Does my health insurance cover an in-home caregiver?

The short answer: they don't cover it "just because," but they're required to cover it in more cases than they'll tell you. The difference is in how you ask.

Updated September 2026 · Orbi, care circle

What does the law say?

In Argentina, the Programa Médico Obligatorio (PMO), the minimum package every health insurer (obra social) or private plan (prepaga) must cover, doesn't list "in-home caregiver" as a named benefit. That's why almost every insurer's first answer is "it's not in the PMO." But the PMO is a floor, not a ceiling, and there are two paths that make coverage mandatory:

• Law 24.901 (disability). If the person has a Certificado Único de Discapacidad (CUD), Argentina's official disability certificate, the obra social or prepaga must cover 100% of the services a doctor orders, including in-home assistance. An older person with dementia, lasting effects of a stroke, advanced Parkinson's or severe dependency can apply for the CUD; many families don't know that, so they end up paying for everything.
• A justified medical prescription + documented dependency. Without a CUD, you can get coverage when the treating doctor explicitly prescribes in-home assistance, with the diagnosis, the level of dependency and why it's needed (to avoid a hospital stay, after a recent discharge, fall risk), and the family shows it can't provide that care. Courts have ordered coverage in these cases, even from large private plans.

What's the difference between home hospitalization and a caregiver?

This is where people get confused. Home hospitalization (internación domiciliaria) is in the PMO: nursing, physical therapy and doctor visits at home, for an acute condition or after a hospital stay, for a limited time. Every insurer covers it with a prescription. A caregiver or home aide doesn't do nursing tasks: she keeps the person company and helps with bathing, eating, getting around and taking medications. It's what the family needs over the long term, and it's what insurers push back on. Often the strategy that works is to first request home hospitalization after a discharge, and from there, using the care team's reports, request in-home assistance as a continuation of care.

What do you need to submit?

• A medical prescription from the treating doctor, with the diagnosis, level of dependency (Barthel or Katz scale if possible), number of hours ordered and the justification.
• The CUD, if they have one or can apply for it.
• A social worker's report or a signed letter explaining why the family can't provide the care (work, distance, the children's ages).
• Recent test results that support the diagnosis.
• A formal written request, filed at the front desk or through the insurer's official channel, with a dated proof of receipt. That's what counts later on.

What if they say no?

1. Ask for the denial in writing. Often just asking for it gets things moving.
2. File a complaint with the Superintendencia de Servicios de Salud, the national regulator for obras sociales and prepagas, on its website or at 0800-222-72583. It's free and is usually resolved within weeks.
3. If there's a CUD or a health risk and they don't respond, an amparo (a fast-track court order) is the way to go: it's quick, there are many favorable rulings, and with a lawyer who specializes in health law it gets resolved within weeks. With a CUD, the odds of winning are very high.

What we know about each insurer

OSDE. Doesn't cover a caregiver routinely. With a CUD and a prescription it's required to cover 100% (there are rulings ordering it to, medications included). Without a CUD, it covers home hospitalization and sometimes a "companion" for a limited time after a discharge. Ask in writing at a service center or through the app.

Swiss Medical. Similar: home hospitalization yes, a caregiver only with a justified prescription or a CUD, and often only after an appeal. You submit the request at member services with a letter and the prescription.

IOMA (Provincia de Buenos Aires). One of the few with a benefit actually called "Cuidador domiciliario" (in-home caregiver), paid as a reimbursement, for members with dependency: you submit IOMA's own form plus a medical and a social report at the local office, and it's renewed periodically. The reimbursement covers part of the cost; ask at the office in your city for the current form and amount.

OSECAC. Covers home hospitalization with a prescription. For a caregiver, same as the rest: with a CUD or documented dependency, and usually after a complaint to the Superintendencia.

OSEP (Mendoza) and APROSS (Córdoba). Cover home hospitalization (nursing and doctor visits at home) with a prescription. For a caregiver, the general rule applies: with a CUD, coverage is fully mandatory; without one, you request it with a medical and social report at the local office, with a letter and proof of receipt.

If your insurer isn't on this list, the rule is the same everywhere: a justified prescription, a CUD if possible, a written request, and a complaint if they say no.

Is it worth getting a CUD for an older person?

Almost always, yes. It's not just about the caregiver: it covers 100% of medications, adult diapers, wheelchairs, physical therapy and transportation. You apply to the municipal or provincial evaluation board, with medical reports. It takes one to three months. A lot of people think "disability" only applies to younger people: it doesn't. Moderate dementia or paralysis on one side after a stroke both qualify.