Medicare’s coverage for caregivers varies on the type of care needed, how frequent care is needed, and where the care is being provided. Certain qualifications must be met for Medicare to cover a beneficiary’s at-home care plan.
A wide range of providers are available to work as caregivers depending on a beneficiary’s healthcare needs.
Acquiring medical supplies to fulfill healthcare needs is another necessity when it comes to at-home care. Medicare does cover durable medical equipment (DME), but only if it meets certain qualifications and is supplied by a company that is in-network.
It’s important for caretakers to fully understand the needs of the beneficiary and what insurance plan a beneficiary has.
Does Medicare Cover Caregivers?
Medicare will cover caregivers. However, beneficiaries must meet certain qualifications in order to be eligible for in-home medical care coverage. As of now, if it is deemed medically necessary for a beneficiary, they are able to use Medicare home health benefits for:
Part-Time (Intermittent) Skilled Nursing Care
Speech-Language Pathology Services
Medical Social Services
Injectable Osteoporosis Drugs for Women
In order for beneficiaries to receive coverage for in-home care services, they must be deemed homebound by a medical provider. This entails that a patient is unable to leave their house to receive medical care and is typically only able to leave home in infrequent instances for events like religious services. However, if a beneficiary is enrolled in an adult day care program, they are still able to receive home health care.
Note: To learn more about Medicare coverage for home health services, visit this source.
Part A (Hospital Coverage)
If a Medicare beneficiary was admitted to the hospital or a skilled nursing facility for three or more consecutive days, they are eligible for Medicare-covered home health care through Part A. Medicare Part A, known as Original Medicare’s hospital coverage, will cover home health services for 100 days as long as a beneficiary is due to receive home health care within 14 days of leaving the hospital or nursing facility.
Part B (Medical Coverage)
If a patient was not hospitalized prior to needing home health care, Medicare Part B will cover their services as long as home services are deemed medically necessary by a licensed provider.
Part C (Medicare Advantage Plans)
Medicare Advantage (MA) plans, otherwise known as Medicare Part C, work to fill the gaps in standard Medicare coverage. Since all MA plans include Part A and Part B coverage bundled into one health plan, home health services will be covered exactly as detailed above. However, since MA plans are provided by private health insurance companies, certain plan types may require beneficiaries to seek in-network home health service providers. Beneficiaries should always contact a licensed insurance agent before selecting a home health provider to ensure no added out-of-network expenses.
Part D (Prescription Drug Coverage)
Part D prescription drug coverage is not included in Original Medicare plans and must be added separately by Medicare beneficiaries. Having a Part D plan will help beneficiaries cover any prescription drugs needed during their home health stay. Since prescription drug plans are offered by private health insurers, certain plans may have limitations on which drugs they cover. Prior to filling a prescription, beneficiaries should be sure to check what their plan covers or speak with an insurance agent to learn more.
Medicare Supplement Insurance Plans
Supplemental Medicare plans such as Medigap (MedSupp) or Dual Eligibles (Medicaid-Medicare) assist beneficiaries with out-of-pocket costs that Original Medicare doesn’t cover. Supplement plans may assist beneficiaries with certain home health care costs that aren’t covered by Medicare. However, since these plans are provided by private health insurance companies, they may require beneficiaries to use providers or prescription drugs that are in-network.
Who Qualifies as a Caregiver?
When it comes to home health care, a variety of home health aides are available to assist patients with a wide range of needs. Common needs for beneficiaries include but are not limited to:
Companion Services: Providers that offer companionship for beneficiaries and assist individuals with finding livelihood and fulfilling daily activities.
Homemaker Services: Providers that assist beneficiaries with errands, housekeeping, making meals, and transportation.
Personal Care Services: Providers that assist individuals with personal care such as eating, daily hygiene, exercise, and more.
Skilled Care Services: Providers that assist individuals with medical needs such as dressing wounds, physical therapy, medicine dosage, and more.
When it comes to the individual providing home health services, beneficiaries have many options available to them depending on the care they need. All providers available for beneficiaries through a home health agency are approved by the federal government through the Centers for Medicare & Medicaid Services (CMS). However, it’s important to note that different providers supply different services.
Registered or Licensed Nurses: Nurses are able to provide skilled care services such as dressing wounds, giving injections or tube feedings, ensuring a patient’s home is safe, monitoring medications, etc.
Professional Therapists: Therapists provide specific care services such as speech therapy, physical therapy, or occupational therapy.
Social Workers: Social workers provide medical social services that are linked to a beneficiary’s social and emotional care. They will evaluate a beneficiary’s home situation, their financial burdens, how active they are in the community, and more.
Self-Directed Caretakers: In certain circumstances, CMS allows family members to provide long-term care for beneficiaries. However, those looking to become family caregivers must first apply, undergo assessment, establish a care plan, create a budget, and then the beneficiary gets the final say in who cares for them. To learn more about applying to be a self-direct caregiver, visit this source.
How to Find a Caregiver
To locate a caregiver in one’s community, beneficiaries can use Medicare’s provider search tool or the U.S. Administration on Aging’s search tool. These tools will allow individuals to find providers near them, compare those providers, narrow their search by agency or care type, and more.
It’s important when searching for a caretaker to evaluate them regularly to ensure they are a good match for the beneficiary’s needs. Use tactics such as interviewing or assessment sheets like Medicare’s home health agency checklist to gauge if the caregiver is well-suited for the individual’s healthcare wants/needs.
Cost of Hiring a Caregiver
When searching for a caregiver, it’s possible to narrow down a search by the rate one is willing to pay for care. Based on a survey by Genworth, the monthly median cost of having an in-home caregiver in 2020 was $4,481. That being said, the cost of having a caretaker can range depending on the rate desired, the amount one’s Medicare or MA plan will cover, and where an individual lives.
Caregiver Coverage Assistance
There are a variety of different methods for an individual to receive financial assistance when they’re in need of a caretaker. Certain financial aids include:
Medigap Plans: Medigap plans, otherwise known as MedSupp plans, work as supplemental plans that fill the gaps in Original Medicare coverage. Most plans include Part D prescription drug insurance along with additional coverage benefits for hearing, vision, dental and more. There are many different types of Medigap plans and to learn more about each type, visit this source.
Medicaid-Medicare (Dual Eligibles) Plans: If an individual qualifies for both Medicare and Medicaid, they are able to enroll in what is known as a “dual eligibles” plan. If a patient has this plan type, Medicare acts as their primary insurance while Medicaid acts as their secondary supplemental insurance. Medicaid works to cover the gaps in the coverage provided by Original Medicare.
Medicare Savings Programs: Certain individuals may qualify for a Medicare Savings Program that is organized by their state. Medicare Savings Programs help to cover additional out-of-pocket expenses that aren’t covered by Original Medicare. To learn more about Medicare Savings Programs, visit this source.
State Financial Resources: Each state provides services for the elderly members in their community. To learn more about the financial assistance provided to those on Medicare in one’s state, visit this source.
- Programs for Veterans: Various financial aid programs are available for veterans to use such as:
Aid and Attendance (A&A): A program that supplements a military pension to cover the cost of a caregiver.
Housebound Benefits: If a veteran has a permanent disability, they may receive housebound benefits that supplement them with a monthly pension for caregiver services.
Program of Comprehensive Assistance: This program provides financial assistance to family members that are caretakers of veterans.
Does Medicare Cover Medical Supplies?
Medicare Part B helps to cover medical supplies otherwise known as durable medical equipment (DME). When a doctor deems certain DME medically necessary for a patient, then it is covered by Medicare Part B. Patients can rent or buy DME, however, in order for Medicare to cover the item, the DME supplier must be in-network. Certain DME equipment may include but is not limited to:
Blood Sugar Monitors
In order for an item to qualify as DME, it must meet the following criteria:
Can withstand steady use.
Is deemed medically necessary.
Is used by an individual that is ill or injured.
Is operated within an individual’s home.
Can last for at least three years.
Note: Medicare only covers DME that is provided by companies that are in-network. To find a DME supplier in Medicare’s network, visit this source.
Important Information For Caregivers
Caretakers and beneficiaries benefit from having a transparent relationship when it comes to finances, health needs, and more. Therefore, it’s valuable for caregivers to speak with beneficiaries and understand what their wishes are when it comes to certain health situations. When first becoming established as a caregiver, one should discuss the following aspects with the beneficiary:
Social Security Number
Medicare Coverage Plans
Contact Information for Other Care Providers (doctors, nurses, specialists, pharmacists, etc.)
List of Current Medications
List of Current Medical Conditions, Medical Treatment Plans, or Symptoms
Allergy Information if Pertinent
List of Emergency Contacts
Note: Caretaking can be an emotionally and physically draining profession. It’s vital for caregivers to actively take care of their own health and wellbeing while providing care to beneficiaries. To learn more about support groups, financial assistance options, and more resources available to caretakers, visit this source.
Understanding Patient’s Medicare Coverage
Beneficiaries may have a wide range of insurance coverage options in addition to their Original Medicare plans. Prior to providing care, caretakers should have an open discussion with beneficiaries about how their insurance coverage operates. Certain insurance plans that patients may have include but are not limited to:
Medicare Advantage (MA) Plans
Medicaid-Medicare (Dual Eligibles) Plan
Medicare Savings Plans
Part D Prescription Drug Plans
- Additional Benefits
Financial Assistance for Veterans
State/County Financial Aid
Caring for Those With Chronic Illness
When caring for an individual that struggles with chronic illness, it’s important to be aware of their ongoing symptoms, who their specialists are if complications arise, and what their current treatment plan is. It’s also important to have an action plan set in the case that certain complications arise with the beneficiary’s condition.
It’s common for depression and anxiety to be prevalent in beneficiaries that struggle with chronic illness. In these cases, it could benefit a caregiver to help a beneficiary coordinate therapy or a support group to help them process their emotions.
Hospitalization & Medicare Coverage
In the event that a beneficiary needs to be hospitalized for their condition, it’s important to understand what Medicare covers so they can be prepared to explain this to the beneficiary. Medicare Part A covers inpatient hospital care when:
A doctor deems it medically necessary
The care needed can only be provided in a hospital setting
The hospital is in-network for Medicare
The hospital stay is approved by the Utilization Review Committee
Medicare Part A will assist with coverage for services such as general medical care, room costs, meal costs, and the cost of DME. Certain services such as entertainment costs with televisions or telephones in addition to personal care items such as razors or toothbrushes may not be covered by Medicare.
Nursing Home & Housing Options
If intermittent caregiving expands into a need for full-time care, a caregiver may have to discuss nursing home or extended care housing options with the beneficiary. Different housing or extended care options may include:
Independent Living Facilities: Settings such as these are meant for patients that can live independently but are searching for assistance with things like meals, social engagement, exercise, and more.
Assisted Living Facilities: In settings such as these, beneficiaries receive assistance with small medical needs, meals, social engagement, prescription drug management, and more.
Continuing Care Retirement Communities (CCRC): CCRCs provide various housing options to accommodate a wide range of healthcare needs.
Adult Day Care: Adult Day Care facilities provide elderly beneficiaries with rehabilitative care and daily activities to keep them active before returning home at night.
Custodial Care: Custodial care provides beneficiaries with additional at-home assistance with things such as personal hygiene, errands, eating, and more.
Skilled Nursing Facilities: Facilities such as these provide intensive 24-hour care for patients who require monitoring at all hours of the day.
Nursing Homes: Nursing homes serve as permanent residences for people who need care for a variety of reasons (physical, emotional, mental, etc.) and require assistance intermittently or actively throughout the day.
Note: To learn more about housing options, visit this source.
Nursing Homes & Medicare Coverage
It can be tricky when it comes to getting Medicare coverage for full-time care or for facilities such as nursing homes. Prior to making final decisions on care or housing options, it’s important for a beneficiary and their caregiver to speak with a licensed insurance agent to figure out what will be covered and what won’t be.
Considering Hospice Care
Hospice care is a type of palliative care that intends to treat beneficiaries that are terminally ill or in the process of dying. As a caregiver, it’s important to be aware that the beneficiary’s health may slip into a place that is out of one’s care abilities. In the event of a beneficiary needing hospice care, a caregiver should discuss a plan of action with the beneficiary while they are still capable of discussing their healthcare wishes.
Hospice Care & Medicare Coverage
In order for a beneficiary to be eligible for Medicare-covered hospice care through Medicare Part A (hospital insurance), they must fulfill the following criteria:
Hospice care is deemed medically necessary by a doctor or provider.
The beneficiary has signed a statement that they are choosing hospice care over other Medicare-approved healthcare options for terminally ill patients.
The hospice program is in-network for Medicare.
Prior to selecting a hospice care organization, beneficiaries and caregivers should speak with the beneficiary’s insurance company to ensure they are choosing the best option.