Under Medicare rules, caregivers are qualified healthcare professionals such as nurses or therapists. Medicare does not pay for care from family members, friends, or privately hired home health aides.
While it is common for people to receive in-home care from others, such as family members and friends, these types of caregivers do not yet qualify for financial reimbursement. Only licensed healthcare professionals do.
This article outlines Medicare-covered care and caregivers, possible financial assistance for caregiver costs, and more.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Certain Medicare plans cover caregiver expenses if the person meets eligibility requirements and the care qualifies as medically necessary.
“Medically necessary” means the healthcare services or supplies necessary to diagnose or treat an illness, disease, condition, or injury — or its symptoms — and meet accepted standards of medicine.
Original Medicare includes Part A, which covers inpatient services, and Part B, which covers outpatient services. Both parts A and B pay for some home healthcare and services.
Other parts of Medicare may help pay for caregiver costs not included in parts A and B. These include:
Medical caregivers provide services such as wound care and therapy, while nonmedical caregivers assist with daily activities and offer emotional support.
Family, friends, and neighbors
Family members, friends, and neighbors often provide caregiving support. Every year, an estimated 65 million people, or 29% of the United States population, provide care for a family member or loved one. On average, these caregivers spend around 20 hours per week providing care.
These duties may include:
- assisting with daily activities, including bathing, dressing, and eating
- helping with medications and wound care
- performing household tasks such as meal preparation, cleaning, and grocery shopping
- providing emotional support and companionship
- ensuring comfort and managing day-to-day needs
Medicare does not cover caregiving services from family members, friends, or neighbors.
Privately hired caregivers
Privately hired caregivers may perform many of the same duties as family members and friends. They may even provide additional therapeutic services if they have professional training in caring for sick or injured people.
Family members and friends often have other responsibilities, including jobs, caring for their children or other family members, and household duties. Caregiving is their job, so privately hired caregivers can spend more time, energy, and focus on the person.
Medicare does not cover caregiving services from privately hired caregivers.
Skilled nurses
Skilled nursing care includes care from licensed professionals such as:
- registered nurses (RNs)
- licensed practical nurses (LPNs)
- physical, occupational, and speech therapists
Skilled nursing services vary depending on the person’s medically necessary needs. Examples include:
- cleaning and bandaging wounds
- giving injections, including medication and nutritional therapy
- helping the person regain physical or communication skills lost due to injury or a health condition
Medicare covers qualifying skilled nursing services from Medicare-certified home health agencies.
Home health aides
Home health aide care includes help with basic, everyday tasks such as:
- feeding
- bathing and grooming
- dressing
- walking
- changing bed linens
Original Medicare will only cover part-time or intermittent home health aide care if the person also receives skilled nursing care or physical, occupational, or speech therapy.
For someone to qualify for caregiver assistance through Original Medicare, a qualified healthcare professional, such as a doctor or nurse practitioner, must assess them face-to-face and certify they are homebound and need home health services.
Being “homebound” means they have difficulty leaving home for the following reasons:
- They require assistance getting around (e.g., wheelchair, crutches, special transportation) due to illness or injury.
- Their condition makes it unsafe to leave home.
- Leaving home requires a major effort.
The person will not qualify if they need round-the-clock care.
Once the person’s doctor or other healthcare professional orders the care, they will give the person a list of Medicare-approved home health agencies in their area. Medicare only covers those approved agencies.
Original Medicare covers qualifying services on a part-time or intermittent basis only.
“Part-time or intermittent” usually allows up to 8 hours of combined skilled nursing and home health aide services per day, totaling 28 hours per week. When a person’s healthcare professional deems more frequent care is necessary, Original Medicare covers up to 35 hours per week.
Original Medicare covers the following part-time or intermittent skilled nursing services:
- care for wounds, such as pressure sores or surgical incisions
- education for patients and caregivers
- intravenous therapy or nutritional support
- administration of injections, including osteoporosis drugs
- monitoring of serious illnesses and unstable conditions
Additionally, Original Medicare covers the following services for people who are homebound:
- physical therapy
- occupational therapy
- speech-language pathology services
- medical social services such as access to resources and counseling
Original Medicare only covers some part-time or intermittent home health aide care if the person also receives skilled nursing care or physical, occupational, or speech therapy. Home health aide care includes help with:
- feeding
- bathing and grooming
- walking
- changing bed linens
Which home health services are not covered by Medicare?
Original Medicare does not pay for:
- 24-hour in-home care
- meal delivery services
- homemaker services, such as shopping and cleaning, unrelated to the person’s care plan
- custodial or personal care, including bathing, dressing, or bathroom assistance when this is the sole type of care the person needs
Original Medicare covers approved home health services at no cost to the person.
After paying the Part B deductible, the person is responsible for 20% of the cost of any Medicare-approved medical equipment. In 2024, the Part B deductible is $240.
Before services begin, the home health agency should explain what Medicare will cover and notify the person if any services or supplies fall outside that coverage. The agency must provide an Advance Beneficiary Notice (ABN) detailing any services it does not cover and the person’s financial responsibility.
Coverage details may differ for people enrolled in Medicare Advantage or another Medicare plan, so it is important to check with their insurer.
People with extra insurance, such as Medigap, should make sure their doctors and other healthcare professionals are aware so they can process claims correctly.
There are other resources that may provide financial assistance to family members and other personal caregivers:
- Medicaid: Medicaid offers programs such as the Self-Directed Care Program that may provide money to family caregivers. Rules vary by state, so check with the local Medicaid office for details.
- The Program of All-Inclusive Care for the Elderly (PACE): PACE provides the same Medicare and Medicaid-covered services, primarily through adult day health centers and in-home services, depending on the person’s specific needs.
- Social Security: The Social Security Administration does not have a specific program for paying caregivers, but people enrolled in certain plans, such as Social Security Disability Insurance or Supplemental Security Income, may use their benefits as financial assistance.
- Veterans Affairs (VA): Eligible veterans can apply for either VA Aid and Attendance benefits or Housebound allowance, which help with in-home care coverage.
Additionally, people and their caregivers may be eligible for certain tax deductions or credits.
Beyond financial assistance, caregivers may need emotional support. Learn more about how caregivers can find help caring for themselves in our guides to caregiver depression and caregiver burnout.
Recent changes to help caregivers
Starting in 2024, the Centers for Medicare & Medicaid Services (CMS) plans to offer financial and educational support to family caregivers, providing benefits for those caring for loved ones with specific health needs.
The changes will include:
- training from medical professionals to help caregivers better manage medical tasks
- creating a billing code to pay Medicare providers for group and individual training
- providing needs assessments and care navigation for individuals with qualifying high risk health conditions
- working with community-based organizations to offer social services
- providing extra support for people with dementia via the Guiding an Improved Dementia Experience (GUIDE) Model
CMS will set the fee schedules and decide how much Medicare will pay for caregiving services, which will guide future reimbursements.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Under Medicare rules, only services from licensed healthcare professionals, such as nurses and therapists, will be paid for by Medicare. Although family members and friends often provide in-home care, they do not yet receive financial support from Medicare.
Original Medicare may pay for home health aide care, such as feeding and bathing, only if the person also receives skilled nursing care or physical, occupational, or speech therapy.