There seems to be some confusion as to whether Medicare pays for a companionship role. As a person involved in the day-to-day lives of a mom living with Alzheimer‘s, I‘ve seen firsthand the benefits and challenges in dealing with many health services. Companion care is no different.
Companion care involves providing not only emotional encouragement but also everyday help and company rather than medical treatment. Although these types of services can naturally make a positive difference for a senior citizen’s life, they are frequently categorized separately from skilled healthcare services by Medicare, which may aid families in seeking care options or prevent surprise fees.
The Soteria Lifestyle team offers caring, individualized home care services and support to meet your needs with dignity and independence. We believe that understanding Medicare’s part of companion care is an easy first step when analyzing the right way to meet your loved one’s care needs.
Understanding Companion Care
A friendly caretaker is also a form of home care for services that are non-medical that provides the aging adult to stay comfortable and independent in their homes. The service/ support it giving for those who are not trained nurses or physical helpers (no skilled nursing or physical habilitation).
Many senior citizens experience loneliness, mobility problems, or problems with completing specific activities of daily living as they age. A companion caregiver can help reduce loneliness and social isolation by assisting in making life much more active and enjoyable for the individual. These sorts of home health care services are most often used by senior citizens who are in need of noncomplex medical care.
What Services Are Included in Companion Care?
Companion caregivers provide a lot of the day-to-day things that enhance the client’s comfort and make life easier. There can be a wide range of services provided, but they may include:
- Casual talking and sharing feelings
- Designing extensive, complex, or intricate meal plans.
- Light baking; this area can also include preparing other basic or simple meals.
- Grocery shopping and errands
- Getting to appointments or community activities
- Light housekeeping
- Medication reminders
- Help with managing daily schedules
- Something else the people I participate with would probably do if we were walking or doing something outside the building:
Does Medicare Typically Pay for Companion Care?
A common misconception held by many families is that once a patient is on Medicare, all home care services are covered. In fact, Medicare makes a distinction between medical and non-medical care and services.
In general, Medicare friends and family care coverage is sparse since companion care is viewed as custodial or personal care rather than medically necessary. Original Medicare only reimburses providers for services ordered by a physician, including skilled nursing, physical therapy, occupational therapy, or certain home health care services.
It also implies that services that range from only providing company, doing household chores, preparing a meal, and giving a ride would generally not fall into the regular Medicare benefit.
Why Medicare Has Coverage Limitations
Medicare was designed to cover medically necessary services and not long-term personal care. Therefore, the medical necessity of the service is the standard of coverage.
For example, Medicare may cover:
- Skilled nursing care.
- What is Home health therapy?
- Speech-language pathology
- Some medical devices.
- Limited home health aide services in addition to skilled care,
However, it is less likely to include services that are provided solely for the comfort, supervision, or companionship of the individual.
In addition, the distinction can inform families to more easily explore further payment options in the event of having to take companion care.
When Home Health Services May Be Covered
While neither of these examples involves a benefit for Medicare in the provision of companion care, the subsidized delivery of home health services can receive benefits in times when the need for home health services arises.
A doctor may also provide home health care after surgery, an extended hospital stay, or when a person becomes very ill. If one is diagnosed as homebound and needs temporary skilled intervention, Medicare may pay for eligible medical services provided in one’s residence.
Any personal attention given to you during these visits is not to be considered in any way as being more important than the treatment given.
Services Medicare May Cover at Home
Eligible home health services often include:
| Covered Service | Purpose |
| Skilled nursing care | Medical monitoring and therapy |
| Physical therapy | 2.3. Improve mobility and strengthen |
| Occupational therapy | Restore daily life skills. Rehabilitation to help restore the client to be able to perform activities of daily living and thus implement complete independence is one aspect of support that is available to the client. |
| Speech therapy | Communication/sollowing aid |
| The healthcare social services | Care planning and counseling. |
| Inadequate or minimal home health aide support | Personal care associated with skilled treatment. For the section on employing occupational therapy approaches to manage problems of personal care, the following was the central definition under discussion: The use of specific planned activities and strategies which involve the client in the process of personal care tasks2 (p45). |
Well, even where the home health care benefits did apply, they were usually short-term and for medical needs, not for around-the-clock help.
Is Companion Care Covered by Medicare Advantage Plans?
Numerous families wonder if Medicare Advantage programs, which are an alternative to traditional ‘Original’ Medicare, provide funding for companion care.
The answer will vary by the specific insurer and policy. Medicare Advantage plans are provided by private insurance companies that have been approved by Medicare. There are some plans that offer benefits over and above those of Original Medicare, such as limited assistance with some in-home services that enhance health and independence.
Coverage, however, also depends heavily on the plan. Coverage for one plan may include caregiver support programs, transportation accommodations, wellness programs, or extra care in the home, whereas another may not have companion care.
Families should thoroughly understand what benefits are covered on their policy or speak with their insurance representative to know exactly what is included in the Medicare Advantage benefits prior to using them.
Questions to Ask Your Medicare Advantage Provider
Before arranging companion care, consider asking:
- Are there any non-medical home health benefits provided in the plan?
- Is there an obligation to use approved care providers?
- Existence of annually reduced number of allowed services?
- Do I need prior authorization?
- What costs are incurred directly by the individual?
Having to find out this information on the day of the meeting can add unnecessary stress to families. It also can result in confusion and unanticipated costs while preparing to care for a family member.
Alternatives for Paying for Companion Care
Because Medicare sometimes offers minimal assistance for non-health-related services, different sources of funding are researched by many families in order to provide the necessary support.
Sufficient financial supports are available that may decrease the cost of companion care, as long as being right for a person’s situation, current health, and eligibility.
Common Payment Options
Families frequently consider:
- Definitions of long-term care insurance: Several attorneys have defined long-term care insurance as any kind of insurance that provides coverage toward a long-term healthcare need.
- Provide to each program that are eligible
- Veterans benefits
- State and local aging assistance programs
- Personal savings
- Cost sharing within the family
Some community agencies and nonprofit organizations may also offer resources to help older persons stay at home safely and lessen financial stress.
Professional providers such as Soteria Lifestyle can provide families with information regarding care options and develop flexible care plans to cater to individuals’ needs and budgets.
Does Medicare Part B Cover Companion Care?
Because Part B of Medicare will pay for much of outpatient healthcare services, many individuals directly inquire, Does Medicare Part B cover companion care? Nonetheless, one should become acquainted with what Medicare Part B intends to cover.
Part B of the Medicare program usually pays for required services including outpatient care, doctor visits, preventive services, durable medical equipment, and some services in the home health setting.
Companion care is also often put into the category of non-medical care. Because companion care doesn’t provide skilled, medical services, Part B usually will not pay family members for the companionship, errands, meal preparation, housekeeping, or transportation. Families usually have to seek out alternate forms of compensation or other private in-home care costs.
Knowing the Difference Can Save Time and Money
Knowing the definitions that Medicare provides can help families in making the right decisions about long-term care.
For example:
- Skilled nursing: it deals with requiring medical assessment and treatment by health/medical specialists.
- Focus on rehab. after ill/injured: Specialty in Home health.
- Provides support with daily living activities, companionship, and emotional support.
Being aware of these variations can help to avoid false anticipation of the benefits gained by Medicare, as well as the time to plan for the necessary care.
Companion Care vs. Home Health Care
The services above are often stated together, yet are markedly different in their scope of practice. Selecting which will best fit the senior’s needs depends primarily on the senior’s condition and need for independence or assistance.
Home Health is when we are dealing with a patient who is returning from the hospital and will need skilled care. A Companion is an intact senior who needs help with tasks such as getting up or out of a chair but still has the capacity for unskilled care.
Read More: How Much Does Companion Care Cost?
Quick Comparison
| Companion Care | Home Health Care |
| Non-medical assistance | Skilled medical services 1 |
| Emotional companionship | Medical treatment and rehabilitation |
| Meal preparation | High level of nursing care. |
| Light housekeeping | Physical/Occupational Therapy |
| Transportation assistance | Physician-directed treatment |
| Medication reminders | Medical monitoring |
| Extended support over time to maintain the desired lifestyle | Typically short-term recovery services |
Knowing what each level of care is able to provide is informative for families in choosing services that will best meet their loved one’s needs today and tomorrow.
Conclusion
Knowing does medicare cover companion care can assist family members in planning for senior care situations. Original Medicare does not offer coverage for general non-medical companion services, but some home health benefits may be provided when skilled care is needed on a health-related basis. Certain plans under Medicare Advantage may provide some additional benefits as well, depending on the provider.
Companionship: For most families, there is no greater investment they can make in a loved one’s life than that of companionship. Perhaps this could be in the way of the services of a professional companion, assistance with household duties, or simply an individual with whom to talk.
Need compassionate companion care for your loved one? Contact Soteria Lifestyle today to learn about our personalized in-home care services and find the right support for your family’s needs.
Frequently Asked Questions
Does Medicare pay for companion care after surgery?
If you qualify, Medicare will probably provide some temporary skilled home health care following surgery. It is unlikely that Medicare will reimburse companionship services only.
Can Medicare Advantage plans include companion care benefits?
Additional home health benefits may be available on some Medicare Advantage plans. The availability and payment for these benefits will be different by insurance and plan. Check with your insurer plan before using any services.
Can family members provide companion care instead?
Yes. Professional caregivers can offer continuous support and flexibility, and support family members in providing informal companion care for many families.
Is companion care considered medical care under Medicare?
A: No. Companion care is generally considered non-medical care because it focuses on companionship, daily assistance, and emotional support rather than skilled medical treatment. For this reason, Original Medicare typically does not cover it.
What types of services are included in companion care?
Companion care usually includes meal preparation, light housekeeping, grocery shopping, transportation to appointments, medication reminders, social interaction, and help with daily routines. These services are designed to help seniors remain safe and independent at home.
How can families pay for companion care if Medicare doesn’t cover it?
Families may use long-term care insurance, private savings, Veterans benefits, Medicaid (if eligible), state assistance programs, or other financial resources to help pay for companion care services.
