A Basic Explanation

For the 52 million Americans who care for a spouse, child, or parent, health insurance can help pay the medical bills and provide some day-to-day support. Though many caregiving services are not routinely included in every ACA-qualified health plan, most insurance providers offer some benefits to help care for a loved one in need.

Expert Advice About Caregiving Coverage

Home Health Care

If someone you are caring for can’t get to the doctor’s office or a hospital, many insurance plans provide options for home visits by doctors, nurses, and other medical professionals. Typically, you’ll have to meet a deductible before such benefits kick in, and in most cases you will share the cost with your insurance company in the form of coinsurance, a copay, or both. Most plans also cap the number of days or hours for this kind of coverage. Despite these limitations, medical home visits can be invaluable for someone who is recovering from a hospital stay or who is homebound and in need of assistance with things like taking medication or physical rehabilitation. Some plans even offer “respite-care benefits,” which are designed to provide a break for the person who carries the responsibility for caregiving.

Skilled Nursing Facilities

When caring for your loved one at home gets to be too much, many plans will cover the cost for a facility and some of the services received outside the home. Once again, coverage is routinely limited to a certain number of days, and benefits are usually subject to a deductible, coinsurance, and/or copays.

Medical health insurance, however, typically does not cover the kind of long-term care someone would get in a nursing home. And Medicare does not cover non-skilled assistance with daily living activities, which is what’s most required for long-term care. That’s why you may want to consider buying a separate long-term health insurance policy. (Note: The time to purchase this type of coverage is way before you need it, since the older you are, the harder it is to get the coverage. If you have any type of chronic condition, there’s a good chance you will be rejected.)

Currently, long-term insurance is not sold on any of the ACA exchanges, but is available directly from certain insurance carriers. In some cases, you may also have the option of some assistance through Medicaid.

Hospice Care

For someone near the end of life, hospice can provide much-needed services to ensure care and comfort, be it at home or in a special facility. Most health plans routinely cover a certain amount of hospice care, but even so, they may limit the number of days they cover and require a deductible before sharing the costs with you.

Caregiving coverage varies from state to state and plan to plan, so be sure to read your summary of benefits carefully. Or check with your insurance broker.