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Who Qualifies as a Caregiver Under Medicare Rules?
Just the Essentials…
Medicare can cover in-home care for medical purposes, but does not usually cover general caregiving.
Medicaid can provide compensation to family caregivers through their Self Directed Personal Assistance Service program.
Certain Medicare Advantage plans may offer additional assistance.
Getting By With A Little Help
The vast majority of senior citizens live at home, often with family members. This means that many people find themselves thrust into the role of caregiver: one of the most difficult positions there is. If you’re here, you’re probably wondering how Medicare can help: either by letting you hire a licensed caregiver, or by providing financial assistance so you can take time off of work to tend to your loved one.
Unfortunately, things aren’t exactly simple. To prevent fraud, Medicare will only cover things deemed medically necessary, and the in-home care provider services most family members provided don’t fall under that category. However, that doesn’t mean you can’t get help at all.
Let’s start with what Medicare does not cover. In general, Medicare won’t cover general homemaking services, including:
Grocery shopping (unless your plan offers a Healthy Foods benefit)
Preparing meals (unless your plan offers a meal delivery benefit)
Help with daily tasks like dressing.
Instead, Medicare covers home health agency services designed specifically to treat medical conditions. This includes things like changing wound dressings, administering medications, providing physical and occupational therapy, and providing any medical social services. To qualify for this coverage, a care recipient must meet the following criteria.
A care recipient must be diagnosed with a specific medical condition. Medicare does not cover home health agency care for “general frailty”
Patients must be under a doctor’s care for said condition
A care recipient must be homebound, meaning they cannot leave the home without assistance
Even if all these criteria are met, Medicare only covers part-time in home care provider services. If a patient needs round the clock care, they’ll need to stay in a hospital or skilled nursing care facility.
A notable exception to the above is hospice care. While in palliative care, a care recipient can receive in-home care and housekeeping services.
Paying for a Caregiver
Unfortunately, many seniors who need assistive care for the activities of daily living or adult daycare don’t qualify for coverage under Original Medicare (Medicare Part A and Medicare Part D). However, they may qualify for benefits from other sources.
Medicaid, which provides health insurance to low-income families, is a bit more lenient about covering home health services. For instance, individuals who require a nursing home level of care may receive coverage for in-home services from a licensed home health agency. Certain states may relax the level of care needed before one qualifies for this coverage, so check with your local Medicaid office to find out the specific requirements.
In many states, an adult child or other family member can receive financial compensation through Medicaid’s Self Directed Personal Assistance Services program. This is particularly likely if your loved one is a veteran, or has a disability that requires them to have specific medical supplies or durable medical equipment (DME). This, unfortunately, is not a particularly well paying role: hourly compensation tends to hover around minimum wage. However, it can be a good supplement for family caregivers forced to cut working hours to care for a loved one.
Some states may require you to undergo a certification process in order to qualify as a family caregiver. This can include taking online or in-person courses and undergoing a background check. In general, you need to be eligible for employment to receive compensation for being a family caregiver, meaning undocumented immigrants and family members on temporary visas do not qualify.
If Medicaid is not an option, there is still hope. Your Area Agency on Aging (AAA) can direct you toward state-sponsored programs that can provide additional assistance. Veterans can also consult their local Veteran Services Office to find additional programs. Some of these programs are independent from Medicaid, but their availability is dependent on your location.
If your loved one has a specific condition, such as cancer, you may be able to find help from a condition-specific organization or charity. Your local AAA can help connect you with these organizations as well.
Medicare Advantage and Caregiving
Because Medicare Advantage benefits are dependent on the specific plan provided by a private insurance company, access to in-home care will vary. Homemaking services are an uncommon benefit, but there are certain services that can still help.
If your Medicare Advantage plan includes a grocery benefit, you may be able to have groceries delivered directly to your home. This benefit is limited to healthy foods, but can cover most of your pantry staples. Some plans also include meal delivery benefits, which are good for homebound seniors unable to cook for themselves. Some plans may also have partnerships with agencies that can provide part time home care and companionship.
If you’re curious what benefits are available from Medicare Advantage plans in your area, we can help. Our licensed agents can help you sort through your options and find a plan that works for you. Call us today at (800) 950-0608, or enter your zip code into our free comparison tool to begin your search.
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