Does Medicare Cover Custodial Care?

Does Medicare Cover Custodial Care?

Does Medicare cover custodial care if you need help with daily living in retirement? Although Medicare is designed to help you afford health care as you age, it doesn't cover every type of care you might need. Necessary but nonmedical care, such as custodial care, may not be covered under your Medicare benefits. Here's what you need to know so you can plan ahead for custodial care costs in retirement.

What Is Custodial Care?

Custodial care includes any kind of nonmedical care that an unlicensed caregiver can reasonably perform. This does not include medical care — activities such as physical therapy, wound care and intravenous injections must all be administered via a skilled and licensed medical professional.

Patients may require custodial care for help with activities of daily living (ADLs) such as bathing, dressing, eating, using the toilet or general mobility. For instance, patients with dementia who are healthy may still require help with ADLs to ensure their safety. In fact, anyone may need this kind of care after an injury or illness.

Since unlicensed caregivers can provide custodial care, this kind of care costs less per hour compared with medical care, which would require having a skilled medical professional on hand. Still, patients may need custodial care around the clock or for a long length of time, meaning the cost of this care can threaten to overwhelm a retirement budget.

Does Medicare Cover Custodial Care?

Unfortunately, Original Medicare (meaning parts A and B) do not cover the cost of custodial care if it is the only type of care you need.

Medicare Part A, also known as hospital insurance, can cover inpatient hospital care, care received in a skilled nursing facility (provided it is not custodial or long-term care), hospice care and some intermittent home health care provided by a skilled medical professional. Medicare Part B, or medical insurance, generally covers preventive services and medically necessary services, which excludes custodial care.

Does Medicare Advantage Cover Custodial Care?

Medicare Advantage plans, which are also known as Medicare Part C plans, are insurance plans administered by private companies. These plans include Medicare parts A and B equivalents and will sometimes include coverage of prescription drugs.

Medicare Advantage plans essentially allow you to receive all of your Medicare insurance through a private insurance company. This raises the question: Does Medicare cover custodial care if you are enrolled in a Medicare Advantage plan?

The short answer is that it depends.

The specific coverage you can expect will vary depending on your choice of plan and insurance company. Some plans do offer custodial or long-term care coverage, and it's likely that more plans will add coverage for this kind of care in the future. The Centers for Medicare and Medicare Services have recently expanded benefits that Medicare Advantage plans can offer, deciding to include a number of custodial care and preventative services (such installing shower grips) to help keep beneficiaries from needing hospitalization.

How Can You Pay for Custodial Care?

There are a number of options available to help retirees pay for custodial care — even without access to Original Medicare benefits or Medicare Advantage coverage. Some possible alternatives include:

  • Long-term care insurance. This type of private insurance pays for nonmedical long-term care after an elimination period has passed.
  • Medicaid. Retirees with an income of 133% of the federal poverty level who are experiencing significant health needs or disability may be eligible for Medicaid, which can cover the cost of custodial care.
  • Medigap. This type of Medicare supplement insurance does not directly pay for custodial care. However, it can help fill gaps not covered by Original Medicare such as co-pays, deductibles and coinsurance. Freeing up that money can help make custodial care less expensive.

The Bottom Line

Though original Medicare does not offer coverage for custodial care, certain Medicare Advantage plans may pay for this important nonmedical care — and there are several avenues to explore for help with making custodial care more affordable.

Emily Guy Birken AuthorThumbnail

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