Key Takeaways
- Medicare covers home health and respite care but leaves gaps in personal and long-term care.
- Medicare has coverage gaps, including limitations on personal and long-term care.
- Caregivers can use local programs, online tools, and expert support to navigate Medicare and find the right coverage.
As our population ages, many Americans find themselves taking on the role of family caregivers for their loved ones.
This responsibility often comes with a steep learning curve, especially when understanding what caregiving services Medicare covers and what it doesn’t.
If you’re a caregiver navigating the complex world of Medicare, this guide will help you understand the essentials of Medicare coverage for caregiving services.
Yes, Medicare Covers Some Caregiving Services
Medicare – a federal health insurance program for people 65 and older and those with certain disabilities – provides coverage for several caregiving services.
This should be a welcome relief for beneficiaries and caregivers facing financial strain due to healthcare costs and burnout from caregiving efforts.
Under Medicare Part A (Hospital Insurance) and Part B (Medical Insurance), beneficiaries can access necessary home health services such as skilled nursing care, home health aides, and physical and occupational therapy.
Keep in mind that a doctor or healthcare provider must certify these services as medically necessary for Medicare to cover these costs. Additionally, an in-network home health agency must provide these services.
Medicare also offers varying levels of coverage for respite care, hospice care, and durable medical equipment (DME). If your loved one needs equipment like a hospital bed, wheelchair, or walker, for instance, Medicare may cover part of the cost.
It’s important to note that Medicare does not cover all caregiving-related costs. Here are some services that Medicare doesn’t pay for:
- Personal Care: Medicare typically does not cover custodial care, such as assistance with bathing, dressing, and feeding. Intermittent home health aide care might include some of these services if the beneficiary also receives skilled nursing or specialized therapy services.
- Full-Time Care: Medicare usually does not cover full-time skilled nursing care. Part-time or intermittent skilled nursing care and home health aide services are limited to 8 hours a day, for a maximum of 28 hours per week.
- Meal Delivery: Original Medicare (Part A and Part B) usually does not cover meal delivery services, although some Medicare Advantage plans may cover them.
- Homemaker Services: Medicare plans do not help with housekeeping, laundry, or shopping tasks.
While Medicare covers some caregiving services, such as home health care and DME, many caregivers are left with out-of-pocket expenses due to coverage gaps.
Need help understanding Medicare coverage options?
At CoverRight, we simplify the process and guide you through choosing the right Medicare plan. Explore your options now.
What Medicare Caregivers Must Know
For Medicare caregivers, understanding the nuances of coverage can significantly impact the quality and cost of care their loved ones receive.
Here are five crucial aspects of Medicare caregiver coverage you must know.
1. Medicare Home Health Care Can Be a Lifesaver
Medicare can provide life-changing support when your loved one needs medical care at home.
Medicare Part A and Part B cover a range of home health services, including:
- Skilled nursing care: This includes services like wound care, medication management, intravenous therapy, and vital sign monitoring.
- Therapy services: Home health services cover physical therapy, occupational therapy, and speech-language pathology services as long as they are deemed medically necessary.
- Home health services: These services help with personal care tasks like bathing and grooming. You are eligible for services only if you get skilled nursing care or therapy.
Under Original Medicare, you pay $0 for covered home health care services.
Make sure your home health agency is Medicare-certified. The agency must tell you (both verbally and in writing) how much Medicare will pay, what it won’t pay for, and how much, if anything, you are liable for in copays or out-of-pocket expenses.
2. Respite Care Can Prevent Caregiver Burnout
Caregiving can be emotionally and physically taxing. Medicare recognizes the danger of caregiver burnout and offers short-term respite care, but only when it is part of a recipient’s hospice benefits.
This service provides a much-needed break for caregivers while ensuring patients continue to receive proper care in their absence. Respite care covers stay in a Medicare-approved inpatient facility for up to five days at a time.
Medicare covers 95% of the Medicare-approved amount for inpatient respite care.
3. Durable Medical Equipment Coverage
Medicare Part B covers a wide range of durable medical equipment.
That includes blood sugar meters, canes, commode chairs, CPAP machines, hospital beds, oxygen equipment, walkers, wheelchairs, and more.
Here’s what Medicare caregivers need to know about DME coverage:
- Prescription Required: A Medicare-enrolled doctor or healthcare provider must prescribe DME for home use.
- Medicare-Approved Supplier: You must obtain the DME from a Medicare-enrolled supplier accepting Medicare assignments. Otherwise, you are liable to pay the full cost. You can find approved suppliers in your area using Medicare’s online supplier directory.
- Cost-Sharing: Once you’ve met the annual Part B deductible, you typically pay 20% of the approved amount for covered DME while Medicare covers the rest.
4. Medicare’s Extra Help Program Can Save You on Prescription Costs
The Extra Help program can be a financial lifeline for caregivers managing tight budgets. This Medicare program assists people with limited income and resources to pay for prescription drug costs.
In 2024, individuals with an annual income of up to $22,590 and resources up to $17,220 may qualify.
Under Extra Help, plan premiums and deductibles are $0, and prescriptions cost no more than $4.50 for generic drugs and $11.20 for brand-name drugs.
You can check your eligibility, apply online, or contact your local State Health Insurance Assistance Program (SHIP) office for help.
5. Local Resources Are There to Support You
Navigating Medicare can be confusing. Fortunately, there are local resources available to help you!
SHIP offers free one-on-one counseling and assistance to help you understand Medicare benefits, compare plans, and resolve problems.
Don’t be afraid to ask for help!
Medicare Challenges for Caregivers and How to Address Them
Even with Medicare’s valuable support, caregivers often face challenges navigating the system and ensuring their loved ones receive the best care.
Here are some common hurdles and how to overcome them.
Unexpected Out-of-pocket Costs
Medicare has a complex structure of copayments, deductibles, and coinsurance.
You must familiarize yourself with these costs and create a detailed budget of healthcare expenses to avoid unexpected costs.
Remember, Medicare doesn’t cover everything. You may have to buy supplemental insurance or be prepared to pay out-of-pocket expenses to optimize your coverage.
Coverage Limitations
Medicare coverage has limitations. It may cover certain services partially and not cover others at all.
Consult with a Medicare counselor or reach out to CoverRight for clarity on what is covered under a specific plan and explore alternative options if necessary.
Care Coordination
Finding Medicare-approved healthcare providers can be difficult at times.
The Medicare Care Compare tool helps you find providers who best match your loved one’s needs.
Staying Organized, Proactive, and Informed as a Medicare Caregiver
Being a Medicare caregiver is a critical and demanding role. It requires alertness, organization, and a willingness to seek out information and support.
Here are some strategies to help you stay on top of your caregiving responsibilities:
- Be Proactive: Don’t wait for problems to arise. Find out about Medicare benefits, coverage limitations, and your loved one’s needs.
- Stay Organized: Maintain a system for tracking medical records, doctor’s notes, medication lists, Medicare coverage details, and interactions with Medicare representatives.
- Take Care of Yourself: Maintain your health by attending regular check-ups and screenings. You can also consider joining caregiver support groups to share experiences and advice.
- Don’t be afraid to ask for help: Medicare rules can sometimes be confusing. For guidance and support, feel free to reach out to Medicare representatives, your local SHIP office, or online resources like CoverRight.
Get the Most out of Medicare
Navigating Medicare as a caregiver can be complex, but you don’t have to do it alone.
CoverRight helps you navigate coverage gaps and find the plan that’s right for your loved ones. Start today.
