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Most Medicare plans, including those offered through Medicare Advantage, do not cover full-time custodial care.
Medicare does cover skilled nursing care and hospice care, which may include custodial services.
Medicaid may cover custodial care, depending on your area. You may also be eligible for custodial care through PACE.
A subset of Medicare Advantage plans called SNPs can cover custodial care for individuals with qualifying conditions.
Try as we might, eventually we all need a little bit of help doing everyday tasks like eating, dressing, or maintaining personal hygiene. In these situations, custodial care can be a massive boon. Commonly offered through nursing homes, custodial care is distinct from nursing care in that it focuses more on maintaining your quality of life rather than treating specific conditions. Unfortunately, this means that custodial care is not typically covered by Medicare. However, certain exceptions and programs exist that can help you get the coverage you need.
It’s important to note the difference between custodial care and skilled nursing care. Skilled nursing care is medically necessary treatment carried out by or under the supervision of a skilled or licensed medical professional. Physical therapy, for instance, is a type of skilled nursing care. Custodial care, in contrast, is focused on daily household activities like bathing or dressing.
Skilled nursing care, which can be carried out in the home or at a specialized facility, often includes elements of custodial care. A nurse might help you dress or bathe yourself, for instance. However, Medicare will not cover custodial care on its own. It needs to be offered in conjunction with another service. What precisely is covered depends on the parts of Medicare you are enrolled in.
Medicare Part A covers stays in skilled nursing facilities and hospitals, as well as any custodial care you receive on an inpatient basis. It does not cover nursing homes, adult day care, or similar services.
Medicare Part A also covers hospice care. Hospice care does include custodial services, but only as part of palliative care.
Certain home health services are covered under Medicare Part B, although these are meant to be short-term services and are not offered on a daily basis. These services may or may not include certain custodial services, but are often not as comprehensive as true custodial care.
Medicaid may cover long-term care for seniors, provided it is delivered in a nursing home. This is more likely if you live in an area served by the Program of All-Inclusive Care for the Elderly (PACE), which provides community-sponsored custodial and healthcare services. The advantage of living in a PACE community is that individuals without Medicaid can still access the services for a small fee. Otherwise, Medicaid may still offer access to custodial services. You can use the official Eldercare Locator to see what services are available in your area.
The lack of Medicare nursing home coverage represents a very large gap in what Medicare provides, so you’d be forgiven for believing that Medicare Supplemental Insurance (Medigap) might cover it. Unfortunately, that is not the case. While Medigap can cover stays in a skilled nursing facility, which often include custodial care, it does not cover at-home or nursing home custodial services except as a part of hospice care.
Medicare Part C: Medicare Advantage is a different story. Though most Medicare Advantage plans do not cover custodial care, some may offer it under special conditions. The majority of these plans are considered Special Needs Plans (SNPs) and cater to individuals with chronic medical conditions. SNPs may cover custodial care, and certain SNPs exist specifically for people living in nursing homes or receiving in-home care. These plans can help cover custodial services but are not offered in every area. A licensed insurance agent can help you review options in your area.
Medicare Advantage may also cover less intensive custodial services, such as adult day care, or support for family caregivers. These options are less comprehensive than true custodial care, but are often more suitable for seniors who only need occasional help.
Our licensed insurance agents can help you review your options for Medicare. Call us today at (800) 950-0608 or enter your zip code to compare Medicare Advantage plans in your area.