Most families start by comparing quotes by the hour. The first sort should be by payer. Medicare, Medicaid, a long-term care policy, a veterans benefit and private pay each cover different kinds of work. The same week can cost very different amounts depending on who holds which hours. You do not need a number yet. You need a list.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Step 1: Name the kinds of help

Write each need on its own line. Mark skilled care, which means nursing or therapy ordered by a doctor. Mark custodial care, which means help with bathing, dressing, meals, reminders and errands. Mark equipment and supplies separately. Put the hours next to each line, even rough ones.

Step 2: Check Medicare first

Medicare's home health benefit, described on Medicare.gov and in the home health rules that CMS administers, generally covers intermittent skilled nursing and therapy. It can also cover some home health aide services that go along with that skilled care. The patient generally has to be homebound, and a doctor has to certify a plan of care. Medicare generally does not cover around-the-clock care, and it does not pay for custodial help on its own. Ask the hospital discharge planner whether a home health agency has been referred. Ask the agency to show in writing which of your listed hours it bills to Medicare and which it does not.

Check your parent's plan type too. Original Medicare and a Medicare Advantage plan can have different home benefits and different rules for who approves them. The plan's own documents answer that question, not the general description.

Step 3: Check the Missouri programs

The Missouri Department of Health and Senior Services runs in-home services programs for eligible older adults. MO HealthNet, the state Medicaid program, covers some personal care for people who qualify. Eligibility depends on income and assets. Ask the discharge planner or your local Area Agency on Aging to screen your parent. The intake will likely ask for income and asset records, so start gathering them now. Missouri statute and DHSS rules set the terms, and those pages are the place to confirm current requirements. The Local Help After a Discharge page lists where to start.

Step 4: Check the paper you already have

Look for a long-term care insurance policy, a veterans benefit if your parent served, and any prepaid service contract. Read two numbers in a policy: the daily benefit and the elimination period. The elimination period is the waiting time before the policy starts paying, and a policy can be real and still pay nothing for the first stretch. The National Institute on Aging publishes plain guidance on paying for long-term care that is worth reading next to your own policy.

Step 5: Sort the hours into three columns

Make three columns: Medicare or Medicaid, policy or benefit, and private pay. Move each line into one column. Then total the private pay column in hours per week. That number is the one to compare with any agency quote. A quote's total cannot be checked against your family's guesses, but it can be checked against the private pay hours you just counted.

Step 6: Ask each quote the right question

Ask whether the quote covers private pay hours only, or whether it includes hours another payer might cover. Ask what happens to the schedule if one payer stops covering a line. Ask for the answer in writing, and keep it with the quote. A quote that cannot say which hours it bills to whom is not ready to compare yet.

Medicare Pays for Some Hours and Not Others: Sort the Bill by Who Pays Before You Price Anything