Does Medicare Pay for Caregivers? Your Guide to At-Home Healthcare

Medicare pays for short-term home health services such as skilled nursing care, physical therapy, and occupational therapy if you cannot leave home and your doctor orders these services.

If you have a medical condition that makes it difficult for you to leave your home, home healthcare may be a more convenient, less expensive, and effective way to get the care you need.

From time to time, Original Medicare (Part A and Part B) may cover medical care given in your home if you’re unable to leave home. Medicare may also pay for some in-home help with your daily needs for a short period after an illness or injury.

But if you need long-term help with daily activities in your home, it’s important to know that Medicare typically doesn’t cover those caregiving services.

Does Medicare cover the cost of in-home caregivers?

Whether Medicare pays for in-home caregivers depends on the kind of care you need, the reason you need care, and the length of time you’ll need it.

If it’s difficult for you to leave home because of an illness or injury, you can use Medicare home health benefits if any of the following apply:

You can’t leave home other than for short outings, such as going to the doctor or religious services. (There is one exception: You can still receive in-home care if you go to adult day care.)

Your doctor verifies that you need at-home care and writes a plan outlining the care you need.

You need skilled nursing care (less than 8 hours per day and no more than 28 hours per week for up to 3 weeks).

Your doctor thinks your condition will improve in a reasonable, or at least predictable, amount of time.

You need a skilled physical, occupational, or speech therapist to design a program to help you improve or maintain your current health or to prevent your condition from worsening.

You need a home health aide to help care for you while you recover.

The home health agency providing your care is Medicare-approved or Medicare-certified.

To remain eligible for in-home care, you’ll need to see your doctor fewer than 90 days before or 30 days after you start receiving home healthcare services.

What in-home services are generally covered by Medicare?

Medicare covers many services, some of which may be provided in your home. Here are some services and the Medicare rules that apply to them.

Physical therapy

If a physical therapist treats you in your home, Medicare is likely to pay for these types of services:

assessment of your condition

gait training and exercises to help you recover from surgery, injuries, illnesses, or neurological conditions such as stroke

postoperative wound care

wound care for injuries, burns, or lesions

Occupational therapy

If an occupational therapist treats you at home, you can expect to receive these kinds of services:

help with establishing daily routines for taking medications, planning meals, and taking care of personal needs

training in strategies to conserve your energy and reduce stress

training to help you carry out daily tasks safely

help to regain the ability to function, given your needs and condition

help with carrying out your doctor’s orders

Speech therapy

If a speech therapist works with you in your home, here are some of the services you may receive:

help with remembering or recognizing words

therapy to help you regain the ability to swallow

therapy to help you eat and drink as normally as you can

education about other ways to communicate if you cannot speak

education about new ways to communicate if you’ve lost your hearing

Nursing care

If a registered nurse or licensed practical nurse comes into your home to care for you, they may:

change your wound dressings

change your catheter

inject medications

provide tube feedings

administer intravenous drugs

teach you about how to take your medications and care for yourself

Home health aides

Home health aides, on the other hand, are likely to help you with these kinds of services:

monitoring your vital signs, such as heart rate, blood pressure, and body temperature

making sure you’re taking your medications the way you should

evaluating whether your home is safe for you, given your needs and condition

checking that you’re eating and drinking in a healthy way

Other services

You may also be eligible for in-home social services. If you qualify, you may get help finding resources in your community to help you adjust to your condition. You may also receive social, emotional, or psychological counseling related to your condition.

Does Medicare cover the cost of in-home custodial care?

Medicare doesn’t typically cover caregivers who help you with the activities of daily living unless this type of care is necessary for a short time while you recover from an illness or injury.

Custodial care generally includes services such as meal delivery or preparation, shopping, laundry, housekeeping or cleaning, help with bathing and dressing, and restroom assistance. Medicare won’t pay for a caregiver to provide these services in your home if these are the only services you need.

Medicare also doesn’t pay for:

24-hour care in your home

full-time skilled nursing care

transportation

Your home healthcare rights under Medicare

Medicare guarantees you certain rights and benefits. You have the right to:

choose your home health professionals

have your belongings and your home treated with respect

get a written copy of your health plan

make your own healthcare decisions

know if your care plan is changing

have your privacy protected

choose a family member or representative to make decisions if you’re unable to make them for yourself

be informed (in writing) of what your costs will be

contact the home health hotline to report fraud or abuse

get written information about how to appeal Medicare decisions and how to report fraud or abuse

How much does it cost to hire a caregiver, and is financial aid available?

A 2023 industry survey on home health costs found that the median cost for a home health aide was $6,292 per month.

If you or your loved one has exhausted your financial resources by paying for in-home caregivers, you may be eligible for Medicare and Medicaid.

Every state has at least one home- and community-based health services waiver program. If you meet the eligibility guidelines, this type of waiver program could help you pay for things such as:

adult day care

housekeeping services

help with daily personal care

changes to your home

help with housekeeping

If you think you or someone in your family might need custodial care, you may want to consider a long-term care insurance policy to help you cover the cost.

A Medicare supplement (Medigap) plan may also help you pay some of the costs that Medicare won’t cover.

Which parts of Medicare cover caregivers?

Part A

Medicare Part A provides hospital coverage. If you were admitted to the hospital for 3 consecutive days or if Medicare covered your stay in a skilled nursing facility, Part A will cover home healthcare for 100 days, as long as you receive home health services within 14 days of leaving the hospital or nursing facility.

Part B

Medicare Part B is medical coverage. If you need home health services but weren’t admitted to the hospital first, Part B covers your home healthcare. But you have to meet the other eligibility requirements.

Part C (Medicare Advantage)

These plans provide the same basic coverage as Original Medicare but are run by private insurers.

A Medicare Part C (Medicare Advantage) plan may require you to get home healthcare from an agency in the plan’s network. Check with your plan for details.

Part D

Medicare Part D plans are also private insurance plans. They cover some or all of the costs of the prescription drugs you may need during your home healthcare period.

Medicare supplement (Medigap)

Private insurance companies offer Medigap policies such as Part C and Part D plans. These policies may help you pay for home healthcare costs that Medicare doesn’t cover.

How do you hire an in-home caregiver?

If you want to research certified agencies in your area, Medicare has a tool to help you find a home health agency. Once you find an agency near you, you can use Medicare’s home health agency checklist to determine whether the agency will provide the level of care you want.

Your State Survey Agency keeps an up-to-date report on the quality of care given by home healthcare professionals. You can check Medicare’s State Survey Agency directory to find the website or telephone number of the agency in your state.

Medicare lets you receive care from only one home health agency at a time. If you decide to change the agency you use, you will need a new referral from your doctor. You’ll also need to inform your agency that you’re switching to another agency.

The bottom line

Medicare doesn’t pay for an in-home caregiver when custodial care services, such as housekeeping and personal care, are all you need. Medicare may pay for short-term custodial care if it’s medically necessary and your doctor certifies that you cannot leave your home.

But Medicare does pay for home health services such as physical therapy, occupational therapy, speech therapy, skilled nursing care, and social services if you’re unable to leave home after a surgical procedure, illness, or injury.

Your doctor must certify that the services are medically necessary, and your home health agency must be Medicare-certified.

Posted : 2024-08-29 10:50

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