How to Pay for In-Home Nursing Care in Texas: Medicare, STAR+PLUS, VA Benefits, and Private Pay
Home Care Directory Editorial TeamMay 2, 2026
Last reviewed for accuracy: May 8, 2026.
Home health care in the Dallas-Fort Worth area can cost anywhere from $22 to $120 or more per hour depending on the type of care, the agency, and the payer. That range is wide enough to be paralyzing - and most families start searching for care without a clear picture of what they will actually pay or who will help cover the cost.
The good news is that most Dallas families have more payment options than they realize. Medicare, Texas Medicaid managed care (STAR+PLUS), private insurance, VA benefits, long-term care insurance, and private pay can all play a role depending on the patient's situation. The challenge is understanding which programs apply, what they cover, and how to access them.
This guide walks through every major payment option available to Dallas-Fort Worth families in 2026.
Quick answer: Dallas families typically pay for in-home nursing care through a mix of Medicare, STAR+PLUS Medicaid managed care, private insurance, long-term care insurance, VA benefits, and private pay. The right option depends on whether the care is skilled, non-medical, short-term, long-term, and whether the patient meets each program's eligibility rules.
What Home Health Care Costs in Dallas
Before diving into payment options, here is what care typically costs in the DFW market:
Private pay, STAR+PLUS Community Attendant Services, some long-term care insurance
Private duty nursing (extended shifts)
$45-$85
Private pay, some Medicaid waiver programs, some long-term care insurance
Live-in care
$225-$350/day
Private pay
These are general ranges. Actual costs depend on the agency, level of care, shift length, location within the DFW metro, and whether the agency charges travel fees for visits in outlying suburbs like McKinney, Frisco, or Weatherford.
Medicare is the single most important payer for home health care in Texas. If your family member is 65 or older (or qualifies for Medicare due to disability), Medicare may cover eligible home health services. In Original Medicare, you generally pay nothing for covered home health services, though Part B cost-sharing can still apply to Medicare-covered medical equipment.
Medicare Home Health Eligibility
Medicare may cover home health services when the patient meets these general requirements: the patient is under the care of a physician or allowed practitioner who orders home health services, the patient needs part-time or intermittent skilled nursing care, physical therapy, or speech-language pathology services (or continuing occupational therapy after the qualifying need begins), the patient is homebound, and the patient receives services from a Medicare-certified home health agency (LCHHS in Texas).
What Medicare Covers
When eligibility requirements are met, Medicare home health benefits may include skilled nursing care, physical therapy, occupational therapy, speech-language pathology, medical social work, and part-time or intermittent home health aide services when provided as part of a skilled plan of care.
What Medicare Does Not Cover
Medicare generally does not cover 24-hour-a-day care at home, personal care when it is the only care needed, homemaker services such as shopping, cleaning, or laundry when those services are not part of the covered plan of care, or meals delivered to the home.
How to Access Medicare Home Health in Dallas
Ask your family member's physician to order home health services. The physician's office will typically coordinate with a Medicare-certified LCHHS agency to begin care. You have the right to choose your agency - you do not have to use the agency the hospital or physician suggests. Browse LCHHS agencies in our directory to compare options.
Texas Medicaid: STAR+PLUS
Texas delivers most Medicaid services through managed care plans. For adults with disabilities and seniors, the primary program is STAR+PLUS, which combines acute care and long-term services and supports (LTSS) into a single managed care plan.
What STAR+PLUS Covers
STAR+PLUS may cover home health services including skilled nursing and therapy through an LCHHS or LHHS agency, Community Attendant Services (CAS) providing personal care assistance, and other long-term services and supports depending on the member's assessed needs, plan authorization, and service plan.
STAR+PLUS Eligibility
STAR+PLUS eligibility is generally limited to adults who are aged 65 or older, blind, or have a disability, and who meet Texas Medicaid financial eligibility requirements. Enrollment in STAR+PLUS is managed through the Texas Health and Human Services Commission.
How to Apply
Apply for Texas Medicaid through YourTexasBenefits.com or contact the HHSC toll-free at 2-1-1. If approved for STAR+PLUS, you will be enrolled in a managed care plan that coordinates your home health and attendant care services.
Private Health Insurance
Many commercial health insurance plans cover some home health services, typically skilled nursing and therapy ordered by a physician. Coverage varies widely by plan, and families should contact their insurance company directly to understand what is covered, what requires prior authorization, and what the copay or coinsurance obligations are.
Private insurance generally does not cover long-term personal care or custodial care. It is most useful for short-term post-surgical or post-hospitalization home health.
Long-Term Care Insurance
If your family member purchased a long-term care insurance policy, it may cover some or all of the cost of home health care - including personal care services that Medicare and private insurance typically do not cover.
Long-term care insurance policies vary significantly in what they cover, what triggers benefits, and what daily or monthly maximum they pay. Review the policy carefully or contact the insurer to understand the benefit structure, elimination period, and documentation requirements.
When filing claims, ask your home health agency to provide detailed invoices showing dates of service, hours, services provided, and the caregiver's credentials.
VA Benefits
Dallas-Fort Worth has one of the largest veteran populations in the country. Veterans enrolled in VA health care may be eligible for VA-funded home health services, and wartime veterans who need help with daily activities may qualify for Aid and Attendance pension benefits that can help pay for private home care.
When insurance, Medicare, Medicaid, and VA benefits do not cover the care your family needs - or do not cover enough of it - private pay fills the gap. This is the most common payment method for non-medical personal care (PAS services), extended-hour or live-in care, and private duty nursing beyond what insurance authorizes.
Tips for managing private-pay costs: ask agencies about minimum shift requirements (some require 4-hour minimums, others offer shorter visits), compare rates across multiple agencies in our directory, ask about discounts for longer shifts or weekly commitments, and keep detailed records of all care expenses for potential tax deductions or Aid and Attendance calculations.
Other Payment Sources
Workers' compensation. If the home health need results from a workplace injury, workers' compensation may cover skilled nursing and therapy services through an LHHS or LCHHS agency.
Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA). Home health expenses may qualify as eligible medical expenses under HSA and FSA rules. Consult your plan administrator.
Tax deductions. Home health care expenses may be deductible as medical expenses on your federal tax return if they exceed the applicable percentage of adjusted gross income. Consult a tax professional for guidance specific to your situation.
Most Dallas families have more options for paying for home health care than they initially realize. Start with Medicare if the patient qualifies for skilled services. Explore STAR+PLUS if the patient meets Medicaid eligibility criteria. Check VA benefits for veterans. Review long-term care insurance policies. And when private pay is necessary, compare agencies carefully and keep detailed records of every expense.
Costs vary by type of care. Non-medical personal care through a PAS agency typically runs $22-$35 per hour. Skilled nursing through an LCHHS or LHHS agency ranges from $45-$85 per hour for private-pay visits. Medicare-covered skilled home health visits generally have no copay.
Does Medicare pay for home health care in Dallas?
Medicare may cover skilled home health services - including nursing, therapy, and medical social work - when the patient is homebound, under a physician's care, needs part-time or intermittent skilled services, and receives care through a Medicare-certified LCHHS agency. Medicare does not cover custodial personal care alone.
What is STAR+PLUS and does it cover home health?
STAR+PLUS is Texas's Medicaid managed care program for seniors and adults with disabilities. It may cover skilled home health services and Community Attendant Services (personal care) depending on the member's eligibility and assessed needs.
Can VA benefits pay for home health in Dallas?
Yes. Veterans enrolled in VA health care may receive VA-funded home health services. Wartime veterans may also qualify for Aid and Attendance pension benefits that can help pay for private home care through any provider.
