Does Medicare Pay for a Caregiver? 

Today in the United States, over 50 million adults are providing caregiving support to members of their families, neighbors, or friends who want to remain in their homes as they get older. These caregivers are typically unpaid and not professionally trained, but they can help with personal (custodial) care and other daily activities like shopping and cooking. 

If you’re one of the millions of seniors who prefer aging at home to an assisted living facility, you might find that you need assistance from an outside caregiver from time to time. Will your Medicare insurance help you cover these expenses? 

How does Medicare help pay for a caregiver? 

If you’re enrolled in Original Medicare Part A (hospital insurance) and B (medical insurance), you may be eligible for home health care services that can include paying for a caregiver under certain circumstances. 

To be eligible, your physician (who accepts Medicare assignment) must certify, after a face-to-face visit, that you need part-time or intermittent skilled medical services, and that you are homebound.

Medicare may consider you homebound if the following conditions apply:

• You have difficulty leaving home without assistance from a wheelchair, walker, cane, crutches, special transportation, or assistance from another person. This difficulty can arise from an illness or injury. 
• Your health care provider recommends that you don’t leave home because of your medical condition. 
• You can’t leave home because of the effort involved. 

Medicare may pay for part-time or intermittent skilled nursing care and home health aide services for up to eight hours a day and 28 hours per week maximum. In some cases, Medicare might cover a caregiver for more hours (but only for a short period) if your Medicare-affiliated health care provider thinks it’s medically necessary. 

Medicare-covered home health care services include the following: 

• Skilled nursing care that is certified to be medically necessary (on a part-time or intermittent basis) 
• Physical, occupational, and speech-language pathology therapy services
• Medical social services
• Home health care aide services in tandem with skilled nursing care (part-time or intermittently) 
• Injectable osteoporosis drugs 
• Durable medical equipment and/or medical supplies you need at home

To receive this coverage through Medicare, your health care provider, who accepts Medicare assignment, must order the care, and it must be provided by a Medicare-certified home health care agency. 

Original Medicare doesn’t cover caregiver services if you only need custodial (personal) care like bathing, getting dressed, etc. Also, it doesn’t cover around-the-clock care, homemaking services, transportation, or delivered meals. 

If you need more than part-time or intermittent skilled nursing care, you would need to pay out-of-pocket. 

How much would you pay for home health care?

Original MedicareParts A and B pay 100 percent of the cost for home health care services it covers if you qualify. If you need durable medical equipment or medical supplies for home use, Original Medicare Part B pays 80 percent of the final approved cost to rent or purchase the equipment from a medical supplier who accepts Medicare assignment. You pay the remaining 20 percent after meeting your Part B deductible for the year.  

If you’re enrolled in a Medicare Advantage (Part C) plan, your provider is obligated to cover the same benefits as Original Medicare Parts A and B for those who qualify. Today, most Medicare Advantage plans provide additional coverage for enrollees. 

Depending on the type of MA plan you have, you might have more coverage for caregiver services. However, your plan might also require that you use in-network providers, or you might have additional copayment or coinsurance charges. 

If you aren’t sure what coverage your MA plan provides, contact your provider for details before making health care arrangements.