no skilled need is a provider to walk away from.
Step 5: What the caregiver will actually do
Non-medical in-home help covers the day-to-day: help with bathing and dressing, meals, laundry, light cleaning, company, walks, rides, and medication reminders when the family has set them up. A caregiver can pick up a prescription as an errand. They do not hand out or manage medicine, and they do not provide nursing care.
Step 6: Get it started
Finish the payer list, settle on a starting number of hours, and call two or three providers with the same task list. Book a short trial week, then look at the first invoice line by line before you add hours. Start Here: Five Steps to Hiring gives you the order, and Local Help lists public offices in the St. Louis area that can help you check what your parent may qualify for.