Medicare and How It Can Affect Caregivers

Written By eric berkman

More and more people are becoming caregivers for their loved ones, such as aging parents or family members with chronic illnesses. Caregiving can be demanding, and many caregivers face financial challenges because they often have to reduce work hours or quit their jobs. A common question is whether Medicare can help pay caregivers for their work.

While Medicare helps cover health-related services, it wasn’t designed to pay family caregivers directly. However, recent changes and certain programs now provide some financial support, though often indirectly.

What Medicare Covers and Its Limitations for Caregivers

Medicare is a federal health insurance program for people 65 and older, those with end stage renal disease, and certain younger individuals with disabilities. It consists of several parts:

  1. Part A: Covers hospital stays, hospice care, and some home health care.

  2. Part B: Covers doctor visits, outpatient care, and some at-home medical services.

  3. Part C (Medicare Advantage): Private insurance plans that offer extra services beyond Parts A and B.

  4. Part D: Helps cover prescription drugs.

While Medicare provides important coverage for medical services, it doesn’t pay for many caregiving activities like helping with bathing, dressing, or preparing meals. Most of these tasks fall under custodial care, which Medicare does not cover. However, Medicare does cover some limited home health care services if certain conditions are met.

Recent Changes to Medicare That Impact Caregivers

While Medicare doesn’t directly pay family caregivers, certain programs have started offering more help to support caregiving. These include changes in Medicare Advantage plans and opportunities in Medicaid for caregivers to get paid in some cases.

1. Medicare Advantage Expansion of Home Care Benefits

Some Medicare Advantage (Part C) plans have started offering extra benefits that traditional Medicare does not. Since 2019, these plans have been allowed to cover services like meal deliveries, transportation, and help with daily tasks for chronically ill patients. This can ease the burden on caregivers by covering costs that they would typically have to handle themselves, even though it doesn’t provide direct payment to family caregivers.

For example, some plans now offer coverage for part-time home health aides who assist with personal care tasks, such as bathing or dressing. While this doesn’t give caregivers a paycheck, it frees up time and reduces costs.

2. PACE (Program of All-Inclusive Care for the Elderly)

The PACE program is designed for elderly people who need nursing home-level care but prefer to remain at home. It combines both Medicare and Medicaid benefits to provide a broad range of services, including medical care and support for activities of daily living. Under PACE, caregivers can receive important assistance, such as training and respite care (temporary relief from caregiving duties).

While PACE doesn’t directly pay caregivers, it does provide services that help reduce the workload of caregiving.

3. Medicaid Waivers

Although Medicare doesn’t typically pay caregivers, Medicaid offers more flexibility. Through Medicaid Waivers, states can pay family caregivers for the care they provide to a loved one who qualifies for Medicaid. These waivers allow states to cover non-medical services and personal care provided by family members. However, these waivers vary by state, meaning that not all caregivers have access to this benefit.

In states that allow it, Medicaid waivers can be a lifeline for caregivers by offering financial support to compensate them for their caregiving efforts.

Medicare Coverage for Home Health Services

For Medicare to cover caregiving services, specific criteria must be met:

  • The patient must be under the care of a doctor.

  • The doctor must certify that the person is homebound (unable to leave home without assistance).

  • The care must be part of a written plan that the doctor regularly reviews.

Under these conditions, Medicare will pay for part-time skilled nursing care, physical therapy, and home health aide services. However, these services are often limited in scope and duration, meaning caregivers may still need to provide a significant amount of unpaid support.

It’s also important to note that Medicare doesn’t cover 24-hour care, meal delivery, or housekeeping when these are the only services needed. For family caregivers providing personal care, such as helping with meals, dressing, or bathing, Medicare will not pay unless it’s part of a larger medical care plan prescribed by a doctor.

How Caregivers Can Get Help Paying for Care

Since Medicare has strict limits on what it will pay for, caregivers often look for additional financial help. Here are a few options that may reduce out-of-pocket caregiving costs:

  • Medigap: These are private supplemental insurance plans that help cover some of the out-of-pocket costs, such as copayments and deductibles that Medicare doesn’t pay for.

  • Medicaid: If the person receiving care qualifies for Medicaid, the program can sometimes cover additional costs that Medicare doesn’t, including paying family caregivers under specific Medicaid Waivers.

  • Medicare Savings Programs (MSP): These programs help people with limited income pay for their Medicare premiums and out-of-pocket costs.

  • Supplemental Security Income (SSI): SSI provides monthly cash benefits to people with limited income and resources, including those with disabilities. These benefits can help cover caregiving costs.

  • Veterans Programs: For veterans or their spouses, programs like Aid and Attendance may provide financial assistance for caregiving services.

Conclusion

While Medicare itself does not directly pay caregivers for the non-medical care they provide, certain programs and recent changes can help ease the financial burden. Medicare Advantage plans may cover some caregiving-related services, and Medicaid Waivers offer opportunities for caregivers to get paid in certain states. Caregivers should explore these options, as well as programs like PACE, Medigap, and Medicaid, to reduce caregiving costs.

For now, caregivers must navigate a complex system to find financial support, but changes in programs like Medicare Advantage are helping to provide more options. Keeping informed about these programs is critical to ensuring both caregivers and their loved ones get the assistance they need. This is an area we understand and can help you navigate. Feel free to reach out.

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eric berkman
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