Medicare Part A and Medicare Part B covers caregivers and caregiving services for patients who require part-time care and have trouble leaving their home or have been advised to remain at home due to their condition.
Here’s a look at the role caregivers play in improving patients’ quality of life, how Medicare covers caregiving services, and what caregivers may cost.
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How Caregivers Can Help Beneficiaries
Caregivers provide a variety of support options for beneficiaries. Common caregiving categories include companion services, home help services, personal care services, and skilled care services.
Companion service caregivers offer human connection to beneficiaries, helping them to find activities they are interested in and assisting them in completing daily tasks. Home help services assist with tasks such as running errands, keeping homes clean, making meals, and transporting patients to appointments.
Personal care service workers help beneficiaries navigate common daily activities such as getting dressed, eating meals, and completing exercise. Medical professionals provide skilled services, including dressing wounds, carrying out physical therapy, administering medications, and following up on healthcare concerns.
Understanding Medicare Coverage for Caregivers
Medicare pays for caregivers if beneficiaries meet specific criteria, including:
- A medical professional approves the use of caregiving services.
- The care needed is intermittent and does not exceed 8 hours per day or a maximum of 28 hours per week.
- The services provided are covered under Medicare, including help with daily activities or providing in-home medical care.
Both Part A and Part B of Original Medicare provide coverage for caregivers. The type and amount of coverage provided depends on the nature of the care they need.
Part A Coverage
Medicare Part A is also known as hospital coverage. It can help pay for caregiving services if patients are admitted to the hospital for three or more consecutive days or if they are moving from a skilled nursing facility back to their home.
Under Part A, Medicare caregivers may be covered for up to 100 days so long as this care begins within 14 days of leaving the hospital or skilled nursing care facility. The type of caregiving covered is based on the needs of the patient. For example, if patients have a chronic condition that makes it hard for them to make their own meals or keep their house clean, Medicare Part A may cover home help services.
Part B Coverage
Medicare Part B, also known as medical coverage, can provide long-term caregiving services. Part B may cover caregiving services after the 100 days of Part A coverage end or may be accessed without the need for a hospital stay. In both cases, however, patients must meet with a healthcare professional to determine the level of care required and certify that home care services are necessary.
Caregiving Services Excluded From Coverage
While Medicare pays for a wide variety of caregiving, some services are excluded. These include:
- 24-hour-a-day care in your home
- Meal delivery services
- Home care services, such as shopping or cleaning, that are not directly related to your care plan
- Personal care that assists with daily activities such as bathing, dressing, or eating — if this is the only type of care required
Who Does Medicare Consider a Caregiver?
Under Original Medicare, there are two broad caregiver service categories: Those provided by approved home health service agencies and those that are self-directed.
Home Health Agency
Caregiving services provided by a home health agency may include registered nurses, professional therapists, and social workers.
- Nurses offer skilled medical care, such as administering medications, monitoring wounds, and managing chronic pain.
- Professional therapists may provide services such as speech, physical, or occupational therapy for patients.
- Social workers offer help with social and emotional needs. Social work services may include an evaluation of financial burdens, current living situation, and the state of patients’ social connections.
Caregiving may also be self-directed. In this case, family members provide care, and their services are covered by Medicare. To receive coverage for self-directed care, selected family members must apply with Medicare and undergo an assessment to ensure they can provide necessary services.
In addition, patients and their family members must also create a detailed care plan and a budget. While self-directed options are evaluated and approved by Medicare, they are managed by state health authorities.
What to Know About Medicare's Independence at Home Demonstration
The Independence at Home (IAH) demonstration is a joint effort from the Centers for Medicare and Medicaid Services (CMS) and medical practices to evaluate the effectiveness of delivering comprehensive primary care services at home. This program has been a success.
In 2022, the IAH saved over $32 million, or an average of $8,222 per beneficiary. In addition, beneficiaries participating in the program saw fewer hospital readmissions within 30 days, used inpatient and emergency services less than their non-IAH counterparts, and had more frequent follow-ups from care providers after events such as hospital admissions or discharges.
Currently, there is only one participating practice in the United States for IAH. Still, the program was recently extended for another three years as CMS looks to evaluate its long-term impact. This means that while IAH may eventually play a key role in care and cost management, mainstream adoption is at least several years away for patients and caregivers.
How Does Medicare Advantage Cover Caregivers?
Medicare Advantage plans, also called Medicare Part C, are private insurance plans offered by approved providers. These plans include Part A, Part B, and, in some cases, Part D, or prescription drug coverage.
While Medicare Advantage plans must provide the same medically necessary services as Original Medicare, they may also include additional benefits such as vision, hearing, and dental care. Depending on the provider, they may also offer extended caregiving benefits that include more frequent care, a higher number of hours of care per week, or relaxed eligibility requirements to obtain caregiving support.
How Much Do Caregivers Cost with Medicare?
Without Original Medicare or Medicare Advantage, patients are responsible for the entire cost of home care services. Consider the cost of home health aides. The average hourly cost for a home health aide is $20. At 28 hours per week, which is deemed part-time under Original Medicare, the cost of this service is $560 each week.
With Medicare, this cost is $0 for the patient. Without coverage, patients and their families pay more than $2,200 each month.
Part A Costs
The deductible for Part A is $1,632 in 2024 for each inpatient hospital period before Medicare begins to pay. This means that you do not need to pay a deductible for home health services when you leave the hospital. Part A also covers 20% of the Medicare-approved amount for durable medical equipment such as wheelchairs and walkers.
It’s also worth noting that in most cases, the Part A premium is $0.
Part B Costs
The deductible for Part B is $240 in 2024, after which Medicare pays for covered home health services and 20% of the Medicare-approved amount for durable medical equipment and medical supplies. Patients also pay a $170.70 (in 2024) monthly premium for Part B.
Medicare Advantage Costs
Medicare Advantage costs are similar to those of Medicare Part A and Part B but differ based on the specific plan purchases.
For example, Medicare Advantage plans often include monthly premiums in addition to copayments and <a class="wpil_keyword_link" href="https://assurance.com/health-insurance/copays-deductibles-and-coinsurance. Copayments are set amounts paid for each service received. Coinsurance is expressed as a percentage, with providers and patients each paying their part. For example, hiring a home care worker might have a $50 copayment each month, and the coinsurance for the service might be 80/20, which means your insurance covers 80% of the cost, and you pay the remaining 20%.
In addition, Medicare Advantage plans may have network restrictions. If home health providers are outside your plan’s network, you may be responsible for the entire cost. Providers inside the network are covered based on coinsurance and copayment policies.
On the plus side, plans may also have an out-of-pocket (OOP) maximum. After you have reached this maximum, your plan covers 100% of your eligible services each year.
How to Get Help Paying for Caregivers
There are also programs available that may help patients pay for caregivers, such as:
- The National Family Caregiver Support Program: Managed by the ACL, this program provides grants to states and territories to fund in-home care.
- The Veteran-Directed Home and Community-Based Services Program: This program is offered to veterans and provides a flexible budget that may allow veterans to hire a family member to help with care.
- State Medicaid Agencies: State Medicaid agencies can help evaluate and approve family members for paid caregiving roles.
Putting It All Together
Does Medicare cover caregivers? Yes — under specific circumstances.
If you need medically approved, part-time coverage for care services such as assistance with daily tasks, physiotherapy for ongoing issues, or companion services to encourage socialization, Medicare may pay for these services. Medicare Advantage plans, meanwhile, may offer additional services such as dental and vision care, but may also include network restrictions.
Given the cost of caregiving services without Medicare, it’s worth finding a Medicare plan — and/or a supplementary program — that provides consistent care coverage.