How Do Families Pay for Geriatric Care Management?
Most families pay for geriatric care management privately, from the older adult’s own funds or with help from adult children. Many long term care insurance policies cover care management, and a trustee or guardian may pay from funds they manage when the documents or court allow it. Medicare and standard health insurance do not cover private care management.
Does Medicare or health insurance cover care management?
No. Medicare and standard health insurance, including Medigap and most Medicare Advantage plans, do not pay for private geriatric care management. This surprises many families, because care managers work so closely with doctors and hospitals. But private care management is not a medical service. It is professional guidance, coordination and advocacy for the whole situation.
You may hear about “care coordination” or “case management” offered by a health plan, hospital or Medicaid plan. Those services can be helpful, but they are usually limited to that plan or setting. A private care manager works for your family across every setting.
What are the common ways families pay?
1. Private pay from the older adult’s funds
This is the most common way. Many families see it as using their parent’s money for exactly what it was saved for: getting good care and staying safe. If someone holds a durable power of attorney, they may be able to pay on the parent’s behalf, depending on what the document allows.
2. Adult children sharing the cost
Siblings sometimes split the cost, especially for an initial assessment and care plan. A sibling who lives far away may contribute money while a local sibling contributes time. It helps to agree on this openly. Our guide to holding a family meeting can help.
3. Long term care insurance
Many long term care insurance policies cover care management, either as a named benefit or as part of home care coverage. Policies vary widely, so read your parent’s policy and call the insurer. Ask:
- Is care management or care coordination a covered benefit?
- Does coverage begin only after an elimination (waiting) period?
- What are the benefit triggers, such as needing help with a certain number of daily activities or having cognitive impairment?
- Does the insurer require a specific type of professional or license?
- What paperwork is needed, and can claims be submitted by the provider or only by the policyholder?
A care manager can also help with the claim itself, since starting long term care insurance benefits often requires an assessment and documentation.
4. Trusts
If your parent or a family member with a disability has a trust, the trustee may be able to pay for care management from trust funds, depending on the trust’s terms. This can include some special needs trusts, where care management helps the beneficiary get services and maintain quality of life. Trustees should check the trust document and talk with the trust’s attorney before paying, because some trusts have specific rules about allowed expenses.
5. Guardianship
When a court has appointed a guardian for an adult, the guardian may use the person’s funds to pay for services that support their care and well-being, within the court’s rules. Guardians often hire care managers to help them carry out their duties, assess needs and monitor care. A guardian should follow the court’s requirements for spending and reporting.
6. Other funds
Some families use proceeds from the sale of a home, an annuity, or other savings set aside for care. Some ask whether care management costs may be tax deductible as a medical expense. That depends on individual circumstances, so ask a tax professional.
We are not attorneys or financial advisors. For questions about trusts, guardianship, powers of attorney or taxes, please talk with an elder law attorney, financial advisor or tax professional.
Can care management save money?
Many families find that good planning prevents expensive mistakes. A care manager can help you avoid paying for more care than needed, or for the wrong kind of care. They can catch problems early, before they turn into an emergency room visit. They can help you compare housing options realistically and avoid a move that does not work. They can flag benefits your parent may be eligible for. We cannot promise savings, but avoiding a single crisis can make a real difference.
What questions should I ask about fees?
Every care management practice is different. Before you begin, ask:
- Is the first conversation free?
- How are fees structured: for the assessment, for ongoing work, for visits or calls?
- Is travel time billed?
- Will I get a written agreement that explains fees?
- How often will I receive invoices, and with what level of detail?
- Is there a retainer or minimum?
- Will you help with long term care insurance claims?
- Do you accept commissions or referral fees from facilities or agencies? (The answer should be no.)
How can we make the most of a limited budget?
Care management does not have to be open-ended. Many families start with only a care assessment and written care plan, then carry out the recommendations themselves. Others bring a care manager in for a specific need: a hospital discharge, a move, a crisis or a family meeting. Ongoing support can be scaled up or down as needs change.
Ways to keep costs focused:
- Gather medical, medication and insurance information before the assessment.
- Decide as a family what questions you most need answered.
- Choose one family contact person to communicate with the care manager.
- Ask for written recommendations you can act on yourselves.
Are there free or low-cost resources too?
Yes. In New Jersey, each county Area Agency on Aging, which also serves as the Aging and Disability Resource Connection (ADRC), offers information and assistance. Call 1-877-222-3737. Some state programs, such as Jersey Assistance for Community Caregiving (JACC) and NJ FamilyCare MLTSS, include care management for people who qualify. In Rockland County, contact the Rockland County Office for the Aging. These services can be very helpful, though they may have eligibility rules, waiting periods or limits on how much time each case receives. See our NJ Medicaid long-term care basics.
Can my parent’s power of attorney pay?
Often, yes, if the durable power of attorney gives the agent authority over financial matters and the payment is for your parent’s benefit. Agents should keep records and receipts. If you are unsure what the document allows, ask the attorney who drafted it.
How Connections Care Management can help
We will explain our fees clearly before any work begins, and the first conversation is always free. We never accept commissions or payment for referrals, so our recommendations are based only on what is right for your loved one. If your parent has long term care insurance, we can help you understand the policy and work through the claim. Many families start with a care assessment and decide from there whether they want ongoing care management. Our benefits and paperwork help can also identify programs your parent may qualify for.
Contact us to talk through your situation.
Common questions
Does Medicare pay for a geriatric care manager?+
No. Medicare and standard health insurance do not cover private geriatric care management, because it is not a medical service. Health plans and hospitals may offer their own care coordination, but it is usually limited to that plan or setting. Many long term care insurance policies do cover care management, so check your parent’s policy if they have one.
Does long term care insurance cover care management?+
Many policies do, either as a specific benefit or as part of home care coverage. Read the policy and call the insurer to ask about benefit triggers, waiting periods, required credentials and claim paperwork. A care manager can often help with the assessment and documentation needed to start benefits.
Can a trust or guardian pay for care management?+
Often, yes. A trustee may be able to pay from trust funds if the trust’s terms allow it, including some special needs trusts. A court-appointed guardian may use the person’s funds for services that support their care, within the court’s rules. We are not attorneys, so trustees and guardians should confirm with their attorney before paying.
Do I have to commit to ongoing care management?+
No. Many families start with a single care assessment and written care plan, then carry out the recommendations themselves. Others bring in a care manager for a specific event, like a hospital discharge or a move. Ongoing support can be added later and adjusted as your loved one’s needs change.
Not sure where to start?
Tell us what is going on. We will listen, explain your options and help you decide on the next step. The first conversation is free.