Home Healthcare Insurance Broker in Texas
Choosing the right home healthcare insurance is one of the most important decisions a Texas resident can make to protect independence, manage in-home care costs, and ensure access to reliable support when it matters most.
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What Home Healthcare Insurance Covers in Texas
Home healthcare insurance is not a single product. It is a category of coverage that includes multiple types of plans and programs, each designed to pay for a different layer of in-home care. The most important distinction to understand before evaluating any coverage is the difference between two types of care.
Skilled Home Health Care
Skilled home health care involves medical services provided by licensed healthcare professionals, registered nurses, licensed vocational nurses, physical therapists, occupational therapists, and speech therapists. These services require a physician's order and are medically necessary for the treatment of a specific diagnosis or recovery from a procedure. Medicare and most private health insurance plans cover skilled home health care when eligibility requirements are met.
Custodial and Personal Care
Custodial care involves non-medical assistance with activities of daily living: bathing, dressing, grooming, meal preparation, medication reminders, and household tasks. This is the most common type of home care needed by aging Texans and those with chronic conditions. Medicare does NOT cover custodial care when it is the only care needed. Most standard health insurance plans do not cover it either. Long-term care insurance and private home healthcare plans are the primary coverage sources for this category.
Medicare covers skilled home health care when a patient is homebound and has a qualifying physician order. Medicare does NOT cover 24-hour home care, custodial personal care when it is the only care needed, or homemaker services not tied to a skilled care plan.
A Texas senior who needs daily assistance with bathing, dressing, and meal preparation but no skilled nursing has NO Medicare coverage for that care.
$24 to $28 per hour — approximately $4,400 per month at 44 hours per week.The average cost of personal home care in Texas is $24 to $28 per hour, approximately $4,400 per month at 44 hours per week. Without private coverage or long-term care insurance, this expense comes entirely out of pocket.
Every Coverage Source for Home Healthcare in Texas
Texas residents drawing on home health care services have access to multiple coverage sources, each with distinct eligibility requirements, covered services, and limitations. Here is a plain-language summary of every major option:
| Coverage Source | What It Covers, Who Qualifies, and Key Limitations |
|---|---|
| Medicare Part A | Covers skilled home health services when you are homebound and have a qualifying hospital stay or physician order. Covers part-time or intermittent skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aide services tied to skilled care. Coverage pays 100% of approved costs and no copay for covered home health services. Does NOT cover 24-hour care, custodial personal care when it is the only care needed, or homemaker services unrelated to skilled medical care. |
| Medicare Advantage (Part C) | Private Medicare plans that may include expanded home health benefits beyond Original Medicare. Some Texas Medicare Advantage plans include personal care allowances, meal delivery during recovery, and extended home aide hours. Benefits vary significantly by plan and carrier. Review each plan's Summary of Benefits before enrolling. Our agent Beatrice Rivas compares Medicare Advantage plans for Texas seniors. |
| Private Home Healthcare Plans | Standalone insurance plans that cover both skilled medical services and non-medical personal care in the home. Coverage includes skilled nursing, therapies, wound care, and personal care assistance with daily living activities. Available to individuals recovering from surgery, managing chronic conditions, or receiving ongoing care at home. Available without Medicare enrollment requirements or homebound criteria. |
| Long-Term Care Insurance | Covers a broad range of home care services including both skilled nursing and custodial personal care. Typically pays a daily or monthly benefit that covers in-home caregivers, skilled nursing visits, and personal assistance. Requires purchase before care is needed — most Texas insurers will not issue LTC coverage after a diagnosis requiring home care. Best purchased in your 50s or early 60s. |
| Texas STAR+PLUS Medicaid | Texas Medicaid program for seniors and adults with disabilities who meet income and asset eligibility thresholds. Covers home and community-based services (HCBS) including personal attendant care, skilled nursing visits, therapies, and homemaker services. No-cost for eligible Texans. Managed care organization (MCO) selection required in most Texas regions. |
| Hospital Indemnity Insurance | Pays a cash benefit directly to you during and after hospitalization, including recovery at home. Can be used to pay for home healthcare services, prescription medications, and caregiving costs that your primary health plan does not cover. Works alongside your existing health insurance as a cash supplement rather than a claim-based reimbursement. |
"Most Texas families come to us knowing only about Medicare. By the time we have mapped their actual coverage situation — including private home healthcare plan options, long-term care insurance for future planning, and Texas Medicaid eligibility — they have a complete picture of what is available, what the gaps are, and what it will cost to fill them."
Not sure which coverage sources apply to your family situation?
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What Medicare Actually Covers for Home Health in Texas
Because Medicare is the most common starting point for Texas families exploring home healthcare coverage, it is worth explaining both what it covers and where its limits are in plain language.
Medicare Coverage Criteria
- You must be enrolled in Medicare Part A and/or Part B.
- Your doctor or nurse practitioner must certify that you need one or more of the following: intermittent skilled nursing, physical therapy, speech-language pathology, or continuing occupational therapy.
- You must be considered homebound, meaning you have difficulty leaving your home without assistance and leaving home requires a considerable and taxing effort. You may still leave home for medical appointments or infrequent non-medical outings without losing homebound status.
- The home health agency must be Medicare-certified.
- For all covered home health services, you pay $0. No copay, no deductible, no coinsurance for Medicare-approved home health visits.
- Care can continue as long as you meet the criteria and your physician continues to certify need. There is no fixed limit on the number of visits.
What Medicare Does Not Cover at Home
- 24-hour care, round-the-clock nursing, or live-in home care.
- Custodial and personal care when it is the only care needed — bathing assistance, dressing, grooming, and meal preparation without a concurrent skilled care plan.
- Homemaker services: housekeeping, laundry, meal delivery, and companion care unrelated to a medical care plan.
- Personal care aides hired independently by the family without a Medicare-approved agency and care plan.
2026 Home Healthcare Cost Data for Texas
Understanding what home healthcare actually costs in Texas is the foundation of any coverage planning conversation. Here are verified cost ranges across all service types and care levels:
| Service Type | Cost Range | Notes |
|---|---|---|
| Companion care and homemaker services | $20 to $30 per hour | Light housekeeping, meal preparation, transportation, and social interaction. Lowest-cost home care option. |
| Personal care assistance | $25 to $40 per hour | Bathing, dressing, grooming, toileting, and mobility assistance. Requires trained personal care aides. |
| Skilled nursing care at home | $50 to $80 per hour | Wound care, IV therapy, medication management, injections, and vital sign monitoring. Requires RN or LVN. |
| Physical or occupational therapy | $75 to $150 per visit | Licensed therapist visits for rehabilitation after surgery, stroke, or injury. Usually Medicare-covered when medically ordered. |
| Part-time care (20 hrs/week) monthly | $1,950 to $2,500/month | Dallas average April 2026: $832/week at 40 hours. Actual costs vary by care level and schedule. |
| Full-time care (44 hrs/week) monthly | $4,400 to $5,339/month | Texas statewide planning benchmark from CareScout/Genworth 2024 Cost of Care Survey. |
| 24/7 live-in care monthly | $15,000 to $22,000/month | Round-the-clock supervision and care. Most expensive option and typically exceeds nursing home costs. |
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Wilkerson Insurance Agency has been helping Texas individuals and families find coverage that works for in-home care situations since 2010. Here is specifically what working with our team delivers:
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Compare all major Texas home healthcare coverage options in one consultation at no cost to you.
Our team, led by LeRoy Wilkerson, consists of licensed, experienced professionals committed to providing personalized guidance on health insurance.
Your family member deserves professional, compassionate care in the comfort of their own home. With the right combination of Medicare, private home healthcare insurance, and Texas Medicaid programs where applicable, in-home care can be both clinically appropriate and financially sustainable. We identify every coverage source available to your family, fill the gaps, and coordinate enrollment across all relevant programs.