Medicare will only cover a non-medical, part-time in-home caregiver if the caregiver works in conjunction with another professional providing skilled care in the home, such as a nurse, physical therapist, speech therapist, or occupational therapist. Medicare Part B benefits help pay for home healthcare services, including caregivers. However, it does not cover 24-hour care, meal delivery, or personal care when personal care is all that is needed. Some government programs pay family or friends of people with disabilities to help with daily activities.
In some states there are programs that pay family members to provide care to those receiving Medicaid (government health insurance for low-income people this program may go by a different name in your state). Medicare only covers home health aides when you're also receiving skilled nursing or therapy services. Medicare only covers home health aides when they're part of a broader skilled care plan, while general caregivers are typically not covered. Medicare Advantage (Part C) plans must provide all the benefits of Original Medicare, including home health services.
You may need to use certain service providers, says Jeannie Fuglesten Biniek, associate director with the program on Medicare policy for KFF. If you have a Medicare Supplement Insurance (Medigap) policy or other health insurance coverage, tell your doctor or other provider so your bills get paid correctly. You can find Medicare-certified home health agencies using Medicare's online Care Compare tool at Medicare. The agency should also tell you (both verbally and in writing) if Medicare won't pay for any items or services they give you, and how much you'll have to pay for them.
Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. Medicare Part B pays for DME that a doctor has prescribed but does not cover medical supplies, such as bandages, used at home. Medicare Supplement Insurance (Medigap) helps pay for out-of-pocket costs that Original Medicare doesn't cover, potentially reducing your overall healthcare expenses. But it can be covered through Part A in some cases after you have been in a hospital as an inpatient for at least three days or a Medicare-covered skilled nursing facility.
The home health agency should give you a notice called the Advance Beneficiary Notice (ABN) before giving you services and supplies that Medicare doesn't cover. While Medicare's coverage for caregivers is limited to specific situations and doesn't include family caregivers, understanding the available options can help you find a solution that works for you and your family. When medical needs require in-home care, many seniors and their families wonder if Medicare will cover caregiver services.
