Companion care typically costs between $30 and $35 per hour at the national level, though what you actually pay depends heavily on where you live, how many hours you need, and whether you hire through an agency or find a caregiver independently. For someone needing 20 hours of care per week at $33 per hour, that works out to roughly $2,640 per month, or about $31,680 per year.
National Average Rates in 2025
The national median for companion care (sometimes listed as “homemaker services”) sits around $30 to $35 per hour. Agency-based in-home care specifically has reached a median of $33 per hour in 2025, with many metro areas running considerably higher. In the San Francisco Bay Area, for example, agencies charge $45 to $60 per hour for the same services.
These rates cover non-medical support: companionship, light housekeeping, meal preparation, help with errands, transportation to appointments, and general supervision for someone who shouldn’t be left alone. If your loved one needs hands-on medical care like wound management or medication administration, you’re looking at skilled home health services, which cost more.
Agency vs. Independent Caregiver
The single biggest factor in what you’ll pay is whether you go through a home care agency or hire a caregiver directly. Independent caregivers typically charge $20 to $25 per hour, while agencies charge $33 to $40 or more. That means agencies run 30 to 50% higher than hiring someone on your own.
The price gap exists for real reasons. Agencies handle background checks, caregiver vetting, scheduling, backup coverage if your caregiver calls in sick, payroll taxes, and liability insurance. When you hire independently, all of that falls on you. You become a household employer, responsible for payroll taxes, workers’ compensation insurance in most states, and finding a replacement on short notice if something goes wrong. Many families find the agency premium worth the convenience, but if budget is the primary concern, hiring independently can save $400 to $600 per month on a 20-hour weekly schedule.
What Drives the Price Up or Down
Geography is the most obvious variable. Care in Hawaii, coastal California, or the Northeast corridor costs significantly more than in the Southeast or rural Midwest. AARP data shows the affordability gap is dramatic: home care consumes around 63% of a typical annual income in some states but exceeds 100% of annual income in others like Minnesota.
Hours per week also affect your rate. Many agencies set a weekly minimum (often 12 to 20 hours) and may offer a slightly lower hourly rate for higher-volume schedules. Conversely, if you only need a few hours on weekends, expect to pay at or above the top of the range. Overnight care, holiday hours, and last-minute scheduling often carry surcharges.
The level of support matters too. Basic companionship, where the caregiver is mostly present for conversation, safety, and light tasks, sits at the lower end. If your loved one needs help with bathing, dressing, toileting, or has dementia-related behaviors that require close supervision, caregivers with that experience command higher rates.
What Medicare Covers (and Doesn’t)
Medicare does not pay for companion care. The program explicitly excludes homemaker services like shopping and cleaning that aren’t tied to a medical care plan, along with custodial or personal care (bathing, dressing, using the bathroom) when that’s the only care someone needs.
There is one narrow exception. If your loved one qualifies for Medicare home health services because they need skilled nursing, physical therapy, speech therapy, or occupational therapy, Medicare will also cover a part-time home health aide to help with tasks like bathing, grooming, and walking. But that aide coverage is tied directly to the skilled care. Once the therapy or nursing ends, so does the aide benefit. And it never extends to the kind of ongoing, open-ended companionship most families are searching for.
Medicaid and State Programs
Medicaid is the more realistic path to financial help for companion care, though eligibility requirements are strict. Most states operate Home and Community-Based Services (HCBS) waivers that cover non-medical support including homemaker services, personal care, adult day programs, and respite care. The goal of these waivers is to keep people in their homes rather than in nursing facilities.
To qualify, your loved one generally needs to meet two criteria: financial eligibility under your state’s Medicaid rules and a demonstrated need for the level of care that would otherwise require a nursing home. Each state designs its own waiver programs with different services, income limits, and waiting lists. Waiting lists are common and can stretch months or even years in high-demand states. Contact your state’s Medicaid office or Area Agency on Aging to find out what’s available locally and how to apply.
Long-Term Care Insurance
If your loved one purchased a long-term care insurance policy years ago, it likely covers companion or homemaker services, though policies vary widely. Most require a benefit trigger, typically the inability to perform two or more activities of daily living (eating, bathing, dressing, toileting, transferring, continence) or a cognitive impairment diagnosis. Review the policy carefully for daily or monthly benefit caps, elimination periods (the waiting period before benefits kick in), and whether it requires using a licensed agency.
Tax Deductions for Care Expenses
You may be able to deduct companion care costs on your federal taxes if the care qualifies as a medical expense. The IRS allows you to deduct medical expenses that exceed 7.5% of your adjusted gross income when you itemize deductions on Schedule A. For care to count, it generally needs to be for someone with a medical condition that requires the assistance, not purely social companionship. If your parent has Alzheimer’s and needs supervision for safety, those costs are more likely to qualify than hiring someone simply for company.
For families with a dependent care need that allows them to work, a Dependent Care Flexible Spending Account can also offset some costs with pre-tax dollars, though the annual contribution limits are relatively low compared to the total cost of ongoing care.
Estimating Your Monthly and Annual Costs
Here’s what companion care looks like at different levels of need, using the 2025 national agency median of $33 per hour:
- 10 hours per week: roughly $1,320/month or $15,840/year
- 20 hours per week: roughly $2,640/month or $31,680/year
- 40 hours per week: roughly $5,280/month or $63,360/year
Hiring independently at $22 per hour would bring those numbers down to about $880, $1,760, and $3,520 per month respectively. These figures don’t account for employer taxes and insurance you’d owe as a household employer, which typically add 10 to 15% on top of the caregiver’s wages.
Care needs also tend to increase over time. Someone who starts with 10 hours a week of light companionship may need 30 or 40 hours within a year or two as their condition progresses. Home care costs have historically risen with general inflation, averaging about 2.5% per year over the past three decades. Planning for gradual increases in both hours and hourly rates gives you a more realistic long-term budget.