Does Medicare Cover Custodial Care?

The Administration for Community Living (ACL) estimates that “at some point in our lives, about 60 percent of us will need assistance with things like getting dressed, driving to appointments, or making meals.”

But it’s difficult to project the level of care you will need, and long-term care vernacular bandied about in the healthcare community can be confusing. A good first step is to learn the distinction between different types of care so you can develop a plan suitable for your needs and budget.

Custodial care 

Long-term care can be described as a wide range of services and support you may need to address your personal care needs. Most long-term care is assistance with the basic personal tasks of everyday life. Custodial care is a type of long-term care, defined by Medicare as “non-skilled personal care, like help with activities of daily living.” 

Custodial care activities include:

• Bathing
• Dressing
• Eating
• Transferring to or from a chair or bed
• Using the bathroom

Caregivers may be family or hired aides, helping you either at home or in a facility. This support does not require professional medical skills. Generally, people receiving custodial care need it long-term.

Custodial care is generally not covered by Medicare, Medigap, or Medicare Advantage plans. However, you may be eligible for long-term non-medical care if you have Medicaid. You can also research long-term care insurance sold by private insurance companies.  

Skilled nursing care

In contrast to custodial care, skilled care is for short-term medical conditions delivered by licensed medical professionals, usually in a skilled nursing facility (SNF). You may qualify for Medicare coverage of SNF inpatient care if your physician certifies that it is medically necessary.

Medicare coverage for a skilled nursing facility includes:

• Semi-private room
• Meals
• Skilled nursing services (not custodial care)
• Physical therapy

Generally, the SNF stay must follow a medically necessary inpatient hospital stay of at least three days. If you meet the criteria, Medicare covers up to 100 days. Coinsurance applies after day 20.

Home health services

Medicare coverage also includes home health services. To qualify, your doctor must perform a face-to-face evaluation, determine that you are homebound, certify that home health services are medically necessary and order the services through a Medicare-certified home health agency.

Home health covered services include:

• Skilled nursing care
• Physical therapy
• Speech-language pathology
• Occupational therapy
• Home health aides (no homemaker or custodial services)

Cost of long-term care

Results of Genworth’s 2020 cost-of-care survey reveal the following national median costs of various forms of care: 

• Assisted living facility: $51,600
• Homemaker services like cooking and cleaning: $53,768
• Home health aide for bathing and dressing: $54,912
• SNF semi-private room: $93,075

Prices vary widely from one state to another. Long-term care is costly, but there are organizations you can access to help you determine an approach that works best for you and your family.