FAIR Health Consumer Access

Preparing for Caregiving

If you know you’re going to have to care for a family member soon, fall is a good time to get prepared. That’s because fall is open enrollment for employer-based health insurance. That means you can change or add to your current health plan. Check out our article in this issue Fall Is Open Enrollment Season. This caregiving article will tell you what family caregiving means. It will also tell you what your health plan may or may not cover, how to estimate costs and more.

What Is Family Caregiving?
Being a family caregiver means providing care for a family member. That care can include:

• Preparing meals;
• Transporting to and from doctor’s appointments;
• Providing help with daily activities, such as bathing, eating, toileting, getting dressed (home adjustments can make this easier);
• Managing medications; and
• Providing emotional support.

You might want or need to become a family caregiver if your family member becomes ill, injured or is recovering from surgery. You might also want or need to care for them as they age.

What Health Insurance May Cover
Health insurance won’t typically cover most care that falls under family caregiving. But it can help cover medically necessary services for your family member.

Commercial insurance. If your family member has commercial insurance, it will usually cover their doctor’s visits, some therapies and medications, and hospital stays. If your family member is a dependent of yours, they’re typically eligible to be covered by your health plan. A dependent is usually your spouse and/or children. Some plans may cover domestic partners as dependents. You may wish to add your aging/disabled parents to your health plan. But to do that, you might need to have legal guardianship over them. Check with your plan about who can be covered and under what circumstances. If you want to add someone to your plan, you can do so during open enrollment.

Public insurance. If your family member qualifies, they may be covered by public insurance. Medicare covers people aged 65 or older and some others with certain conditions—find out more about Medicare coverage in our article What You Need to Know About Medicare. Medicaid covers people of all ages who have low income—find out about Medicaid coverage in our article All About Medicaid. Both plans cover doctor visits and many other medically necessary services, including some long-term care. Long-term care can include help with daily activities. Medicaid may cover transportation to and from medical appointments as well. Your family member may also be able to get both Medicare and Medicaid coverage. Find out more about dual eligibility here.

What May Not Be Covered by Health Insurance
Nonmedical care. Commercial health insurance often won’t cover nonmedical care. That includes most of family caregiving. However, there are ways to get paid to be a family caregiver, which can help you manage the time commitment and overall costs. Find out more in our Help for Caregivers article.

Long-term care. Commercial health plans often won’t cover long-term care, but disability insurance or long-term care insurance can help. And, as mentioned earlier, Medicare or Medicaid may cover some long-term care. Find out more in our article Managing Costs of Long-Term Care.

Home adjustments. Many commercial health plans won’t cover home adjustments, such as wheelchair ramps or grab bars. However, Medicare may cover durable medical equipment, such as walkers, canes, crutches and commodes. And some state Medicaid programs may cover ramps, grab bars and stair lifts, among other items. Contact your state’s Medicaid agency to find out what’s covered where you are.

How to Estimate Costs
Our consumer website can help you estimate the cost of care for your family member. You can use our cost lookup tools to budget for procedures or tests they may be getting. And you can even look up equipment they may need, such as a wheelchair. Try it out here.

Find Other Resources
If you find yourself preparing to care for a family member, check out available resources, such as our list of resources for older adults and family. Also check out the National Alliance for Caregiving’s general caregiving resources here.