How Do I Get Medicare To Pay For Caregiver

Does Medicare pay for a caregiver?

Original Medicare only covers treatment by certain types of caregivers. Rules apply depending on the kind of care a person receives and the services a caregiver provides.

Medicare is a federal health insurance program for people 65 years and older or under 65 years who have specific health conditions.

Original Medicare consists of Part A, which covers inpatient services, and Part B, which covers outpatient services, including some at-home care.

A person must meet specific eligibility rules to get home care services, and sometimes, extra costs may apply that Medicare does not cover.

This article discusses the different types of caregivers, what Medicare pays for, and help with out-of-pocket costs.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.

Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.

Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

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There are different types of in-home caregivers. Some help with nonmedical personal care, while others offer medical services.

Common types of caregivers include:

companion services: offering fun activities, supervision, or company
personal care services: assisting with personal care, including exercise, eating, dressing, and more
homemaker services: helping with housekeeping, meals, shopping, and transport
skilled care: often licensed healthcare professionals who help with wound care, physical therapy, or medicine

Medicare pays for caregivers when:

a person is under the care of a doctor
a doctor has certified a person as homebound
the care delivered is through a written plan that the doctor regularly reviews

Although Medicare stipulates that a person must be homebound to receive coverage, they may leave home for short periods to attend doctor visits or for non-medical reasons, such as religious services.

A person must usually qualify under Medicare parts A and B to get home care coverage. Some of the services Medicare covers include:

part-time skilled nursing care
physical therapy
occupational therapy
speech and language therapy
part-time home health aide services

Private insurance companies administer Medicare Advantage (Part C) plans. Sometimes these plans cover extra services, such as transportation to medical appointments and adult daycare.

Some Medicare Advantage plans tailor their benefits to groups of people who have a specific chronic illness. These Special Needs Plans (SNPs) help those with certain conditions, such as diabetes, chronic heart failure, or dementia.

Medicare does not pay for caregivers that provide the following:

24-hour care at home
meal delivery
homemaker services when this is the only service needed
supervision, or personal care, when this is the only service required

Medicare Part B covers durable medical equipment (DME), but it does not include all items, such as bandages and medical tape.

Medicare covers medically necessary DME when supported by a doctor's letter. Equipment may include:

blood sugar monitor and test strips
canes, crutches, scooters, walkers, and wheelchairs
commode chairs
Continuous Positive Airway Pressure (CPAP) devices
hospital beds
nebulizers and medications
oxygen equipment
suction pumps
traction equipment

To qualify as DME, an item must:

be able to withstand steady use
be needed for a medical reason
only be used by someone who is sick or injured
be used in a person's home
be expected to last at least 3 years

A person may need to rent or buy the DME they need. Medicare only pays for DME supplied by companies enrolled with Medicare.

Suppliers not enrolled with Medicare can charge more for DME. A person is responsible for paying all costs over the Medicare-approved amount.

Medicare has provided a helpful search tool for individuals to locate DME in their area.

Paying for care can be expensive. However, there are options available to help individuals cover costs they would otherwise have to pay out-of-pocket, including:

Medigap: Private insurance companies administer Medicare supplement insurance, or Medigap plans, to help to pay Medicare parts A and B copayments, coinsurance, and deductibles. Medigap plans K and L have an out-of-pocket limit. Once someone's costs reach this limit, the plan pays 100% of Part B services, which could lower the amount paid for caregivers.
Medicaid: Individuals qualify for Medicaid if they have limited resources and income or a disability. The rules can differ by state. Medicaid may help with costs that Medicare does not cover. The Medicaid Self-Directed Care Program allows people to hire family members to care for them. Family members of veterans or people with disabilities may qualify. A local Medicaid office can offer advice on eligibility and answer questions about enrollment.
Medicare Savings Programs (MSP): Medicare Savings Programs are plans for those with limited resources. How the plans work can differ by state, but all assist with paying Medicare out-of-pocket costs.
Supplemental Security Income (SSI): People qualify for Supplemental Security Income (SSI) because they have limited income and resources or a disability. It provides a cash benefit each month, which is different from the Social Security retirement benefit.
Extra Help: Those who qualify for Medicaid, SSI, or an MSP automatically qualify for Extra Help. The program helps pay for the cost of prescription medication under Medicare Part D, including monthly premiums, coinsurance, and deductibles. The coverage levels depend on someone's income and resources.

Medicare Part B benefits help pay for home healthcare services, including caregivers. It does not cover 24-hour care, meal delivery, and personal care when personal care is all that is needed.

If a person expects to use an item, such as a walker, for at least 3 years, Medicare may cover it as DME. Medicare Part B pays for DME that a doctor has prescribed but does not cover medical supplies, such as bandages, used at home.

People may get help with out-of-pocket costs through Medicare Advantage plans or Medigap. People with limited income and resources can find additional support through Medicaid and other programs.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Last medically reviewed on June 9, 2021

Caregivers / Homecare
Health Insurance / Medical Insurance
Medicare / Medicaid / SCHIP