Does Medicare Cover Companion Care?

When we are sick, we become more dependent on other people. Especially when we are older, we often need more help and become more dependent. So having a caregiver is great for someone who needs help in their daily life.

Because of this, a common question many people have is, “does Medicare cover companion care?” In this article, we answer that question in clear, plain English. You will also find the average costs of caregiver care and other helpful info.

Does Medicare Cover Companion Care?

The short answer is yes; Medicare will cover the cost of in-home caregivers. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your caregiver. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for in-home caregivers. However, not all types of caregivers are covered by Medicare. Medicare has home health benefits, and they may provide coverage for an in-home caregiver if you have an illness or injury.

However, for Medicare to provide coverage for your in-home caregiver, you must meet at least one of the following conditions:

You aren’t able to leave your home unless it is a short outing such as going to the doctor. Medicare will still pay for your in-home caregiver care if you go to adult daycare.
Your healthcare provider orders that you need in-home caregiver care and writes a plan outlining the kind of care you need
You need skilled nursing care. However, skilled nursing care cannot last longer than 8 hours per day and 28 hours per week for up to three weeks
Your healthcare provider thinks that your condition will improve in a reasonable amount of time
You need assistance from a skilled physical, occupational, or speech therapist to design a program that can help you improve or maintain your current state, or prevent it from getting worse
The home-health agency that will provide the in-home caregiver care is Medicare-approved

Some of the services that you may receive in in-home caregiver care include:

Physical therapy
Occupational therapy
Speech therapy
Nursing care
Home-health aides

If you are admitted to a hospital for 3 continuous days or stayed in a skilled nursing facility with Medicare coverage, Medicare Part A provides coverage for 100 days of home healthcare. You receive this home healthcare within 14 days after getting discharged from the hospital or skilled nursing facility.

On the other hand, if you are not admitted to a hospital but need home healthcare, Medicare Part B provides coverage.

Medicare Part C and Part D Coverage for Companion Care

Medicare Advantage plans (Medicare Part C) also provide coverage for companion care. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and your out-of-pocket costs will vary depending on the specifics of your plan.

Medicare Part D provides coverage for prescription drugs that you need during your home healthcare period.

How Much Does Companion Care Cost?

While it varies by state, in-home caregivers usually cost around $20 per hour. The average monthly cost of a caregiver is around $4,000.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.