Medicare Benefits for Caregivers
But until recently, the Medicare system offered scant support to these caregivers.
Fortunately, that’s about to change starting this year, as Medicare expands benefits and supports available for training at-home and family caregivers like Hunter Biden to provide support for older Americans suffering from Alzheimer’s, dementia, cognitive decline, and a wide range of physical disabilities and chronic medical conditions – allowing them to age gracefully at home for as long as possible, and stay out of hospitals and institutions.
If you or a loved one or family member are a caregiver or a recipient of care from an informal caregiver, this article will provide you with the basic information you need to know to benefit from the changes being implemented this year.
The Problem
The number of seniors and caregivers potentially affected is massive:
- About 34 million Americans provide care to an adult with a disability or illness each year.
- According to the AARP and the United Health Hospital Fund, 46% of caregivers help with medical and nursing tasks for supported individuals. And more than 96% report helping with activities of daily living (ADLs).
- More than six in ten caregivers are working full- or part-time while providing support.
- 25% of caregivers say it is very difficult to get assistance that is both affordable and helpful, with this percentage rising to 29% for higher-hour caregivers.
At long last, the Centers for Medicare & Medicaid Services (CMS) is acknowledging the crucial role that family caregivers play in supporting frail older adults.
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Medicare Benefits for Caregivers Background
Historically, Medicare has only covered services provided directly to beneficiaries. It has nearly entirely excluded the needs of family caregivers. This is true despite the important role that family caregivers play in helping to reduce Medicare expenditures by keeping Medicare beneficiaries safe and out of the hospital.
This year, Medicare is beginning to shift its stance: The Center for Medicare and Medicaid Services is rolling out several new changes aimed at supporting caregivers with better training.
These changes include:
- Paying Medicare providers to train family caregivers.
- Covering a social needs assessment and care navigation for patients with specific conditions.
- Creating an integrated care model for dementia patients and their families.
Let’s take a closer look at each one of these reforms and how they may benefit you:
Caregiver Training Benefits
Starting in this year, the Center for Medicare Services will introduce a billing code that allows Medicare providers, such as physicians, nurse practitioners, physician assistants, and therapists, to be compensated for training family caregivers.
This training is essential as some 48% of family members are often expected to perform complex medical tasks without any formal training. Prior to this year, there was no formal mechanism in place to compensate medical professionals for the time and effort involved in providing training for informal and untrained caregivers.
While this initiative is promising, practical implementation may pose challenges. Physicians, who might be the ones billing for this service, often lack the necessary skills or time to provide comprehensive training. It may be more effective if this training is conducted by nurses or therapists, possibly in community-based settings like adult day centers or senior centers. Unfortunately, these organizations are not typically recognized as Medicare providers, and CMS will need to address this gap.
Care Navigation Benefits
Another significant initiative is the inclusion of a health-related social needs assessment and care navigation.
This program will allow physicians to collaborate with non-medical providers, such as community-based social service organizations and community health workers, who are well-suited to assist with these tasks. Initially, this benefit will be limited to patients with “high-risk conditions,.
GUIDE: Guiding An Improved Dementia Experience
Another new initiative, set to launch in 2024, is designed for families of seniors with Alzheimer’s or dementia. The Guiding an Improved Dementia Experience (GUIDE) program will support comprehensive care coordination, caregiver education, support, and respite services for informal and family caregivers.
The GUIDE program will also provide people living with dementia and their caregivers with access to a care navigator to help coordinate services and connect them to resources available in their communities.
At this point, however, the program is limited to dementia cases and not extended to other individuals with serious chronic conditions.
The Importance of Family Caregivers
These new initiatives by the Biden administration mark a significant step forward in supporting family caregivers. There are still questions regarding the specifics, such as the exact compensation for these services, the frequency of their availability, and the definition of a family caregiver. Additionally, the willingness of medical practices to participate in these programs remains to be seen.
Despite these uncertainties, the new benefits for caregivers highlight a critical shift in recognizing the essential role family caregivers play. These initiatives aim to reduce barriers to effective caregiving and help individuals with chronic conditions age comfortably at home for longer periods. Most importantly, they underscore that family caregivers matter.
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What To Do Now
If you are a supported individual on Medicare or a family caregiver, here’s what you can do to benefit from these new initiatives:
- Consult with Your Doctor. Speak with your healthcare provider to determine your case qualifies for these new services.
- Look into Medicaid programs in your state. Many states have programs that pay informal caregivers to provide care. These programs are called consumer-directed personal assistance programs (CDPAPs). As an example, here is the dedicated page for CDPAP programs in New York.
- Understand the Services. Ensure you understand the training, assessments, and care coordination services that are now covered.
- Community Resources. Look for community-based organizations that might offer relevant training and support. For example, you can contact the Alzheimer’s Association HelpLine at any time day or night for information on caregiver resources and programs in your area.
- Stay Informed. Keep reading this blog, and subscribe to the MediGap Advisors Health and Wealth Newsletter to stay up to date on all the latest initiatives, programs, news and benefits from Medicare.
These new Medicare benefits for caregivers are a testament to the evolving recognition of the vital role that family members play in the healthcare system. By providing training, support, and integrated care models, CMS aims to empower caregivers and improve the quality of care for patients.
For Further Reading: Things Medicare DOESN’T Cover – And How To Protect Yourself|How To Get the Most Out Of Your Prescription Drug Coverage in 2024|What Kind of Medicare Plan Is Best for Me? (QUIZ)
Christine Corsini is one of your Personal Benefits Managers at MediGap Advisors. She loves working for Medigap Advisors especially helping clients choose the right Medicare plan.