For a caregiver to qualify under Medicare rules, they need to be a home healthcare provider with a professional certification.
They need to be either a skilled nurse practitioner, occupational therapist, speech pathologist, or physical therapist. Medicare does not provide any assistance for family caregivers or full-time carers.
Many people over the age of 65 struggle with health issues and require a caregiver—whether it’s because of an injury, chronic or acute sickness, or cognitive decline. Sometimes, a family member will be able to step in and act as a caregiver, making sure they’re fed, comfortable, and taking their medication.
But for many people, this isn’t an option. Relatives simply can’t leave their own work or children to be caregivers.
Medicare’s home health benefits will cover a short-term, part-time skilled nurse as a caregiver if required by a doctor. You’ll have access to this benefit for up to 21 days (less than 8 hours a day) or, in specific circumstances, even up to 35 days.
You’ll also receive cover for an occupational therapist, speech pathologist, or physical therapist.
What Qualifies as a Caregiver’s Responsibility & How Does Caregiver Status Work?
Caregiving can include a variety of duties, all depending on what you actually need. You may need assistance from a skilled nurse for certain therapies, caring for a wound, or keeping up with your medications.
Or you could need help with general housekeeping, grocery shopping, meals and eating, getting dressed, help with exercise, and transport if you need to go to an appointment.
In some cases, caregivers are even there to keep you company and keep you entertained with fun activities so that you’re not alone.
When it comes to qualified caregiver status, Medicare acknowledges this on two levels: the first is an unpaid caregiver who has a personal connection to the patient, and the second is a Medicare-approved service provider who gives medical assistance at the patient’s home.
If you have a family member or friend who wants caregiver status, be over the age of 18 and must help with essential daily tasks such as preparing meals, taking medications, or providing you with emotional support. They need to be able to prove they’re having a positive effect on your health and wellness.
Additionally, they need effective communication skills so they can advocate for you, and they need to be able to adhere to any plan your doctor has put together.
For a paid caregiver to receive caregiver status from Medicare, they need to be on the recognized list of home health care agencies. They need to have a state license and be certified either as a skilled nurse, occupational therapist, speech pathologist, or a physical therapist.
Only medically necessary caregiver work is paid for by Medicare and they don’t cover long-term or full-time caregiving.
What Can a Caregiver Provide, According to Medicare?
According to Medicare caregiver requirements, a caregiver can provide skilled nursing services (such as wound care, assistance with medication, and specific therapies), occupational therapy, speech pathology, and physical therapy.
What Qualifies as a Caregiver: Skilled Nursing
For Medicare to cover a skilled nurse as a caregiver, they need to be a licensed practical nurse or a registered nurse with a state license.
They need to have the ability to deal with wounds, monitor medication, manage intravenous drugs and feeding tubes, as well as provide education on diseases. Essentially, this skilled nurse needs to adhere to any plan that your doctor has created for you.
What Qualifies as a Caregiver: Alternative Approved Caregivers
Other approved caregivers are occupational therapists, speech pathologists, and physical therapists.
Occupational therapists ease your stress, set up a plan to follow your doctor’s orders at home and make sure you have healthy daily habits in your home to help you in your recovery.
If your ability to communicate has been impaired (for example, if you’ve had a stroke), a speech therapist will help you learn to speak again or, if that’s not possible due to hearing loss, help you learn a new way to communicate with your loved ones.
A physical therapist can help you recover in the case of physical injury, exercise after surgery, look after wounds, and even rebuild muscle and relearn to walk.
What Medicare Does & Does Not Cover
Currently, Medicare only covers skilled nurses, occupational therapists, speech therapists, and physical therapists who are registered with an agency that is Medicare-certified.
However, medicare caregiver requirements may change under a new billing code that will provide training to unpaid caregivers so that they can help family members with basic medical assistance.
Original Medicare Part A and Part B both cover part-time, short-term caregiving in full, as long as a doctor states that it’s necessary.
You won’t have to pay out of pocket for anything except any equipment you might need on Medicare Part A. If you’re on Medicare Part B, you’ll have to pay a deductible and coinsurance on equipment.
If you have Medicare Advantage, you need to check the fine print on your policy. While your provider will have to offer the same benefits as Original Medicare, they might charge you a copay or have further restrictions on the home health agency you can use.
You will also need to check whether you need authorization for the service.
Medicare Advantage Part C has some additional benefits that cover care related to specific trauma and illnesses such as cancer, dementia, and stroke. It’s worth having a look at Special Needs Plans and what they offer.
What Home Services Are Offered By Medicare?
The following home services are offered by Medicare as long as it’s someone who qualifies as a caregiver under medicare rules:
- Part-time skilled nursing
- Occupational therapy
- Speech therapy
- Physical therapy
- Part-time home health aide
- Medical social services
What Caregiving Services Are Not Offered By Medicare?
We’ve covered what qualifies as a caregiver under Medicare, now let’s look at what won’t be covered:
- Food delivery
- Transportation
- Long-term care
- Full-time care
- Non-medical care
- Household management
- Errands
- Non-medical activities
- Personal care tasks
What Does a Caregiver Cost?
With Medicare, a part-time, short-term caregiver should cost you nothing as long as you go according to their Medicare caregiver requirements.
If you’re on Medicare Advantage, there may be a copayment, so you should check the plan you’re on and make sure what benefits are offered.
Without Medicare, caregiving costs vary according to your needs and can become quite expensive. If you need a medical professional, such as a skilled nurse, occupational therapist, speech pathologist, or physical therapist, you could pay up to $200 an hour.
For a companion caregiver without medical skills or certifications, you’ll likely end up paying around $27 an hour, depending on where you live.
Of course, you can have a family caregiver take over for free, but it will still have an impact on their life and ability to work.
What Other Aid is Available?
If you’re a veteran, Veteran Affairs should be able to help you find caregiving services in your area. Reach out to your local department and find out what’s available in your specific case.
There are tax credits and deductions for caregivers, so if you have a family member acting as a caregiver, make sure they’re taking full advantage of those when they file their taxes.
It’s important to check what qualifies as a caregiver in this instance.
How Can You Find Affordable Caregiver Options Outside of Medicare?
If you don’t have Medicare or don’t fit the Medicare caregiver requirements, don’t worry, you still have options.
First off, talk to loved ones and see if someone (or multiple people) can help you. You might find your niece is a student and has some free time, or your nephew can help out after his shift.
Asking more than one person lessens the load and means there are more hands available to help.
If you don’t have anybody who can help, reach out to your community and find out if any services in your neighborhood can assist you. There are many programs out there designed to help those who need care but struggle to afford these services.
Finally, talk to independent professional caregivers who aren’t part of an agency because they might be more affordable than an agency service.
To Wrap Up
We know that finding a caregiver isn’t an easy task, and deciding what to do after trauma or illness is difficult.
It’s important to remember that you have options, whether or not you have Medicare.
With Medicare, you have the option of a part-time, short-term caregiver who is Medicare-certified.
With Medicare Advantage, you should have the same benefits, but there may be a copay and some restrictions, so you’ll need to speak to your provider.
Without Medicare, you can get a family caregiver, seek help from your community, or hire an independent professional caregiver.
If you’d like help navigating all this, you can always talk to a PlanFit-approved agent about your options. Click below to get coaching and pick the right plan for you: