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Syam Adusumilli
Adjacent Gaps · ADJ.01

Executive Summary: The Caregiver Household: When the Coverage Unit and the Care Unit Are Not the Same Thing

By Syam Adusumilli · 2 min read
Executive Summary Read the full article.

ADJ.01 — Adjacent
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The 2025 AARP and National Alliance for Caregiving report documents 63 million Americans providing unpaid care to adults or children with chronic, disabling, or serious health conditions, nearly 50 percent more than in 2015. Seven in ten family caregivers are employed, but 27 percent have reduced hours or shifted to part-time and 16 percent have stopped working entirely. The annual value of unpaid family caregiving labor has been estimated at $873.5 billion by Columbia University researchers.

ERISA group health plans cover spouses and children under 26, not parents. The care recipient is on Medicare for acute care and outside employer benefit reach for everything else. Medicare does not cover custodial care, the assistance with daily activities that constitutes the actual work of most family caregiving. The $873.5 billion in annual unpaid labor occurs entirely outside the coverage architecture because the architecture was built around the employment unit, and the caregiving household is organized around the care unit.

Two partial paths exist within current law. Under IRC Section 152(d), a qualifying relative whose gross income falls below approximately $5,200 for 2025 and for whom the taxpayer provides more than half of total support can receive tax-excluded employer contributions toward Medicare premiums and qualifying medical costs through a properly structured HRA. The gross income threshold limits this path to caregiving households where the parent’s income is genuinely low. The second path is DPC membership: a parent on Medicare can enroll in a DPC practice at $70 to $90 per month, giving the DPC physician a coordination role across both coverage systems. The employer who understands the Section 152 path, layers DPC for both caregiver and care recipient, and contracts with a care coordination platform creates a retention differentiator for a workforce segment that is growing and that no existing product addresses.