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A Comprehensive Guide: Medicare Support for Caregivers

Simplifying Subsidy Estimates

AARP reports that approximately 48 million caregivers care for someone over age 18, and 19% are unpaid. Another study found that 78% of family caregivers incur out-of-pocket costs, with an average annual expenditure of $7,200.

So, if you are responsible for caring for a sick loved one, you may be eligible to receive Medicare support for caregivers. As a caretaker, tending to a sick family member makes maintaining a job and paying the bills challenging. 

Managing all the responsibilities drains you mentally, physically, and financially. That’s why it’s essential to become educated on Medicare and caretaker support. Using our comprehensive guide to caregiver support (self-directed care), you can get the help you deserve.

image of doctor speaking to caregiver about medicare support
Medical concept, patients listen to advice from medical professionals.

What Is Medicare?

Medicare is a federal health insurance program covering adults older than 65 and those under 65 with specific health conditions. Health insurance is provided primarily to low-income families who cannot afford the alternatives.

Original Medicare consists of Part A, Part B, and Part D. Part A (hospital insurance) provides coverage for inpatient services. Part B (medical insurance) handles outpatient services that include at-home care, while Part D manages prescription drug costs. 

If you need additional insurance, you can apply for Medicare Advantage, which includes additional benefits such as hearing, dental, vision, fitness, medical transportation, and critical support for patients with severe illness. With Medicare Advantage, you can receive:

  • Health Maintenance Organizations
  • Preferred Provider Organizations
  • Private Fee-for-Service Plans
  • Special Needs Plans
  • Medicare Medical Savings Account Plans

How to Qualify For Medicare Caregiver Support

A healthcare professional must deem it medically necessary to be eligible for Medicare caregiver support. However, you must meet other criteria as well.

You may qualify for caregiver support if your family member is:

  • Unable to leave the house independently (i.e., uses a cane, wheelchair, walker, or crutches)
  • It is not recommended that they leave the house due to their medical condition
  • Cannot leave home because it requires a significant effort

The patient must also meet the following conditions:

  • Under the care of a medical professional and receive services under a care plan created and reviewed regularly by a doctor or practitioner.
  • The doctor must certify that the patient needs intermittent skilled nursing and other forms of therapy (physical therapy, speech therapy, etc.). Medicare defines Intermittent care as:
    • Fewer than 7 days a week
    • Less than 8 hours per day for up to 21 days (Medicare will extend this limit under particular circumstances)
  • The patient must be homebound, and your practitioner must verify this.

It is important to note that Medicare will not cover home services if they are needed full-time. Nor will they pay caregiver costs if your loved one is stable (which must be determined by a physician). Lastly, all home care must be medical. 

However, Medicare will cover 80% of durable medical supplies and provide you with specialized home health services to lessen the burden. 

Medicare Benefits For Family Caretakers

The benefit of at-home care is that it reduces the risk of accidents while improving your family member’s mental health. 

If you’re feeling stressed, the good news is you don’t have to do it alone. Don’t worry! Medicare provides a wide variety of support to alleviate your workload. Although they do not offer direct family caregiver compensation, they will pay for at-home specialists. Medicare will pay for home services rendered over a 30-day period. Payment is dependent on the patient’s condition and care needs. 

Services include:

  • Home Health Aids: Part-time assistance from experienced home health workers. But they must come from a certified agency. Medicare provides an online tool to find one based on your location.
  • Medical Social Workers: Manage emotional concerns and challenges surrounding the management of a disability or illness.
  • Occupational Therapists: Aid with patient’s daily activities so they can manage their responsibilities more efficiently.
  • Physical therapists Improve patient mobility to restore independent function. Physical therapy is great for those who have endured loss of movement from extended hospitalization.
  • Speech/Language Pathologists: Used for patients who suffer from a stroke—therapy targets recovering lost speech, communication, and swallowing ability.
  • Skilled Nursing Care: When family caretakers need a break, nurses can perform at-home injections, change wound dressings, check blood pressure, dispense medication, etc.

Services exclude:

  • 24-hour care at home
  • Meals delivered to your home
  • Shopping, cleaning, and laundry
  • Custodial services such as bathing, dressing, and bathroom use (when this is the only care needed)

When you’re services are ending, you have the right to appeal, especially if you feel they are ending prematurely. By submitting a fast appeal, an independent reviewer will re-evaluate your case and advocate for you. 

Enrolling In Self-Directed Care

The enrollment process depends on whether the patient is at home or in the hospital. If they’re in the hospital, a social worker will arrange for a Medicare-certified home health agency (HHS) to evaluate your loved one. If you are at home, you can ask a doctor for a list of certified HHS agencies. 

To prepare for the application, here are some other steps you should follow:

Assessment: The first step is assessing your loved one with a physician to determine what services are needed.

Planning: Your family member and a healthcare provider should create a written plan detailing all daily living assistance, such as bathing, dressing, and feeding. Contingency plans should be available for coverage when the care provider is off, and instructions for fill-in caregivers should address risks.

Budgeting: Depending on the assessment’s results, this will determine the budget for goods and services.

Selection: When you set the care plan, the recipient chooses a caregiver or surrogate. Then, you can apply for the most appropriate Medicare support for caregivers.

Additional Resources: Veteran Affairs (VA) Benefits

If you are a veteran and need further assistance, here are some VA programs that will work alongside Medicare benefits:

Aid & Attendance Benefits: This program supplements a military pension to cover the cost of a caregiver, using specific criteria for eligibility. 

Housebound Benefits: Housebound veterans who qualify for these benefits and have no dependents can receive a Maximum Annual Pension Rate (MAPR) of $19,598. Those eligible for housebound benefits with at least one dependent can receive a MAPR rate of $24,562. For each dependent, veterans receive an additional $2,743. 

Veteran-directed care: allows qualified former service members to manage their long-term support. The program provides veterans the option of choosing the goods and services they find most useful (assistance with daily living, bathroom aids, and help with prosthetics)

Comprehensive Assistance For Family Caregivers: provides a monthly stipend to family members who serve as caregivers for veterans in need.

Please note that having VA benefits will not affect your Medicare benefits. However, Medicare will not cover any services from a VA facility.

My Healthcare Direct

At My Healthcare Direct, we prioritize your loved one’s home healthcare needs and will help you navigate Medicare support for caregivers. More so, we provide simple, reliable, and direct advice regarding all your health insurance questions. 

We can also advise you on the following:

If you need help enrolling in Medicare, our experienced insurance agents will assist you. Contact us today to speak with one of our agents.

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