Private Pay vs. Medicaid: Understanding Your Home Care Payment Options
Home Care for Alzheimer’s & Dementia in Iowa That Feels Like Family
Dr. Aishat O. MPH
6/22/20253 min read
Choosing the right way to pay for in-home care can feel overwhelming. Between out-of-pocket costs, government programs, and the fine print in eligibility rules, it’s easy to lose sight of what really matters: finding compassionate, reliable support for your loved one. In this guide, we’ll unpack the two primary payment paths—Private Pay and Medicaid Waiver—so you can make an informed decision that fits your family’s needs and budget.
1. Private Pay: Flexibility & Control
What It Is
Private Pay means you cover care costs directly, either out of savings, a pension, or long-term care insurance. You’re not restricted by government rules or bureaucratic approvals—your only limit is your budget.
Key Advantages
Total Choice: You select your caregiver, schedule, and services without waiting for state approval. Whether you need two hours a week or round-the-clock support, you call the shots.
Speed of Service: Once you decide to start, Maxona Care can have a trained caregiver in your home within 24–48 hours. No lengthy applications or waiting lists.
No Eligibility Barriers: There are no income or asset tests—if you can pay, you can access care.
Considerations
Budget Impact: Rates typically range from $35 average per hour in Iowa (varying by region and service level). Costs can add up quickly for high-touch care (overnights, 24/7).
Tax Benefits: Many families don’t realize that home care expenses may be tax-deductible if they exceed a percentage of your adjusted gross income. Check with your tax advisor.
Insurance Coordination: If you have long-term care insurance, verify which services and providers are covered to maximize benefits.
2. Medicaid Waiver: Subsidized Support for Eligible Families
What It Is
Iowa’s Medicaid Home and Community-Based Services (HCBS) Waiver programs—such as the Elderly Waiver—let qualifying seniors and individuals with disabilities receive non-medical home care at reduced or no cost.
Key Advantages
Reduced Out-of-Pocket Costs: Waiver recipients typically pay little to nothing for covered services like personal care assistance, homemaker support, and respite care.
Broader Service Scope: In addition to personal care and homemaking, waivers may cover adaptive equipment, home modifications (grab bars, ramps), and adult day services.
Care Coordination: A Medicaid case manager helps develop and monitor your care plan, ensuring services match evolving needs.
Eligibility & Process
Financial Assessment: Income and asset limits generally align with Supplemental Security Income (SSI) thresholds. Spousal “impoverishment” rules may protect a healthy spouse’s resources.
Functional Assessment: A qualified assessor evaluates daily living challenges—bathing, dressing, meal prep—to confirm the need for home-based support over facility care.
Enrollment & Waitlists: Waiver slots can fill up, so families often face waiting lists. Once approved, you’ll work with a case manager and authorized provider like Maxona Care to finalize your plan.
Considerations
Approval Timeline: Plan ahead—waiver authorization can take several weeks or months.
Provider Limits: You must use state-approved agencies. Maxona Care is fully enrolled as a Medicaid Waiver provider, so we handle paperwork and scheduling.
Care Plan Flexibility: While comprehensive, changes to your care plan may require additional approvals.
3. Side-by-Side Comparison
Feature Private Pay Medicaid Waiver
Speed to Start 24–48 hours Weeks to months (eligibility)
Cost to Family Full hourly rate Minimal co-pay or none
Service Flexibility Fully flexible Must follow approved care plan
Provider Choice Any qualified agency/person Must use waiver-enrolled agency
Additional Covered Services Limited to what you pay for Includes equipment & mods
4. Which Option Is Right for You?
Short-Term Need & No Eligibility Issues? Private Pay is ideal for post-surgical recovery or temporary respite.
Long-Term, Ongoing Care With Financial Constraints? The Medicaid Waiver offers peace of mind and greater affordability.
Mixed Approach? Many families start with Private Pay while their waiver application is pending, then transition once approved.
5. How Maxona Care Can Help?
Whether you choose Private Pay or the Medicaid Waiver, Maxona Care is here to guide you:
Expert Navigation: We walk you through waiver applications, assessments, and documentation.
Seamless Onboarding: Our “Fast Start” process means caregiving can begin in just 1–2 days for private pay clients.
Dedicated Care Coordination: From personalized care plans to 24/7 support, we adjust services as needs evolve.
Ready to explore your options? Contact Maxona Care today at (470) 756-1751 or visit www.maxonacare.com for a free consultation. Let us help you find the payment path that keeps your loved one safe, comfortable, and thriving at home.
