Does Medicare Cover Caregivers?
If you or an aging parent would like to stay at home as long as possible, aging in place, you’re probably thinking about how to handle this. If you find yourself as a working adult caring for an aging parent, you are most likely anxious about how to manage your loved one’s care while balancing everything else in your life. You don’t have to do it all, there are many services available for aging in place, but the question is affordability and quality.
You’ve probably wondered if your healthcare will cover at-home services and what you’ll have to pay out of pocket for. Generally speaking, Medicare will not cover long-term daily activity support at home. In certain situations, Medicare Part A and B will cover short-term medical care at home, but only deemed necessary by the physician.
So what about long-term solutions?
The general set of questions to be answered are: the kind of care needed, the reason for the care, and the duration of this type of care. These questions will help you to assess the types of options available.
In-Home Medical Care
Medicare does cover some in-home health benefits that will apply in the following circumstances:
The individual can’t leave home unless for short outings such as to the hairdresser or Church. *Adult daycare beneficiaries can still receive in-home care.
The individual’s doctor recommends at-home care and puts together a plan outlining care.
The individual needs could be met by a home health aide while the patient recovers.
The individual’s doctor believes the patient’s condition will resolve in a reasonable amount of time. (ambiguous we know)
The individual needs a skilled therapist (speech, occupational, physical) in order to design a program to help the patient improve, maintain a current state, or keep from getting worse.
The individual’s needs can be met with skilled nursing care meeting the following restrictions: less than 8 hours per day and no more than 28 hours per week for a duration of three weeks.
The caregiver finds a home health agency that is covered by Medicare (Medicare-approved.)
In order to remain eligible for in-home care (all options mentioned above) and have Medicare cover it, you would need to see the physician 90 days before receiving the care, or 30 days after the individual starts receiving the home healthcare services.
What services are available at home?
Medicare will cover services that come into the home. Below is a list of services that Medicare will cover, along with the qualifying rules.
Physical Therapy
Occupational Therapy
Nursing Care
Home Health Aides
Speech Therapy
Individual’s might be eligible for additional in-home social services that can be found in the community. There are possibilities of support for social, emotional or psychological counseling related to the condition the individual has. These services are being extended to virtual methods for those who are considered “at risk” of Covid-19.
What Medicare will not pay for: in-home custodial care. This means that if the individual will only need assistance with cooking or meal delivery, household chores, bathing and dressing, assistance using the bathroom, etc. Unless the individual needs these services for a short amount of time due to illness or injury. Medicare will also not pay for 24-hr care in the home, full-time skilled nursing care, or routine transportation.
What rights do you have for in-home healthcare under Medicare?
to choose your home health provider
to have your belongings and your home treated with respect
to get a written copy of your health plan
to make your own healthcare decisions
to know if your care plan is changing
to have your privacy protected
to choose a family member or representative to make decisions if you’re unable to make them for yourself
to be informed (in writing) of what your costs are going to be
to contact the home health hotline to report fraud or abuse
to get written information about how to appeal Medicare decisions and how to report fraud or abuse
There are numerous organizations that can help you make a plan that fits your needs. Search your community for a home health agency, you can use this tool, and speak with them to make sure they can provide the care your loved one requires.
As a note: Medicare will only let an individual receive help from one home-health agency at a time. Once you decide on an agency, the individual will need a new referral from the doctor. The individual will also need to inform the old agency that you are switching providers. Just make sure the agency you choose is Medicare-certified!
