UnitedHealthcare does pay for caregivers in some situations, but what it covers depends on your plan and the kind of care involved. Standard employer, marketplace, and Medicare Advantage plans pay for skilled home health visits from nurses and therapists, and for a home health aide who helps with personal care while that skilled care is in place. Ongoing, non-medical help with bathing, dressing, meals, and other daily tasks — including payment to a family member who provides it — is generally available only through the Medicaid-linked plans UnitedHealthcare administers, such as Dual Special Needs Plans and state Home and Community-Based Services waivers.
Skilled Nursing and Therapy at Home
On a standard UnitedHealthcare plan, home care is covered when a doctor certifies it is medically necessary and the work requires a registered nurse, licensed practical nurse, physical therapist, speech-language pathologist, or occupational therapist. Typical examples are wound care, injections, post-surgical rehabilitation, and managing complex medication regimens that an untrained person cannot safely handle.1eCFR. 42 CFR Part 409 Subpart E – Home Health Services Under Hospital Insurance
Two conditions have to be met. You must be homebound, meaning leaving home takes a major effort, requires help from another person or a device, or is not recommended because of your condition. Short, infrequent outings for medical appointments or religious services do not disqualify you. The skilled care must also be needed part-time or intermittently — generally up to eight hours per day of combined nursing and aide services, with a maximum of 28 hours per week.2Medicare.gov. Home Health Services
Each home health episode runs 60 days. If you still need care at the end of that window, your doctor must recertify your eligibility, and a face-to-face encounter is required for the initial certification.3eCFR. 42 CFR 424.22 – Requirements for Home Health Services
Home Health Aide Help Tied to Skilled Care
Once skilled nursing or therapy is in place, Medicare and UnitedHealthcare Medicare Advantage plans also cover a home health aide to help with personal care. Aides can assist with bathing, dressing, grooming, nail and oral hygiene, feeding, help getting in and out of bed, walking, and simple dressing changes that do not require a nurse. They can also support medications you normally take on your own and help with exercises that are part of your therapy plan.4eCFR. 42 CFR 409.45 – Dependent Services Requirements
The aide visits must be tied to your skilled care plan. Your doctor orders them, specifies the frequency, and a home health agency in UnitedHealthcare’s network sends the aide. When the skilled care ends, the aide services usually end with it unless you qualify for ongoing coverage under one of the Medicaid-linked plans below.
What Standard Plans Will Not Pay For
Medicare and UnitedHealthcare Medicare Advantage plans do not pay for round-the-clock home care. If you need someone in your home 24 hours a day, that falls outside the benefit.2Medicare.gov. Home Health Services Custodial care on its own — help with bathing, dressing, eating, or using the bathroom when that is all you need — is also excluded. Standard policies treat those daily living tasks as non-medical, and coverage attaches only when they come alongside an active skilled nursing or therapy plan.1eCFR. 42 CFR Part 409 Subpart E – Home Health Services Under Hospital Insurance
Some Medicare Advantage plans offer small supplemental benefits that Original Medicare does not — a limited number of non-medical personal care hours after a hospital or skilled nursing facility discharge, covering companionship, meal preparation, and light housekeeping during recovery. These extras vary by plan, so check your Evidence of Coverage or call the number on your member ID card.5Medicare.gov. Medicare and You 2026
Ongoing Personal Care Through Dual Special Needs Plans
Broader coverage for everyday personal care exists mainly through Dual Special Needs Plans, which serve people enrolled in both Medicare and Medicaid. UnitedHealthcare administers these plans in many states, and they are built to help you stay at home instead of entering a nursing facility.6UnitedHealthcare Community Plan. Dual Special Needs Plan (D-SNP) Benefits Personal care aides hired through approved agencies help with bathing, dressing, meal preparation, and other daily tasks on a regular schedule.
How many hours you receive depends on your plan and a functional assessment of your needs. Aides must work for a participating provider in UnitedHealthcare’s network and meet state background check and training requirements. These plans often add other benefits as well, including a monthly credit for healthy food and over-the-counter products, and transportation to medical appointments and grocery stores at no cost.7UnitedHealthcare. Medicare Advantage Member Transportation Benefits
Many of these programs run through Home and Community-Based Services waivers, where demand exceeds funding. Average waits for a waiver slot stretch to three years or more in many states, so if you anticipate needing non-medical personal care, applying early matters. Other Medicaid-funded services may still be available while you wait.
Paying a Family Member as Your Caregiver
UnitedHealthcare administers state Medicaid programs that use a self-directed care model. You choose who provides your personal assistance, and that person can be a relative or friend. The program pays the caregiver for the hours worked, with you or your representative acting as the employer.
Hourly rates vary by state, region, and local wage law. Pay generally runs from roughly $15 to over $20 per hour, with some programs paying more for specialized tasks or high-cost areas. Your state Medicaid agency or UnitedHealthcare’s community plan office can confirm the rate for your program.
The caregiver registers with a fiscal intermediary, a third-party company that handles payroll, tax withholding, and workers’ compensation on behalf of the program. The caregiver logs hours and tasks, and the intermediary issues payment. Training requirements vary: some states require an orientation covering infection control, safe transfers, and emergency procedures, while others ask for very little.
Family Members Who Usually Cannot Be Paid
Most self-directed programs do not allow spouses to be paid caregivers, though some state waivers make exceptions. Parents of minor children are also commonly restricted. Each state program sets its own list of eligible and ineligible relationships, so confirm the rules with your plan before choosing a family caregiver.
Taxes on Family Caregiver Pay
Caregiving payments count as income. The IRS treats most paid family caregivers as household employees rather than independent contractors, because the person receiving care has the right to direct what tasks are performed.8Internal Revenue Service. Family Caregivers and Self-Employment Tax
Social Security, Medicare, and Unemployment Taxes
If a household employee earns $3,000 or more in cash wages during 2026, the employer owes Social Security and Medicare taxes on those wages. Several family relationships are exempt from these payroll taxes regardless of the amount paid:9Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
- A spouse is exempt from Social Security, Medicare, and federal unemployment taxes.
- A child under 21 is exempt from Social Security, Medicare, and federal unemployment taxes.
- A parent is exempt from Social Security and Medicare taxes in most cases, and always from federal unemployment tax.
- Any employee under 18 is exempt from Social Security and Medicare taxes unless caregiving is their main occupation.
Even when payroll tax exemptions apply, the wages are still subject to federal income tax. The employer is not required to withhold income tax unless the caregiver asks for it by submitting a W-4.9Internal Revenue Service. Publication 926 (2026), Household Employer’s Tax Guide
Difficulty-of-Care Exclusion for Caregivers Who Share the Home
A significant tax break applies when the caregiver lives in the same home as the person receiving care. Under IRS Notice 2014-7, Medicaid waiver payments for non-medical support services can be excluded from gross income entirely, whether or not the caregiver is related to the recipient. Payments for care provided outside the caregiver’s home do not qualify.10Internal Revenue Service. Internal Revenue Bulletin 2014-4
Self-Employment Tax
If payment comes from an insurance company or state agency to care for a family member in your home and you are not caring for others as a business, you generally do not owe self-employment tax. Report the income on Schedule 1 of your Form 1040. If you run a caregiving business, such as an adult day-care that serves multiple clients including a relative, the payments are subject to self-employment tax and go on Schedule C and Schedule SE.8Internal Revenue Service. Family Caregivers and Self-Employment Tax
Getting a Request Approved
Call the number on the back of your member ID card and ask for the case management or home health department. A coordinator walks you through intake and reviews your medical documentation. Expect a home visit from a social worker or nurse to evaluate your living situation and care needs in person.
Your doctor will need to provide a statement of medical necessity describing your functional limitations and the help you need, along with a Plan of Care that spells out the frequency, tasks, and expected duration of services. Medicaid-managed programs also require a functional assessment covering transfers, medication management, bathing and personal hygiene, and safe mobility at home.
UnitedHealthcare generally decides prior authorization requests within 72 hours for urgent situations and within 15 calendar days for non-urgent ones.11UnitedHealthcare. Transparency in Coverage The approval notice spells out authorized hours, covered services, and the start date.
Appealing a Denial
You have the right to appeal if UnitedHealthcare denies your request. On Medicare Advantage plans, the deadline is 60 calendar days from the date on the denial notice, and the notice itself explains how to file.12UnitedHealthcare. Medicare Advantage (Part C) Coverage Decisions, Appeals and Grievances Medicare Advantage appeals follow a five-level path: plan reconsideration, an outside Independent Review Entity, an Administrative Law Judge hearing, the Medicare Appeals Council, and finally federal court.13Centers for Medicare & Medicaid Services. Parts C and D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance Medicaid-managed plan appeals follow your state’s Medicaid fair hearing rules instead, and your denial letter will specify the correct process and deadlines.