According to the National Institute on Aging, in 2015, about 4.7 million senior citizens were utilizing home-health care including having a caregiver. There are many reasons why a senior would need a live-in caregiver, such as helping stabilize health conditions, monitoring, provide therapy, and help with daily activities.
Live-in care is when a fully trained caregiver lives with you in your home and helps you with your specific needs to help you feel comfortable inside your home. Medicare covers home healthcare, but does Medicare cover live-in caregivers? We explain.
Medicare and caregivers
It is common for Medicare to cover home healthcare, but many factors determine whether Medicare will provide coverage. For example, the reasoning on why you need the care and how long you will need it for. Medicare covers any service deemed medically by your physician.
If you are home ridden due to an injury or illness, Medicare may cover your home healthcare. But there are certain criteria you must meet for your care to be covered.
If any of the following applies to you, Medicare may cover your home health care:
- Your doctor confirms you need at-home care and writes a plan about the care you need.
- You require skilled nursing care, occupational, or speech therapy.
- You can’t leave your home for outings such as seeing the doctor or religious service.
- Your physician believes your conditions can improve in a reasonable amount of time.
- You must be home ridden, and a doctor certifies that you are homebound.
- Medicare approves home healthcare.
So, there is a chance Medicare will cover home healthcare, but you must meet specific requirements. But does Medicare cover a long-term live-in caregiver?
Medicare and long-term care
As briefly mentioned, the length of time for your care is one factor determining if Medicare will cover home healthcare. The length of your care matters because Medicare will not cover long-term care; Medicare only covers short-term care.
Long-term care is described as any service or support you need for personal care. For example, Medicare does not cover custodial care, such as helping you bathe, get dressed, or eat. Medicare typically does not cover a caregiver who helps you with daily activities unless it is short-term and deemed medically necessary by a physician.
If a caregiver lives with you, Medicare will not pay for the caregiver’s meals, housing, or transportation. Medicare will not pay for a caregiver transporting you, 24-hour care from a live-in caregiver, or full-time skilled nursing care. If you opt for a long-term live-in caregiver, expect to pay 100% of the costs out-of-pocket.
In-home services covered by Medicare
Medicare does not cover long-term care or a live-in caregiver. However, Medicare does provide coverage for in-home services that are short-term. For example, Medicare will cover physical therapy and speech therapy inside your home.
There are many reasons why a senior would need physical therapy. For example, if you manage a long-term illness and are trying to improve your health and mobility. If physical therapy is deemed medically necessary by your physician, Medicare should cover it.
If you require at-home physical therapy, Medicare will likely cover your assessment and exercises to help you recover from an illness, injury, surgery, and provide wound care. The Part B deductible would apply for these services, and you would pay a 20% coinsurance after you have met the Part B deductible. If you have a Medigap plan, the Medigap plan will likely pick up the coinsurance costs.
Many seniors need speech therapy to help with their cognitive and communication skills. If you are receiving treatment from a speech therapist inside your home, Medicare will cover services such as:
- Therapy to help you swallow.
- Therapy to help you eat and drink.
- Education over ways to communicate if you cannot speak and new ways to communicate when you lose your hearing.
- Help to recognize and remember words.
Medicare Part B covers these services at 80% after you have paid the Part B deductible. Therefore, leaving you responsible for the 20% coinsurance.
How to pay for a live-in caregiver
Even though Medicare does not cover a live-in caregiver, there are options on how you can pay for this type of service. If you have a Health Savings Account (H.S.A.), you can use those funds to help with your out-of-pocket costs. You could also consider long-term care insurance to help fund a live-in caregiver. However, you will want to research long-term care insurance thoroughly as many plans have limited benefits.
Medicare covers home healthcare for those who qualify, and when home healthcare is deemed medically necessary by a physician. Medicare will not cover a long-term live-in caregiver but will cover short-term care. Visit Medicare.gov for more information on Medicare and live-in caregivers.