Unpaid family caregivers keep the U.S. health care system going.
Medicare is now trying to do more to support them.
A client's question: "My grandfather was just diagnosed with dementia, and I've become his main caregiver. Are there any new Medicare benefits that could help us?"
Our answer: Here are some of the Medicare caregiver support features that are changing this year.
1. Medicare now covers caregiver training.
For the first time, Medicare is paying providers for structured caregiver training.
This means that clinicians — including physicians, nurse practitioners and therapists — can now get paid to teach family members how to safely perform tasks such as wound care, administering medications and helping with mobility.
This benefit was introduced in the 2024 Medicare Physician Fee Schedule final rule. Medicare program managers hope it will improve at-home care, reduce rehospitalizations and support efforts to keep people in their homes.
Training can be delivered in person or via telehealth.
Through Sept. 30, paid training can be delivered in person or via telehealth to all Medicare beneficiaries.
After that, paid in-person training will be available for all caregivers. Paid telehealth training will continue to be an option for caregivers in rural areas.
To use this benefit:
◆ Families should ask their provider if they offer Medicare-covered caregiver training.
◆ Care teams must document the training and use appropriate billing codes (G0539–G0543).
◆ Sessions can be scheduled during hospital discharges or at the start of new care plans.
More details are available at Medicare.gov – Caregiver Training Services.
2. Principal illness navigation services are available to support complex care.
In 2024, Medicare added Principal Illness Navigation services, or PIN services, to help patients with high-risk chronic conditions — such as cancer, dementia or heart failure — manage care transitions and use community resources.
Certified navigators or peer specialists deliver these services under the supervision of a physician.
The intent is to reduce confusion, improve adherence to care plans and connect patients with nonclinical support.
For eligible beneficiaries, this includes help with:
◆ Scheduling and preparing for medical appointments.
◆ Understanding treatment regimens and care plans.
◆ Getting transportation, housing support or food assistance.
To qualify, patients must have a condition that lasts at least three months and be at increased risk of hospitalization or functional decline. Providers bill for the service monthly under codes G0023 and G0024.
PIN services may be especially useful during care transitions, such as after hospital discharge or during the start of home-based treatment.
You can find more information about PIN services in the Health-Related Social Needs FAQ.
3. Dementia caregiver support expands through the GUIDE model.
The Centers for Medicare and Medicaid Services' new structured dementia care support program, the Guiding an Improved Dementia Experience model, or GUIDE model, was launched in 2024.
CMS plans to make it available through 294 more organizations in July.
The GUIDE model is supposed to support efforts by family caregivers to keep individuals with dementia in their own homes.
Services include:
◆ A 24/7 helpline for real-time caregiver assistance.
◆ A dedicated dementia care navigator for ongoing guidance.
◆ An annual respite care benefit of up to $2,500.
Eligibility requirements include enrollment in Original Medicare, a formal diagnosis of dementia and residence in a non-institutional setting.
Families interested in the GUIDE program should ask their health care providers if they are participating.
4. Additional caregiver support tools are available through Medicare.
Beyond training and navigation services, Medicare is reinforcing caregiver support through existing programs:
◆ Telehealth caregiver training remains fully covered nationwide through Sept. 30. After that, only caregivers in rural areas will have telehealth access.
◆ Behavioral health training will be reimbursed under Medicare when caregivers support patients with serious mental illness or cognitive decline.
Hospice respite care will provide caregivers with up to five days of relief while patients receive inpatient care in a Medicare-approved facility.
These tools are critical for caregivers facing burnout or managing care for patients with mental and behavioral health challenges.
Resources can be accessed via Medicare hospice providers or behavioral health professionals who participate in Medicare.
Here are two sites that can provide more information:
Credit: CMS
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