Does Medicare cover a caregiver?

Do you have a loved one who needs extra support handling everyday tasks? While you want to help them as much as you can, sometimes, life gets in the way. Balancing busy schedules, work, kids, errands, and all your other demands can make it difficult to spend as much time with your loved one as they need.

If this sounds familiar, you might be interested in the services of an at-home caregiver. Having an extra person to assist with your loved one’s physical, medical, and emotional needs would be incredibly beneficial. But, can Medicare pay for a caregiver? 

The short answer is yes— Medicare Part A and Medicare Part B can be used to cover home health care from a paid caregiver. However, there are some conditions to this coverage and certain criteria that need to be met, even with the best Medicare companies. Keep reading to learn more about Medicare and whether it will cover this important service for your loved one.

Before reading more about how Medicare can cover a caregiver, take a moment to compare your Medicare options. Enter your ZIP code to see free quotes for Medicare coverage today.

Will Medicare cover a caregiver?

Retirees, people with disabilities, and people with chronic illnesses are target groups for Medicare coverage. These groups also have the greatest need for help from a caregiver, which explains why Medicare covers this important service. However, there are a few important things to note about the specifics of this coverage.

Medicare specifically covers part-time or “intermittent” home health services. That means it will not provide coverage for 24/7 in-home care services. Medicare also won’t cover care that doesn’t have a medical component. So, you won’t get coverage for meal delivery, custodial care services, or homemaker services that don’t include a medical component.

To qualify for coverage for a caregiver, the Medicare recipient also has to meet certain criteria, including:

• They must be receiving care from a doctor.
• They must be homebound, with doctor certification of their condition.
• The doctor must certify that the person needs intermittent skilled nursing care.
• The home health agency must be Medicare-certified.

If all of these criteria are met, then you’re set to get coverage.

What is a caregiver?

The job of a caregiver is in the name: they provide care to those who need help in their everyday lives. People who may need family caregivers include those with an injury, chronic illness, or disability that makes it difficult to navigate daily tasks on their own.

Many people act as informal caregivers for family members or friends, and there are many caregiver resources that can help.. But, caregiving is also a profession. Professional caregivers are trained to assist their patients in home settings, as well as health care settings, such as hospitals.

What does a caregiver do?

Caregivers provide physical, emotional, and medical support when people need it most.

Common responsibilities of a paid caregiver include:

• Arranging and monitoring medical care (ex. doctors appointments, medicine schedules)
• Providing medical services (ex. drawing blood, administering injectable drugs)
• Helping with personal care (ex. bathing, grooming, dressing)
• Doing light housework
• Cooking and preparing meals
• Running errands
• Driving to appointments
• Aiding in medical and financial decisions
• Providing companionship and emotional support

Caregivers aren’t just medical professionals—they’re companions who are well-equipped to accommodate a variety of unique medical and physical needs. If you have a loved one who requires more support in daily life, a caregiver could help fill in the gaps.

What is Medicare?

While your loved one may have Medicare coverage, you may not fully understand the ins and outs of this type of insurance. Essentially, Medicare is a health insurance program run by the federal government. It’s only available to an older adult aged 65 or older and people with certain disabilities or conditions (such as End-Stage Renal Disease or ALS).

Parts of Medicare

Medicare advantage plan is made up of multiple parts, each of which covers different aspects of medical care. The core components are Parts A, B, and D.

• Part A: Hospital Insurance – Medicare Part A covers visits to hospitals, nursing home facilities, and hospice centers. Importantly, Part A also covers home health care. (Keep this in mind for later!)
• Part B: Medical Insurance – Medicare Part B is the most general of the three parts. It can cover doctor’s visits, outpatient hospital care, and durable medical equipment. Like Part A, Part B can also provide coverage for home health care.
• Part D: Drug Coverage – Medicare Part D provides coverage for prescription drugs. It’s not always required, and you may have to opt-in for an additional cost.

Medicare Parts A and B cover home health care, and you will also have coverage if you opt for Medicare Part C, otherwise known as Medicare Advantage (read our “Medicare Part A Coverage: An Expert Guide” for more information).

Case Studies: Medicare Coverage for Caregivers

Case Study 1: Mary’s Story

Mary, a 75-year-old Medicare recipient, was recently diagnosed with a chronic illness that has made it challenging for her to perform daily tasks on her own. Her doctor recommended home health services to assist her with her medical and personal needs. Mary met all the requirements for Medicare coverage of a caregiver.

Medicare Part A and Part B provided coverage for part-time home health services, ensuring that Mary received the necessary support to maintain her well-being.

Case Study 2: John’s Situation

John, a 68-year-old retiree, had a significant fall that resulted in an injury. He needed assistance with mobility, medication management, and other daily activities during his recovery process.

With a doctor’s recommendation, John qualified for Medicare coverage as a caregiver. Medicare Part A and Part B covered the intermittent home health services provided by a paid caregiver, enabling John to receive the necessary care while healing at home.

Case Study 3: Sarah’s Journey

Sarah, a 70-year-old Medicare recipient with a chronic illness, required ongoing medical attention and assistance with daily tasks. Her doctor determined that she met all the criteria for Medicare coverage as a caregiver.

Sarah’s Medicare Advantage plan helped cover the costs of caregiver services beyond what Original Medicare provided. This additional coverage eased the financial burden for Sarah and ensured she received the comprehensive care she needed.

Can Medicare pay for a caregiver? The Bottom Line

In the right circumstances, Medicare will cover a caregiver.

Now that you know how a family caregiver will be covered by a Medicare plan, you can feel confident in taking the steps to hire one. Of course, Medicare may still leave you with out-of-pocket costs, and you might want to find coverage for those costs as well.

Both Medicare Supplement and Medicare Advantage plans can reduce the out-of-pocket costs left by Original Medicare. Which one is right for your loved one depends on their needs.

Before you get a caregiver with Medicare, make sure you have the best coverage. Enter your ZIP code for free Medicare quotes today.