Can Medicare Pay for a Caregiver?
Medicare does not cover full-time in-home care by a caregiver, although it does provide some coverage for short-term stays in skilled nursing facilities. Medicare may also help adults pay for some in-home care if they use a Medicare-certified home health care provider.
What Medicare covers and does not cover is complicated. In many cases, it provides limited coverage for different health needs, but will not typically cover a full-time caregiver. Let’s take a deeper look at what Medicare covers, as well as what it doesn’t cover for adults and their families.
What Does Medicare Pay For?
The primary benefit of Medicare is to cover medical expenses for illness or injury for qualified people. This may include covering your hospital stay and doctor’s appointments as well as preventative screenings and support. Medicare may also cover testing you need, many types of outpatient care and help with mental health care needs.
In some cases, Medicare can help pay for part-time nursing care, including the health aides you may need or for occupational and physical therapy. However, it has limitations when it comes to paying for a caregiver.
For example, you cannot rely on Medicare to cover your long-term needs, such as in a memory care location or in a nursing home. It also does not provide coverage for 24-hour in-home care. Medicare does provide for some financial coverage for short-term stays in a skilled nursing location, such as to help you recover from medical procedures or illness that no longer warrants remaining in a hospital. This coverage is generally limited to short-term care of 100 days or less.
What About a Caregiver?
Some Medicare supplemental health insurance plans may help pay for caregivers. Medicare may cover some home health services, such as:
- Physical therapy
- Occupational therapy
- Part-time skilled nursing care
- Medical social services
- Intermittent home health aide services
However, it does not cover having someone in the home 24-hours a day. It also doesn’t cover having meals delivered to the home, any homemaker services such as cleaning or laundry – if this is the only service you need – or custodial or personal care like bathing, dressing and toileting – if this is the only care you need. If you need these services in addition to the services that Medicare covers, such as part-time skilled nursing care, you may still be able to receive those services as part of your larger care plan.
Are You Eligible for Medicare?
Medicare eligibility depends on many factors. You may be able to obtain coverage if you meet specific eligibility standards including:
- You are under the care of a medical doctor and you are getting services under the plan of care that was set by that doctor.
- Your doctor certifies that you need one or more of the following:
- Intermittent skilled nursing care (this must be more than just having your blood drawn)
- You need continued occupational therapy services, physical therapy, speech or speech and language pathology services. There are very specific definitions for this, and your doctor must specify that they are necessary.
- You must be homebound, which means that you cannot leave your home for this care. Your doctor must certify that this is the case.
For more information on eligibility and what Medicare covers, visit Medicare.gov.
What About Medicaid?
Medicaid is another option that may help pay for the support you need. Medicaid provides financial coverage for many medical needs and may cover having a person come to your home to fulfill your health requirements.
Medicaid is a state-specific program. Each state establishes the rules and coverage options that fall under it, but in every state, there are income requirements to obtain access to Medicaid. Actual income requirements range from one state to the next but, if you qualify for Medicaid, it can be an excellent way to supplement the coverage you get for your caregivers. Some of the support that Medicaid typically covers include:
- Respite care services, which provide care for a friend or relative while a caregiver is away
- Memory care services may be available through a Medicaid waiver in most states
- Assisted living services and care may be available through some Medicaid waiver programs
You can find more information about New York’s Medicaid program, what it covers and who is eligible on Medicaid’s New York overview webpage.
Other Options for Financial Assistance
If you do not qualify for coverage under Medicare or Medicaid, there may be help available in other forms. Be sure to check with your Medicaid office as a first step in finding available financial assistance as they often have supplemental resources as well as more information for those who need it. These offices tend to be more knowledgeable about local programs that can help you.
If you are a member of the U.S. Armed Forces or a veteran, you may qualify for some financial aid under the VA benefits you receive. The best support is typically available under the VA’s Aid and Attendance program, which provides additional financial support on top of your normal VA pension. The level of support is based on when you served and your care needs, but can provide funds for caregivers who help you with daily activities or long-term care needs in a supportive living environment, such as assisted living or memory care.
Outside of your local Medicaid office and the VA, you can also consider the resources below to help pay for a caregiver:
- Supplemental Security Income may be available to help supplement your current income.
- The Administration of Aging provides information and resources to help seniors find financial aid. It also offers legal assistance, health insurance counseling and long-term care planning resources.
- The Americans with Disabilities Act National Network is another good resource as it can help you with federal government programs as well as transportation needs.
Finding the Help You Need Is Possible
When Medicare does not provide the type or level of care your loved one needs, it’s essential to reach out for support that’s more customizable. Consider other federal, state and local programs that may be able to help you pay for a caregiver, as well as other support options. For example, if an in-home caregiver isn’t covered, you can consider a supportive living community with assisted living or memory care, depending on your needs.
The Brielle offers both assisted living and memory care, as well as respite services for caregivers who need time to take care of essential needs, or just relax and recharge. We know paying for support services can be difficult, so our pricing structure is designed to be affordable while offering you the maximum amount of support. Contact us for more information on our services and pricing or see what life is like at The Brielle by taking a virtual tour.