Does Blue Cross Blue Shield Cover Caregiver Expenses? Understanding Your Policy Benefits

Introduction

Our research highlights the primary challenge faced by family caregivers of older adults– the financial burden of long-term care. Among these challenges is the difficulty in affording support at home for custodial tasks like bathing, supervision, feeding, and medication management. Families often express feeling lost and uncertain about where to start when it comes to understanding if tasks like these are paid for by health insurance or not. For example, many Americans mistakenly believe that private insurers like BCBS, as well as government programs like Medicare and Medicaid, will cover their needs comprehensively as they age. However, in reality, private and public insurance rarely covers care at home unless it's short-term and medical, such as physical therapy, wound management, or other skilled nursing (home health) prescribed by a physician. In contrast, coverage often falls short of routine, daily custodial tasks, and families must figure out a way to pay out-of-pocket or complete the tasks themselves for a loved one.

It's crucial for new family caregivers to grasp the nuances of healthcare insurance coverage early in their journey. This understanding can empower them to make informed decisions and reduce the financial stress associated with caregiving. Many Americans must pay more attention to the importance of preparing for long-term care expenses while still active in the workforce. This pervasive misconception in the population that Medicare and healthcare insurance will cover their care in retirement comprehensively exacerbates the financial strain on family caregivers when care is eventually needed, leaving families ill-prepared for the reality of caregiving expenses. As families navigate this complex landscape, they must grapple not only with confusing insurance coverage and policy terms but also with the sobering realization that the quality of care they can afford may not meet their expectations.

Further, new family caregivers early in their journey don't always understand that healthcare insurers predominantly address skilled nursing or medical home care, leaving non-medical services such as companion care and assistance with daily living tasks (i.e., custodial care) beyond the scope of coverage (and out-of-pocket). Through our collaborations with non-medical home care providers, we have found that the hourly rate for quality professional caregivers ranges from $25-$65 per hour. Understanding these subtleties and potential costs is critical for savvy family caregivers who will need to arrange for custodial care at some point. They quickly realized that they would either need to pay for custodial care out of their family's savings or social security or arrange to complete the care themselves to save on costs.

By proactively exploring and being attentive to what types of care insurance cover and what it doesn't, caregivers and care recipients can begin to responsibly plan on how to arrange and finance comprehensive support for both themselves and their loved ones throughout their caregiving journey. This proactive approach can help caregivers avoid financial surprises and ensure that their loved ones receive the care they need.

Main Points

• Private insurers like Blue Cross Blue Shield and government programs like Medicare and Medicaid often do not cover routine, non-medical caregiving tasks at home, leaving families to bear the financial burden themselves.
• Misconceptions about insurance coverage for long-term care lead many individuals to underestimate the need to save for caregiving expenses during their working years, exacerbating financial strain when care becomes necessary in retirement.

Family caregivers need to grasp the limitations of insurance coverage, especially regarding non-medical services like companion care and assistance with daily tasks. By reassuring them about the availability of funding options, we can make them feel hopeful and less anxious about the financial aspect of caregiving. Knowing potential costs and funding options is crucial for effective planning and ensuring quality care for loved ones.

What Does Private Insurance like BCBS Cover?

Private insurance coverage from policies like Blue Cross Blue Shield (BCBS) distguish between medical and non-medical home care services. For example, BCBS plans typically encompass short-term medical home care services that a physician prescribes but not custodial services that are long-term and routine in nature. 

Covered services often include skilled nursing care, rehab, or physical therapy – all care requiring a licensed healthcare professional to assist with medical tasks. However, the coverage tends to exclude non-medical services such as companionship or routine assistance with daily living activities (ADL) like bathing, grooming, or meal preparation. As a result, family caregivers often find themselves grappling with the financial burden of these unreimbursed expenses. 

It's estimated that caregivers may spend on average $7,242 each year for non-medical services, depending on the level of care required by their loved ones. While providing care themselves can save costs, caregivers should also be mindful of the trade-offs, including potential disruptions to employment and personal life. The economic value of unpaid labor for caregiving for an older adult in the U.S. is estimated to be about $470 billion annually and is expected to increase over the next decade.

What Does Public Insurance like Medicare and Medicaid Cover? 

Medicare and Medicaid serve as pillars of support for many older Americans and those with low income or assets, but both have distinct coverage and eligibility criteria that vary from state to state. Medicare primarily provides medical care that is short-term and requires skilled nursing care, including services like primary care, hospital stays, skilled nursing facility care, and certain home health services. 

However, Medicare typically does not cover long-term custodial care costs, such as assistance with activities of daily living (ADLs) or supervision for individuals with cognitive impairments (also referred to as "memory care"). 

On the other hand, Medicaid offers more extensive coverage for long-term care services, including nursing home care and some home and community-based care services (HCBS). Medicaid eligibility criteria often hinge on income and asset thresholds, with some states implementing "spend down" provisions that allow individuals to qualify by depleting their assets to meet eligibility requirements. It's crucial for caregivers to understand Medicaid's eligibility criteria and coverage nuances like this to determine a strategy – either spend down assets to qualify for Medicaid or arrange financially to support the costs of care through private insurance, Medicare, and out-of-pocket (i.e., savings).

From our conversations with families in our research, we find that many caregivers are unaware of these nuances prior to becoming a caregiver and are often confused and unsure of where to go to make a comprehensive plan.

Financial Resources and Assistance for Family Caregivers

Explore Financial Aid Programs

In addition to healthcare insurance coverage, caregivers can explore various financial aid programs and assistance options to alleviate the economic burden of caregiving. Public assistance programs, such as Supplemental Security Income (SSI) and Supplemental Nutrition Assistance Program (SNAP), may provide financial support to eligible individuals, including caregivers and care recipients. Additionally, local Area Agencies on Aging (AAA) offer resources, including respite care vouchers, transportation services, support groups, educational workshops, and caregiver training programs. AAAs are the go-to resource for families who are new to caregiving because they are government-supported and aware of niche resources that may only be available in certain local areas or offered by community groups or volunteer organizations.

Comprehensive Long-Term Care Financing and Legal Planning for Family Caregivers

Long-term care financial planning is important to be prepared to manage the costs of caregiving. A sound financial strategy includes planning for expenses incurred through chronic illness management, disability care, aging-related conditions, and recovery from surgeries or injuries. A comprehensive approach maximizes the utilization of multiple insurance types (public and private) and personal resources, including retirement savings, family caregiving, and community resources or services.

Comprehensive family care planning for an older adult encompasses long-term care and also includes critical medicolegal preparations and estate-related asset management strategies to safeguard an older adult's assets, quality of life, and end-of-life wishes. Ideally, this planning would involve engaging both a certified financial planner (CFP) (and possibly a tax professional or CPA) and elder law attorneys to navigate the complexities of an individual's unique situation. Their expertise helps in the creation of trusts, drafting of wills, and setting up durable powers of attorney. Additionally, establishing advanced directives, living wills, and medical powers of attorney is essential to ensure that care preferences are respected and upheld.

A thorough approach and comprehensive planning provide peace of mind and ensure that caregivers are well-equipped to manage the demands of caregiving. Caregivers with comprehensive plans are more empowered to deliver intentional and compassionate care to their loved ones and feel supported in all facets of the caregiver's role in a sustainable manner.

Example of a Comprehensive Care Plan

Current and Future Care Needs Anticipated

• Current Health Status: Jane Doe, aged 72, was diagnosed with early-stage Alzheimer's and mild arthritis.
• Anticipated Future Needs: Likely progression to require more intensive cognitive support and physical assistance within the next 5 years.
• Care Provisions: Regular in-home caregiver visits, increasing to daily assistance as the condition progresses. Evaluation for specialized Alzheimer's care programs.

Preferences for Home, Assisted, and Nursing Level Long-term Care

• Home Care: Preference for staying at home as long as feasible with the support of a live-in caregiver.
• Assisted Living: Selected an assisted living facility specializing in dementia care located within 10 miles of the family home to ensure easy access for family visits.
• Nursing Home Care: If necessary, pre-approved admission to a high-rated nursing facility that provides advanced medical and palliative care services.

Financial Plan, Emergency Fund, and Insurance Strategy

• Long-Term Care Insurance: An active policy that covers in-home care, assisted living, and nursing home care for up to $200,000 with inflation protection.
• Healthcare Insurance, Medicare, and Medicaid: Medicare Advantage plan with a Medicaid "spend-down" backup plan for additional coverage as needed.
• Emergency Fund: Savings account designated with $50,000 for unforeseen medical and care expenses.
• Investment Strategy: Diversified portfolio designed to support long-term care funding without compromising the standard of living.

Legal Documentation

• Will: Updated will detailing asset distribution among children and grandchildren, including specific allocations for care funding.
• Durable Power of Attorney: Appointed daughter, Anne Doe, as the durable power of attorney for financial decisions.
• Health Care Proxy: Appointed son, John Doe, as the health care proxy to make medical decisions when Jane is no longer capable.
• Advanced Directives: Clearly outlined instructions for end-of-life care preferences, including a do-not-resuscitate (DNR) order.
• Living Will: Documented wishes concerning medical treatments and life-sustaining measures in scenarios where Jane cannot communicate her decisions.

Navigating Mental and Behavioral Health Support

The caregiving journey can be physically, mentally, and financially demanding, often leading to mental health challenges among caregivers. Recognizing the importance of mental well-being, caregivers who proactively seek support are better able to provide higher-quality care to their loved ones. Many health insurance providers offer access to mental health benefits, including counseling services, therapy sessions, and psychiatric consultations. Additionally, caregivers can find community and camaraderie in local support groups, caregiver networks, and online communities dedicated to caregiving. These forums are free and offer a safe space for caregivers to share experiences, exchange insights, and seek advice from peers who understand the challenges and triumphs of caregiving firsthand. We recommend that caregivers join a Facebook group dedicated to caregivers or a community like the Olera.care Health Aging Community as a first step to getting connected with other caregivers.

To further support mental health, prioritizing respite is essential. By integrating respite services into the comprehensive care plan, caregivers can ensure that funds and schedules are allocated for regular breaks. Routine respite services might include adult day care, in-home companionship care, or relying on other family members to supervise the care recipient for a few hours each week. This planned downtime allows primary caregivers essential time to themselves, providing an opportunity to rest, pursue personal interests, or simply recharge, which is vital for maintaining overall health and sustaining the capacity to care effectively.

5-Step Action Plan for Creating a Comprehensive Long-Term Care Plan

This plan can be used at any point in your caregiver journey:

Step 1. Assess and Document Care Needs

What do I do? Evaluate the current health status and anticipate future care needs of your loved one. Include assessments for cognitive support and physical assistance.

Why It's Important? Accurate assessment helps in tailoring the care plan to address specific health conditions and anticipated care expenses, ensuring appropriate care adjustments over time.

Who can help me? A geriatric care manager or a licensed healthcare professional, such as a nurse or a physician, can assist in evaluating the current health status of your loved one and anticipate future care needs.

Step 2. Determine Care Settings and Preferences

What do I do? Choose preferred care settings based on comfort, necessity, and financial feasibility—options might include preferences towards home care, assisted living, or nursing home care for now or in the future. Consider the proximity to family for visits and the level of medical care provided.

Why It's Important? Selecting the right care setting enhances the quality of life for your loved one and aligns with their personal preferences and medical needs. It also provides time to plan for the costs associated with various options well ahead of time.

Who can help me? Consulting with a geriatric care manager or a social worker specializing in elder care can provide guidance in thinking about the most suitable care setting based for you or your your loved one's medical needs, personal preferences, and financial situation. They can also offer information about care facilities that may not be available online and assess the level of medical care provided.

Step 3. Develop a Financial Strategy for current and anticipated costs of care

What do I do? Create a detailed financial plan that includes consideration of private insurance coverage, eligibility for Medicare or Medicaid, private funding, and the exploration of additional public and private financial aid programs. Understanding the costs associated with each chosen care setting in the previous steps will help you develop a plan to pay for the care you prefer.

Why It's Important? A robust financial plan ensures you can afford the necessary care without compromising financial stability.

Who can help me? Certified Financial Planners (CFP) can assist in creating a comprehensive financial plan, including a short- and long-term budget, to help you meet goals no matter where you are starting. They can also help evaluate insurance coverage and eligibility for Medicare or Medicaid and explore additional public and private financial aid programs.

Step 4. Establish Legal and Medical Directives

What do I do? Work with Elder Law Attorneys to draft essential documents like wills, trusts, durable powers of attorney, advanced directives, living wills, and medical powers of attorney.

Why It's Important? These legal instruments protect the rights and wishes of your loved one, ensuring that critical decisions reflect their preferences and that assets are managed according to their wishes.

Who can help me? Research elder law attorneys specializing in estate planning and medicolegal preparations and book an initial consultation. They can help draft essential legal documents such as wills, trusts, durable powers of attorney, advanced directives, living wills, and medical powers of attorney. Additionally, they can guide managing assets, qualifying for government programs through Medicaid, and ensuring that critical documentation about assets and estate-related issues reflects your and your loved one's wishes.

5. Incorporate Support Systems and Caregiver Wellness

What do I do? Engage with support networks and implement routine respite care to ensure the caregiver has time to recharge, which might include using services like adult day care, in-home companionship, or scheduling other family members to provide care while you take a break.

Why It's Important? Supporting the primary caregiver's well-being is essential for sustaining their ability to provide ongoing, effective care.

Who can help me? Searching online for local support groups or caregiver networks can provide emotional and practical support for caregivers. Community organizations, such as churches or nonprofit agencies, may offer respite care services for free or adult day care.

Frequently Asked Questions

What types of in-home care services are covered by Blue Cross Blue Shield insurance policies?

Blue Cross Blue Shield insurance policies typically cover medical home care services prescribed by a physician, such as skilled nursing care, physical therapy, and medical task assistance. However, non-medical services like companionship or assistance with activities of daily living (ADLs), such as bathing or meal preparation, are often not covered under these policies. If your loved one requires non-medical home care services, consider exploring alternative options such as community programs, Medicaid, or long-term care insurance to help reduce out-of-pocket costs and finance these necessary services.

Are family members eligible to receive payment for caregiving services under Blue Cross Blue Shield plans?

Family members are generally not eligible to receive direct payment for caregiving services under Blue Cross Blue Shield plans. However, some states have Medicaid programs that may offer reimbursement for family members for their labor-providing care.

Does Blue Cross Blue Shield offer any special programs or benefits for caregivers of patients with dementia?

Blue Cross Blue Shield may offer special programs or benefits for caregivers of patients with dementia, including caregiver support groups, educational materials, and community resource matching. Caregivers should review their plan details or contact their insurance provider for information on available resources tailored to dementia caregiving needs.

How does Blue Cross Blue Shield cover home health care, and are there any specific stipulations?

Blue Cross Blue Shield may cover home healthcare services prescribed by a physician and provided by an approved, licensed healthcare provider. Coverage details and stipulations can vary, so caregivers should refer to their policy documents or contact their insurance provider for specific coverage information regarding home health care.

Can a spouse be compensated for providing caregiving services through Blue Cross Blue Shield health plans?

Typically, spouses are not eligible to receive direct compensation for providing caregiving services through Blue Cross Blue Shield health plans. While direct compensation may not be an option, spouses can explore alternative avenues for financial assistance, such as Medicaid, which can reimburse family caregivers for caregiving labor. However, this varies by state. While financial compensation for family caregivers may not be available in most states, seeking out support and resources can still provide valuable assistance to spousal caregivers in managing their caregiving responsibilities.

Author Bio

Dr. Logan DuBose is a MD and co-founder of Olera.care. He writes about dementia, Alzheimer's, and other age-related conditions. He is a Texas A&M MD/MBA alum. Olera specializes in merging clinical practice with innovative solutions for the aging population.