Can Medicare Pay for a Caregiver?

Can Medicare Pay for a Caregiver?

There might come a time when you or a loved one needs extra care. Home health care is often an effective and convenient way to get the care you need, but it usually doesn't come cheap. Medicare offsets some health care costs — but can Medicare pay for a caregiver? Here's what you need to know.

Can Medicare Pay for a Caregiver?

It depends. Medicare covers specific caregiver services in certain situations, but it all depends on the type of care you'll need, how long you'll need it and what your Medicare coverage is.

To qualify, you must be enrolled in Medicare Part A or B. You also need to be considered homebound because of an illness or an injury. For Medicare's purposes, being homebound means that your doctor has determined that you need extra help getting out of your home or that leaving your home is not advised. It doesn't mean you have to be home 24/7 —under Medicare's rules, you can be considered homebound and still attend religious services, doctor's appointments, adult day care or specific special occasions.

You'll also need to be under a doctor's care, and your doctor will need to review your care plan every 60 days. You must see your doctor in person less than 90 days before home caregiver services begin or within 30 days after they have started.

Which Caregiving Services Are Covered by Medicare?

Your Medicare coverage won't cover every type of home care. Medicare doesn't cover in-home custodial care or extended daily living help. This includes full-time skilled nursing care, around-the-clock care, meal delivery services, laundry and cleaning services or personal care (for example, help with bathing or using the bathroom).

Medicare does cover the following services:

  • Part-time or occasional skilled nursing care, including changing dressings and cleaning wounds, placing and changing IV lines, injections, tube feedings and prescription drug education.
  • Home health aides who check blood pressure, assess pain levels, review home safety, monitor medications and educate other caregivers on care plans.
  • Professional therapists, such as speech therapists, occupational therapists and physical therapists.
  • Social workers who provide medical services.

Caregiver coverage is generally intended for shorter periods, such as recovering from illness or injury. Medicare coverage limits skilled nursing care to fewer than seven days a week and less than eight hours a day for up to 21 days.

Your Medicare plan will also cover up to 80% of the costs of any prescribed medical equipment, such as a walker.

Other Ways to Cover Caregiving Costs

Because Medicare probably won't cover all your needs, there are alternatives and forms of supplemental insurance available to help pay for caregiving expenses.

If you have a Medicare Advantage plan (Medicare Part C), you might have more flexibility with your coverage. Some plans cover nonskilled in-home care, including help with custodial care. Make sure you check what your plan covers, though, as coverage varies by carrier.

Medicare Supplement insurance (Medigap) is another option. Medigap plans fill in the gaps left by traditional Medicare plans. However, Medigap plans vary by state, and most don't offer enhanced in-home caregiver coverage. If you're looking to Medigap as an option, explore what's available.

Consider long-term care insurance, too. Though long-term care policies don't usually cover medical costs, many can help you pay for in-home caregiver services such as custodial care and skilled nursing care. Long-term care policies can also help cover the costs of full-time care facilities, such as nursing homes and assisted living centers.

When it comes to your health or the health of a loved one, the most important thing to do is explore your options so that you can make the best possible decision. Plan for these needs early, and you won't need to worry about your finances when you should be focused on your health.

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