Private Pay for Home Care in New Hampshire: What You Need to Know

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Private pay remains the most common method families use to cover senior home care costs in New Hampshire. It refers to out-of-pocket payments made by the individual receiving care or their family. While it may seem daunting, private pay offers flexibility and access to a wide choice of care providers without strict insurance requirements.

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There are several ways families in New Hampshire manage private pay:

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1. Personal Savings and Retirement Funds  

Some families use IRAs, pensions, or savings accounts to cover home care expenses. Others rely on Social Security income or the proceeds from downsizing a home. Financial advisors often recommend planning ahead, allocating a portion of retirement funds toward potential future care.

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2. Family Contributions  

In many situations, multiple family members may contribute toward a loved one’s home care. It can be helpful to formalize this arrangement with shared budgeting or group decision-making to reduce long-term tension.

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3. Home Equity Solutions  

For homeowners, tapping into property value is a common strategy. Reverse mortgages and home equity lines of credit (HELOCs) offer ways to convert home equity into cash that can pay for care while the senior continues to live at home. It’s crucial to understand the long-term implications of these choices, including potential fees and future estate impact.

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4. Life Insurance Conversions  

New Hampshire residents with life insurance policies can sometimes convert their policy into a long-term care benefit. This option allows the policyholder to receive regular payments that can be used to pay for home care, in exchange for transferring ownership of the policy.

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5. Annuities and Structured Settlements  

If your loved one has structured financial products, such as annuities, some can be repurposed to provide monthly payments that fund care. This approach requires coordination with a qualified financial planner or elder law attorney.

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Private pay has the advantage of simplicity—there’s no eligibility paperwork or coverage limits—but also requires careful long-term planning. The good news is that families in New Hampshire often find that starting early and working with a local financial advisor or elder care consultant can make this path much more manageable. In many cases, families combine private pay strategies with insurance options to stretch their resources further.

Insurance Options: What’s Covered—and What’s Not—in New Hampshire

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When the topic of paying for senior home care comes up, many families instinctively turn to health insurance or Medicare, hoping these programs will take the pressure off. But in New Hampshire—as across the U.S.—coverage is usually limited when it comes to non-medical in-home care.

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Medicare  

Medicare will only cover home health care on a short-term basis when prescribed by a doctor—typically following a hospitalization, surgery, or acute illness. Services must be medically necessary and provided by a Medicare-certified agency. Coverage often includes intermittent skilled nursing, therapy, and some home health aide services—but does not cover ongoing personal care or supervision.

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Medicaid (NH Medicaid/Choices for Independence Waiver)  

Medicaid, managed at the state level in New Hampshire, offers broader home care coverage than Medicare—especially for low-income seniors. The Choices for Independence (CFI) Medicaid Waiver is a key resource. It allows eligible seniors to receive long-term care services at home rather than in a nursing facility. Covered services can include help with daily activities, homemaker assistance, respite care, and even certain home modifications.

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Eligibility for CFI is based on age, income level, assets, and the need for a nursing-facility level of care. Applying for this waiver can be complex and time-consuming, but it’s a potentially invaluable funding stream.

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Long-Term Care Insurance (LTCI)  

If your loved one has a long-term care insurance policy, this can provide significant financial help for home care. LTCI policies generally reimburse costs for a broad range of services, from personal care to skilled home visits, as long as specific eligibility criteria are met. These usually relate to the individual needing help with at least two Activities of Daily Living (ADLs), such as dressing or bathing.

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Policyholders should carefully review their plan documents or consult with the insurer to activate benefits. New Hampshire does not mandate what LTCI must include, but many plans sold in the state follow the national partnership model that coordinates with Medicaid later on.

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Veterans Benefits  

Veterans and their surviving spouses may be eligible for assistance through the Aid and Attendance Pension Benefit, which can help cover in-home care costs. This federally funded program requires the veteran to meet certain service and medical criteria and is managed through the VA system. Many residents in New Hampshire access this benefit with the help of an accredited VA claims agent or elder law attorney.

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In summary, insurance-based options usually make home care more affordable when combined with private pay sources—but they rarely cover 100%. Understanding coverage limits, plan terms, and eligibility requirements is crucial for families to avoid surprises and build a sustainable plan.