Private Pay, Medicaid and Medicare Clients Search Differently. Give Each Its Own Campaign.

Three families call a home care agency on the same Monday. The first will pay out of pocket for a companion three afternoons a week. The second has a mother who qualifies for the state's Medicaid in-home program. The third has a father coming home from the hospital who needs a nurse and a physical therapist, paid for by Medicare. Same agency, same phone number, and in most accounts, the same Google Ads campaign.

They didn't search the same way, and they aren't worth the same to the agency. This last chapter splits the account by how families pay: which words each payer's families type, which of those searches an agency should want, and how the pieces from the other fourteen chapters fit into one account.

Families Type "Medicare" Ten Times as Often as "Private Pay"

We looked up how families in our example market, Chicago, search when payment is part of the question. Keyword Planner's monthly averages for the metro area, with close variants pooled together:

• "medicare home care": 1,300 searches a month
• "va home care": 320
• "medicaid home care": 140
• "does medicare pay for home care": 140
• "private pay home care": 110
• "long term care insurance home care": 40

Counting distinct searches in the 24,442 we pulled for Chapter 5 tells the same story: 758 mention Medicare, 301 mention Medicaid and 60 mention veterans or the VA.

The families who will actually pay privately rarely say so. They search for the service ("in home care," "24 hour home care") or the cost, and nearly nobody types "private pay." Medicare is the word families reach for, and that creates the biggest decision in this chapter.

Most Families Searching "Medicare" Want Care It Won't Pay For

Medicare's home health benefit is real and generous for the people who qualify. It covers skilled care at home, such as nursing and therapy, for patients who are homebound and under a plan of care from a doctor or allowed practitioner, after a face-to-face visit. Medicare.gov says covered patients pay nothing for those services.

It's also narrow. Medicare doesn't cover "24-hour-a-day care," "homemaker services," or "custodial or personal care" when that's the only care someone needs. That describes most of what non-medical home care agencies sell: help with bathing, meals, companionship, supervision for a parent with dementia.

So "medicare home care" means two different things depending on who's advertising. Our reading is that many of the families typing it need custodial help and will end up paying privately, through long-term care insurance, or through Medicaid if they qualify.

• A Medicare-certified home health agency should bid on these searches in its own campaign, with ads that say who qualifies (Chapter 8) and a page that explains eligibility.
• A non-medical agency shouldn't advertise Medicare coverage it can't provide. It can still answer the question the family is asking, on a page of its own: what Medicare pays for, what it doesn't, and how families in your area pay for the rest. That page can sit behind a small campaign for question searches such as "does medicare pay for home care," with ads that promise an answer rather than coverage.

The answer page doesn't need to be long. Four short sections cover it: what Medicare pays for at home and who qualifies; what it doesn't pay for, in Medicare's own words; how families in your area pay for ongoing care, whether out of pocket, through long-term care insurance, through Medicaid or through veterans benefits; and how to reach you to talk it through. Write it for the daughter who just learned Medicare won't cover her mother's afternoons, not for a benefits specialist.

That second approach is honest and useful, and it reaches families at the moment they discover they'll need to pay. It's also exactly the kind of page Chapter 13 warned about, so keep it out of AI Max's reach and never let Medicare wording drift into a private-pay ad.

Medicaid Searches Lean Toward Nursing Homes, so the Home Care Campaign Needs Its Own Negatives

Medicaid pays for more home care than any other source, and families do search for it. But the biggest Medicaid searches in our pull aren't about home care at all. In the Chicago metro, 590 searches a month ask about Medicaid paying for a nursing home, against 140 asking about Medicaid and home care. Many others are about eligibility rules rather than finding a provider.

A home care agency that takes Medicaid wants a campaign built around how its own state names the program. In Illinois, that's the Community Care Program, run by the Department on Aging for people 60 and older who meet the asset limit and a needs assessment. Other states use waiver program names that families learn from a caseworker and then type into Google. Add "medicaid caregiver" and "medicaid personal care services" searches if you serve them.

Then add the negatives that keep the campaign on home care: "nursing home," "assisted living," "eligibility," "application," "income limit," and the names of programs you don't participate in. Medicaid families often call to ask whether they qualify; the intake team should be ready to answer, but the budget should go to searches from families looking for a provider.

Long-Term Care Insurance Shows Up on the Call, Not in the Search

One payer barely registers in search. "Long term care insurance home care" gets about 40 searches a month in the metro area. Yet about 5.8 million people hold stand-alone long-term care insurance policies nationally, and a family with a policy is often the best private-pay client an agency can have. They don't search by their policy; they search for care, and mention the policy on the phone.

So long-term care insurance belongs on the private-pay side of the account, as a line in the ads and a section on the private-pay page, not as a campaign of its own. Tribute Home Care in our example market says it helps families complete and submit the paperwork for insurance claims. That's the kind of promise worth making in an ad, if your office will actually do the work.

Veterans benefits work the other way around. Families of veterans do search by the benefit: the VA searches in our metro pull add up to more than the Medicaid home care searches. That supports a small veterans campaign, but only for an agency with a real role in veterans care, either contracted to provide it through the VA or helping families apply for benefits such as Aid and Attendance. The page should say plainly which of those your agency does, because a family that calls expecting the VA to pay and learns otherwise is a lead you paid for twice.

Give Each Payer Its Own Campaign, Keywords and Landing Page

Put the pieces together and a home care account looks like this:

• Private pay, with ad groups by service as Chapter 4 built them: companion care, personal care, dementia care, 24-hour care, respite. Its ads talk about the care and the caregiver, never about coverage.
• Medicaid, built on your state's program names, with its own page explaining how families start.
• Medicare home health, for certified agencies only, with eligibility on the page.
• Veterans, if you're contracted through the VA's Community Care Network or help families use Aid and Attendance, with a page that says which.
• Brand, for searches of your agency's name (Chapter 9).
• Out-of-area, for adult children searching from another state (Chapter 9).
• Recruiting, in its own campaign with its own goal (Chapter 14).

Each payer campaign gets its own budget and its own target cost per lead, set from what a client on that payer is worth. Chapter 7 did that math and Chapter 3 set the ceilings, so this chapter doesn't repeat it. What matters here is that the searches, ads and pages match: a Medicaid family lands on a Medicaid page, and a private-pay family never reads the word "Medicare."

Ask How Care Will Be Paid For in the First Minute of Every Call

The campaigns only stay honest if the leads are sorted the same way. Chapter 2 showed that families ask who pays before they ask which agency; the intake call should follow the same order. In the first minute, ask four things: how care will be paid for, who the care is for, where they live, and when care needs to start.

Then record the answer. Chapter 1 set up labels for private pay, Medicaid and Medicare leads; the payer the family names on the call is the label. When a family starts care, import that start of care back into Google Ads with its payer attached. Review the numbers by payer once a month, not in one account-wide total. A campaign can look expensive per lead and still be the best one in the account, because its clients stay longer or pay more per hour. After a few months each campaign has its own cost per client, not a blended number that hides a Medicaid campaign losing money inside a profitable private-pay one.

Fifteen Chapters Build One Home Care Account, in This Order

Here's the whole guide as one build, in the order our method puts it live:

1. Track client leads, not applicants, with labels by payer.
2. Match ads to the family's stage, payment question first.
3. Price the lead from what a client is worth over time.
4. Build one page per service, home care and home health apart.
5. Split the keyword list and cut job, facility and brand searches.
6. Start on exact match; add broad match at about 30 client leads a month.
7. Bid by payer, one target cost per lead each.
8. Write ads from family reviews, with the rules on claims.
9. Set location and launch settings, plus one out-of-area campaign.
10. Lock Performance Max away from the careers page.
11. Reach families early with Demand Gen, everyday help, no diagnosis.
12. Win the map with the right category and honest reviews.
13. Put text guidelines on AI Max before switching it on.
14. Recruit caregivers in a campaign of their own.
15. Split the account by payer, so every campaign has a real cost per client.

The guide home keeps all fifteen chapters in one place.

Agencies that want this account without building it themselves can hand it to our Google Ads management, which sets up home care and home health accounts in exactly this order, starting with tracking.