Caregiving for an ill or older loved one often makes the difference between living comfortably at home or in an institution. However, it can call for tremendous emotional and financial sacrifices. This unpaid work is estimated to cost 36 billion hours and $600 billion, exceeding all out-of-pocket healthcare spending in 2021. Genworth Financial reports professional homemaker and home health aide services cost an average of $4,957 and $5,148 per year, respectively.
Many family caregivers receive little guidance or support to perform tasks that healthcare professionals get paid to do. Fortunately, Medicare provides programs to ease the burden.
What is a caregiver?
Medicare defines a caregiver as an individual who assists and supports someone who is elderly or has a temporary or chronic illness, disability, or frailty. A professional can be hired to provide this care for eligible Medicare beneficiaries, but a caregiver can also be a relative or friend who offers this care at no cost.
Caregivers may include:
- Neighbors
- Caregivers at nursing facilities or assisted living facilities
- Private caregivers
- Senior services agencies
What services does caregiving include?
Caregiving can involve one or more of these services:
- Skilled care. Assistance offered by licensed healthcare professionals for help with medications, wound care, and therapies.
- Companion services. Keeping company, offering supervision, and facilitating fun activities.
- Homemaker services. Assisting with housekeeping, meal preparation, transport, and errands.
- Personal care services. Helping with dressing, eating, exercise, and other daily living activities.
When might a caregiver be needed?
A person may need a caregiver for a variety of reasons. Typically, the needs are serious and long-term, such as chronic or acute illness, age-related frailty, or cognitive impairment. A caregiver can also be of help in long-term recovery from an injury.
Does Medicare pay for family caregivers?
Medicare will help pay for a caregiver if the services qualify for Medicare’s home health benefits. However, it will only cover services from Medicare-approved agencies, not individuals. Caregiving services must be medically necessary. A physician or healthcare provider must certify that the recipient is homebound except for brief periods. The doctor must also create and maintain a plan of care.
The recipient must also qualify for home care coverage under Original Medicare Parts A and/or B. Part A covers hospital inpatient care, and Part B covers outpatient services, including home health care.
What does Medicare pay for?
Medicare will pay for medically necessary services administered by qualified professionals, including:
Part-time or intermittent skilled nursing care
Medicare Part A covers intermittent skilled nursing care for less than eight hours daily. This is usually up to 21 days, but it can be up to 35 days in certain cases. Care rendered on fewer than seven consecutive days may also constitute part-time or intermittent care. Home health skilled nursing may entail tube feedings, changing wound dressings, intravenous (IV) drug administration, and disease management education.
For Medicare to cover this type of care, it must be administered by a registered nurse or licensed practical nurse.
Part-time home health aide services
Home health aides assist with daily activities that you cannot perform yourself due to illness or injury, such as bathing, eating, and dressing. They also ensure that your home is free of injury hazards and consistently monitor your vitals so that any issues will be addressed before they escalate to medical emergencies.
Physical therapy
Medicare can pay for in-home physical therapy services like wound care and gait training. This type of therapy often incorporates exercises to strengthen areas weakened by trauma (such as injury, surgery, or stroke) to help the individual regain use of the affected area(s).
Speech-language pathology services
A speech therapist can provide speech-language pathology services to individuals in their homes. These services are aimed at individuals with compromised communication skills resulting from speech and hearing deficits. Speech therapy includes education about new or alternative communication strategies in hearing and/or speech loss cases. Speech therapy can also assist individuals in eating and drinking as normally as possible and remembering words.
Occupational therapy
Occupational therapy equips people with the knowledge and habits necessary to go about daily life as independently as possible. An occupational therapist can help a person successfully establish an everyday routine that enables them to follow doctor's orders more closely, address personal needs, and manage stress.
Medical social services
Medical social services involve counseling or assistance from a social worker. These services aim to help individuals deal with emotional issues that negatively impact their health and well-being.
How much does Medicare charge for caregiver services?
Medicare is not a caregiver agency and does not charge for caregiver services. It is a federally funded health insurance program that pays for caregiver services from Medicare-approved agencies under specific circumstances.
Out-of-pocket costs for Medicare policyholders for caregiver services will vary by the exact service provided. If a medical provider certifies the individual to be homebound and the services are deemed medically necessary, Original Medicare will cover home health visits at no charge.
Medicare Advantage plans may provide additional home health coverage not offered by Original Medicare plans (e.g., meal delivery and non-skilled personal care). However, certain costs and restrictions may apply.
What caregiver services are not covered by Medicare?
Medicare home health benefits will usually not pay for the following services:
- Long-term medical or non-medical care
- Custodial or non-skilled personal care, in most cases
- Meal delivery
- Transportation
Can I find help paying for a caregiver?
Seniors and individuals with certain chronic illnesses can explore several options to help cover home care costs. Potential resources include:
PACE
The Program of All-Inclusive Care for the Elderly (PACE), a joint Medicare Medicaid program, helps people continue living in their homes instead of entering a care facility. People with Medicare, Medicaid, or both can join this program. PACE works with beneficiaries, families, caregivers, and professional healthcare providers to develop and execute a coordinated care plan.
PACE services include primary care, home care, personal care, meals, prescription drugs, social services, and necessary transportation. If the healthcare team determines that you need more services than Medicare and Medicaid will cover, PACE may cover them for you.
You can sign up for PACE if:
- You’re at least 55 years of age
- You reside in a PACE organization’s service area
- Your state verifies that you require nursing-home level care
- PACE services could help you live safely in the community
If you have Medicare, you’ll need to pay a monthly premium for the long-term care portion of the PACE benefit. You must also pay a monthly premium for Medicare prescription drug coverage. PACE does not charge a deductible or copayment for any care, service, or medication that the PACE team approves.
Medigap
Medigap's private Medicare supplemental insurance policies can help pay for Original Medicare copayments, deductibles, and coinsurance. Some plans have out-of-pocket limits beyond Part B services. This could lower what you would pay for Medicare-covered caregiver services.
Medicaid
People with limited income or resources may qualify for Medicaid. The Medicaid Self-Directed Care Program lets participants hire relatives to care for them. Contact your local Medicaid office for details on eligibility and enrollment.
Additional help
Individuals with full Medicaid coverage, an MSP, or SSI benefits may get Extra Help automatically, or you can sign up for it. This state program helps with Medicare prescription drug costs, making more funds available for caregiving services. Income limits apply.
Supplemental Security Income (SSI)
SSI is also designed for people with a disability and limited income. It provides a monthly cash benefit.
Medicare Savings Programs (MSPs)
MSPs can help people with limited resources pay for out-of-pocket costs. Plans vary by state.
Caregivers are a desperately needed source of help for aging people or dealing with an extended illness or injury. Medicare does not generally compensate these individuals directly for their contributions. However, MSPs and various state organizations provide hands-on and financial assistance to meet the needs of vulnerable people in our communities.
FAQ
Does Medicare pay for family caregivers?
Medicare does not pay family caregivers, but the program does pay approved agencies that provide home healthcare for individuals who meet Medicare guidelines for home care. However, some states have programs that reimburse family caregivers. Eligibility and reimbursement criteria vary by state. Contact your local Area Agency on Aging to learn what is nearby.
Where can I find a Medicare-approved caregiver?
To find a Medicare-approved home health agency, check out Medicare’s tool to find and compare providers where you live. You can also see what level of care each agency offers. Your state survey agency maintains an up-to-date status on the quality of care home health agencies provide in your state.
Where can I find caregiving support resources?
Your local Area Agency on Aging can inform you about local caregiving services and support for caregivers. Caregivers of veterans can visit the VA Caregiver website for resources. These agencies might connect you with non-medical in-home care assistance and transportation options.
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Family caregivers are relatives, friends, or neighbors who assist a person with a chronic illness or disability without pay.
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Medicare Part B (Medical Insurance) can help cover professional caregiver services when medically necessary.
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Original Medicare benefits won’t pay for 24-hour care, homemaker services, or personal care if these services are all you need.
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Medicare will only pay for intermittent in-home skilled nursing services.
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Some states offer funding or reimbursement to family caregivers.
9 resources
- AARP. Valuing the Invaluable: 2023 update - strengthening supports for family caregivers.
- Medicare. Help with drug costs.
- CMS. Caregiver partners.
- Medicare. Special needs plans (SNP).
- U.S. Bureau of Labor Statistics. Patterns of caregiving and work: evidence from two surveys.
- Medicare. Medicare’s home health benefit.
- Medicare. Home health services.
- Medicare. Quick facts: program of all-inclusive care for the elderly (PACE).
- Eldercare.gov. Caregiver corner.
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