In-Home Companion Care: Costs, Services & How to Provide It (2026)
In-home companion care costs $18-$32/hr. See what is covered, who pays (Medicare, Medicaid, VA), and how agencies staff companion services. Updated 2026.
Companion Care Cost Calculator
Adjust the inputs and watch costs update instantly.
Weekly
$480
Monthly
$2,064
Annual
$24,960
Compare: assisted living averages $4,500-$6,000/month nationally.
Default rates sourced from BLS Occupational Employment Statistics, Home Health and Personal Care Aides (SOC 31-1120), May 2024 data.
Key Takeaways
- Companion care provides social support, no medical tasks.
- Typical cost runs $18 to $32 per hour.
- Medicare does NOT cover it; Medicaid waivers often do.
- VA Aid and Attendance can fund eligible veterans.
- Agencies: check the FLSA exemption before setting pay.
Estimate Your Companion Care Cost
The true monthly cost of in-home companion care depends on three numbers. Those numbers are how many hours per week you need, your local hourly rate, and how many weeks per year you plan to cover.
BLS data shows the national median rate for home care aides is around $24/hour as of 2024. Plug in your own hours and rate above to see weekly, monthly, and annual costs update live, and compare the total against the price of assisted living.
What Is In-Home Companion Care?
In-home companion care provides scheduled social support, light household assistance, and safety supervision for older adults, with no medical procedures and no hands-on personal care. It keeps seniors engaged and safe at home without the cost or disruption of a facility.
Companion care
Companion care is non-medical, in-home support focused on reducing social isolation and helping seniors maintain daily routines safely at home.
Companion caregivers are not home health aides. A companion's day looks like conversation, errands, light meal prep, a ride to the doctor, and a reminder to take medications. For many families arranging in home companion care for seniors, this is the first and gentlest step.
8 common companion care services
- Conversation and social engagement
- Light housekeeping and laundry
- Grocery shopping and errands
- Meal preparation (not tube feeding)
- Transportation to appointments
- Medication reminders (not administration)
- Reading, games, and hobbies
- Safety supervision and fall watching
Social isolation is a documented health risk. The CDC links chronic loneliness in older adults to higher rates of cognitive decline, more hospitalizations, and increased mortality. That is why an in home companion matters medically even though the work itself is not medical.
What Companion Care Does NOT Include
Companion care does not include bathing, dressing, wound care, injections, or any task requiring a certified aide or nurse. Those tasks belong to personal care aides and skilled home health staff, who hold different certifications.
| Task | Companion Care | Personal Care / Home Health |
|---|---|---|
| Bathing / dressing | No | Yes |
| Medication reminders | Yes | Yes (admin: HHA only) |
| Wound care / injections | No | Yes (skilled nurse) |
| Meal prep | Yes | Yes |
| Transportation | Yes | Sometimes |
| 24/7 medical monitoring | No | Yes |
This distinction matters for licensing, billing, and FLSA. Companion-only agencies operate under lighter regulatory standards than personal-care or skilled providers in most states, which shapes everything from staffing to insurance. The agency-owner section below covers what that means in practice.
How Much Does In-Home Companion Care Cost?
In-home companion care typically costs $18 to $32 per hour in 2024 to 2025, with a national median of about $24/hour based on BLS data for home care aides. Your actual rate depends mostly on where you live and whether you hire through an agency.
Agency rates run 30 to 50% higher than direct-hire rates. That markup pays for overhead, backup coverage when your caregiver is sick, liability insurance, and background screening. Hiring directly is cheaper but leaves you without a replacement and responsible for your own vetting, so the cost of companion care reflects which path you choose.
| Region | Typical hourly range |
|---|---|
| Northeast | $26-$35 |
| Southeast | $17-$24 |
| Midwest | $18-$26 |
| Southwest | $19-$27 |
| West | $22-$32 |
Monthly costs depend entirely on hours per week. A common starting schedule of 20 hours per week at the $24 national median works out to roughly $2,064 per month (20 x $24 x 4.3 weeks). Slide the hours up or down in the calculator above to see how quickly the elderly companion care costs change with your schedule.
Factors that move your rate
Urban vs. rural location | agency vs. direct hire | overnight vs. daytime | specialized dementia care | holiday and weekend premiums.
Compare this to assisted living at $4,500 to $6,000 per month nationally. For a senior who needs companionship and light help but not round-the-clock facility care, in home companion care cost is a fraction of that. Use the calculator above to estimate your specific monthly and annual figure before you call any agency.
Does Medicare Pay for In-Home Companion Care?
Medicare does not pay for in-home companion care. It only covers skilled nursing and therapy services prescribed by a doctor as part of a home health plan of care, not companionship or custodial help.
Medicare exclusion
Medicare Part A and Part B explicitly exclude custodial and companion care unless the patient also qualifies for skilled home health services. Source: Medicare.gov.
This surprises most families. Medicare does cover home health when a doctor orders skilled nursing, physical therapy, or occupational therapy, but companionship is categorically excluded from that benefit. So the answer to "does Medicare cover companion care" is a clean no for the social-support side of care.
Most families pay out of pocket, but three alternative sources can offset costs significantly. Knowing which one fits your situation often turns an unaffordable plan into a workable one. The funding paths below cover who qualifies and how to claim each one.
What Does Pay for Companion Care?
Medicaid HCBS waivers, VA Aid & Attendance, long-term care insurance, and private pay are the four realistic funding paths for most families. Each has its own eligibility rules and its own paperwork.
Medicaid HCBS Waiver
Funds companion care for income- and asset-eligible seniors in most states. Companion services are billed under a state-approved waiver code. See Medicaid.gov for waiver details and our Medicaid HCBS waiver programs by state guide for state-level breakdowns.
VA Aid & Attendance
Pays eligible veterans up to about $2,300/month and surviving spouses up to about $1,400/month as of 2024. See VA.gov for current benefit amounts and our guide to VA benefits for in-home care for the full application process.
Long-Term Care Insurance
Many policies cover companion care after the elimination period. Check policy language for non-medical home care, daily benefit limits, and claim documentation rules before assuming coverage.
Private Pay
The most common path. Stretch the budget by reducing hours, sharing care across siblings, or negotiating agency rates for a recurring weekly schedule.
Coverage varies by state
Medicaid HCBS waiver coverage varies by state. Some states cover companion care under personal care waiver programs; others require a separate home-and-community-based waiver. Check your state Medicaid agency or visit Medicaid.gov.
For agency owners, the payer mix matters. Medicaid-billable companion care requires specific service codes and visit documentation, while non-Medicaid companion care is typically private pay or long-term care insurance. The ACL tracks how older adults use these services nationally, and the federal payer rules shape how you bill.
Signs Your Parent May Need In-Home Companion Care
The clearest sign is a pattern of withdrawal: skipped meals, missed appointments, reduced contact with friends, and statements of loneliness or purposelessness. One bad week is normal; a steady drift away from routine is the signal worth acting on.
7 signs to watch for
- Increasing social withdrawal or refusals to leave home
- Skipped meals or unplanned weight loss
- Missed medical appointments or medication doses
- Home more disorganized than usual
- Direct statements of loneliness or boredom
- Slow recovery after illness or hospitalization
- Reduced mobility creating isolation (cannot drive)
The 40-70 rule says start the conversation before a crisis. Once a parent is past 70 and the adult child is past 40, it is time to talk about care rather than wait for an emergency. Federal data from the ACL shows how common home-based support has become for this age group.
Pro tip
Frame the first companion visit as 'someone to help around the house' rather than 'a caregiver.' Seniors resist caregiving labels but accept practical help.
Companion care can be a trial run. Starting with 10 to 15 hours per week of a live in companion for elderly support, or scheduled daytime visits, often delays or avoids more intensive and expensive care settings. For a structured needs assessment, work through our ADL-based assessment to determine your parent's care level.
Companion Care vs. Personal Care vs. Home Health: Which Does Your Parent Need?
Choose companion care when your parent needs social support and help with daily routines; choose personal care when they need hands-on bathing, dressing, or toileting; choose home health when a doctor has ordered skilled nursing or therapy. Matching the tier to the actual need keeps you from overpaying or underbuying.
| Companion Care | Personal Care | Home Health | |
|---|---|---|---|
| Typical tasks | Conversation, errands, reminders | Bathing, dressing, grooming | Wound care, injections, PT/OT |
| License required | Usually none (varies by state) | HHA/CNA certification | RN/LPN/PT/OT license |
| Medicare-covered | No | No (unless with skilled care) | Yes (if criteria met) |
| Avg. hourly cost | $18-$32 | $22-$38 | $35-$75+ |
Many families start with companion care and step up. The usual progression runs companion care, then personal care, then home health, then a facility. By keeping a senior engaged and safe, companion care sits at the front of that path and often delays the move to costlier tiers.
One roof, three tiers
Some agencies offer all three tiers: companion, personal care, and skilled nursing. That makes transitioning easier for the client and simpler to coordinate for the family.
For agencies, companion-only scope is the lowest regulatory burden. Non-medical companion agencies often operate without a license in states that do not require one for non-ADL care. For how this maps to care tiers, see how companion care differs from personal care and home health and the state-by-state home care licensing requirements.
For Agency Owners: How to Launch a Companion Care Service Line
Companion care is the lowest-barrier service line a non-medical home care agency can add. It needs no clinical staff, carries a lighter regulatory burden than personal care in most states, and rides strong demand from the 73 million baby boomers now reaching peak care-need age.
The market opportunity is real. BLS projects home care aide employment to grow 22% through 2032, much faster than the average for all occupations. Companion care is the entry point for most families, so agency owners who offer it capture top-of-funnel clients who later convert to higher-acuity services.
Companion care also opens the door to your full menu. For the complete startup path, see how to launch a non-medical home care agency.
FLSA and the Companionship Services Exemption
The FLSA 29 CFR Part 552 companionship services exemption has been significantly narrowed. As of 2015, it applies only to direct employers such as families, not to third-party agencies.
2015 DOL rule
Third-party home care agencies CANNOT use the companionship exemption to avoid paying overtime to companion caregivers. If your agency employs a companion caregiver working 40+ hours/week, federal overtime rules apply. Source: 29 CFR Part 552.
This means companion caregiver overtime is your liability. Under the 2015 Department of Labor rule, agencies must track every hour, pay time-and-a-half above 40 hours, and stop relying on the old exemption. For the mechanics, see the overtime rules for home care agencies.
What to Pay Companion Caregivers (BLS Data)
The BLS national median for home health and personal care aides (SOC 31-1120) is $15.68/hour as of May 2024, and companion caregiver pay typically falls within this range. Regional differences are large, so set pay against your local market, not the national figure.
| Region | Median hourly | 90th percentile hourly |
|---|---|---|
| National | $15.68 | $21.94 |
| Northeast | $18.42 | $25.10 |
| Southeast | $13.91 | $19.30 |
| Midwest | $14.85 | $20.60 |
| West | $17.20 | $23.50 |
Pay to retain
Pay at or above the regional 25th percentile to reduce turnover. Companion caregiver turnover costs agencies $2,000-$5,000 per lost hire in recruitment, onboarding, and client disruption.
8-Step Companion Care Service Line Launch Checklist
Most companion care service lines launch in 60 to 90 days. The bottlenecks are background checks and referral-partner outreach, not licensing.
Define companion-only scope
Document in writing what your caregivers will and will not do.
Check state licensure
Most states do not require a license for non-ADL companion services; some do. See the state-by-state home care licensing requirements guide for details.
Hire and background-check
Run federal plus state-specific background checks before the first client visit.
Set your hourly rate
Price 20-35% above your caregiver wage to cover overhead, insurance, and margin. See how to price your companion care service line in our rate setting guide.
Draft service agreements
Cover scope of care, scheduling terms, cancellation policy, and liability waiver.
Set up scheduling software
Companion care needs caregiver-client matching, recurring visit management, and time-tracking. AveeCare's caregiver scheduling for companion care agencies handles all three.
Get referral partners
Hospital discharge planners, geriatric care managers, senior centers, and Area Agencies on Aging are the fastest lead sources.
Enroll in Medicaid (optional)
To accept Medicaid-funded clients, enroll as a Medicaid provider with your state agency before the first referral.
AveeCare is built for non-medical companion care agencies.
Scheduling, client management, caregiver time-tracking, and visit documentation are purpose-built for non-medical providers across all 50 states.
Frequently Asked Questions About In-Home Companion Care
Does Medicare pay for in-home companion care?
No. Medicare Part A and Part B do not cover companion care, custodial care, or homemaker services. Medicare only covers home health services when a doctor orders skilled nursing or therapy as part of a home health plan of care. For funding, families typically turn to Medicaid HCBS waivers, VA Aid & Attendance, long-term care insurance, or private pay.
How much does in-home companion care cost per month?
In-home companion care typically costs $18-$32 per hour, with a national median of around $24/hour based on 2024 BLS data. At 20 hours per week, that works out to approximately $2,000-$2,800 per month at national median rates. Costs are higher in the Northeast and West and lower in the Southeast and Midwest.
What does companion care include?
Companion care includes social engagement and conversation, light housekeeping, grocery shopping and errands, meal preparation, transportation to appointments, medication reminders (not administration), and safety supervision. It does not include hands-on personal care tasks like bathing, dressing, wound care, or any procedure requiring a certified aide or nurse.
Who pays for companion care if Medicare doesn't?
Four sources can offset the cost. Medicaid Home and Community-Based Services (HCBS) waivers fund companion care for income-eligible seniors in most states. VA Aid & Attendance provides monthly benefits up to $2,300 for qualifying veterans and up to $1,400 for surviving spouses. Long-term care insurance policies often cover companion care after the elimination period. Most families supplement or fully self-pay through private pay.
Do I need a license to start a companion care agency?
It depends on your state. Many states do not require a license for agencies that provide only non-medical companion services (no hands-on personal care). States like California, New York, and Illinois do require a home care organization license even for companion-only agencies. Always check your state health department's requirements before operating. See our state-by-state home care licensing guide for details.
What is a companion caregiver's typical salary?
The BLS reports a national median hourly wage of $15.68 for home health and personal care aides (SOC 31-1120) as of May 2024. Companion caregiver pay typically falls in this range. Pay varies significantly by region. The Northeast and West Coast generally pay $18-$22/hour, while the Southeast averages $13-$16/hour.
Sources
- 1.BLS Occupational Employment Statistics, Home Health and Personal Care Aides (SOC 31-1120). Median and percentile wage data by region. Accessed 2026-05-25.
- 2.BLS Occupational Outlook Handbook, Home Health and Personal Care Aides. Job growth projections and role duties. Accessed 2026-05-25.
- 3.Medicare.gov, Home Health Services Coverage. Confirms companion and custodial care is not covered. Accessed 2026-05-25.
- 4.Medicaid.gov, Home and Community-Based Services (HCBS) Waivers. State waiver programs that can fund companion care. Accessed 2026-05-25.
- 5.VA, Aid and Attendance and Housebound Benefits. Benefit amounts for veterans and surviving spouses. Accessed 2026-05-25.
- 6.ACL, Aging Statistics. Federal data on older adult service utilization. Accessed 2026-05-25.
- 7.CDC, Social Isolation and Loneliness in Older Adults. Isolation prevalence and health risks. Accessed 2026-05-25.
- 8.29 CFR Part 552, FLSA Companionship Services Exemption. Overtime rules for companion caregivers. Accessed 2026-05-25.
About the Author
Cal Nesvig is a Founding Partner at AveeCare, which builds home care agency software for non-medical and companion care providers across all 50 states. He writes about companion care operations, caregiver workforce economics, and home care compliance based on direct work with agency owners.
This guide is informational and not legal advice. Verify state licensing and FLSA wage-and-hour obligations with your state agency or a qualified attorney before operating.
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