Does my insurance cover in-home caregiver services?

Identifying a trusted caregiver to come into your home to provide care or companionship can feel like an overwhelming task. Often this task is being managed when the need is immediate, like when you or a loved one is preparing to come home from the hospital or from a rehabilitation facility. In all of your planning to make sure that the transition is smooth, you may not have considered the need for caregiver or companion services at home or how those services will be covered financially. 

It seems logical to assume that if you have insurance then this sort of in-home care would be covered just like other services designed to help with the rehabilitation and recovery process after a hospital stay. Unfortunately, the services that insurance plans cover in the home are not always clear. 

Traditional Medicare Coverage

Traditional Medicare refers to Medicare Part A and Part B. Some services or equipment needed after a hospitalization may be covered by Medicare Parts A or B, such as nursing care, physical therapy, occupational therapy, and speech language pathology services. Medicare Parts A and B do not cover companion services like help running errands or doing laundry, overnight care, meal planning or what is considered custodial care like help with dressing or bathing needs. Because there are limits on the services covered by Medicare Parts A and B, there are supplemental plans, known as Part C, or Medicare Advantage Plans.

Medicare Advantage Plans are offered by private companies and are designed to add extra benefits over and above what is offered and covered by Medicare Parts A and B. The most common companies that offer Medicare Advantage Plans include:

• United Healthcare
• Humana
• Blue Cross Blue Shield (includes Anthem)
• CVS Health (Aetna)
• Kaiser Permanente
• Centene
• Cigna

Extra Benefits from Medicare Advantage (Part C) Plans

Extra benefits offered by Medicare Advantage Plans usually include services for vision and hearing such as having exams and getting eyeglasses and hearing aids.  Dental care is also usually included but plans vary from only offering preventative care and cleanings to offering more comprehensive benefits such as needing crowns or other dental repairs. 

Fitness benefits are also generally included in many Medicare Advantage Plans and may cover things like gym memberships or access to other fitness programs like Silver Sneakers. What varies by plan however, is the length of coverage  (monthly or annually) or if there are limits on the amount of coverage (covers up to 20 % of the membership).

In-home care is minimally covered or not at all under Medicare Advantage Plans

Medicare Advantage Plans vary widely on what is considered to be in-home support or caregiver support. Some of these plans cover professional services in the home and may even pay for the family member to function as a caregiver. Unfortunately, these services are limited to a certain number of hours (30 hours annually which equates to a little over a half hour of care per week.)

Despite advertising these extra benefits, only 4% of enrollees in Medicare Advantage Plans in the United States have caregiver support coverage.