Medicare Coverage of Custodial Care
What It Is
Custodial care is nonmedical assistance -- either at home or in a nursing or assisted-living facility -- with the activities of daily life (such as bathing, eating, dressing, using the toilet) for someone who's unable to fully perform those activities without help. Custodial means the kind of care that can be safely performed by someone without medical, nursing, or other professional training. The need for such care could arise from a specific physical condition, general frailty, or mental incapacity (such as Alzheimer's or other forms of dementia).
Neither Medicare Part A, Medicare Part B, nor a Medicare Part C Medicare Advantage plan (also called a Medicare Advantage plan) covers custodial care, even short-term.
If a patient qualifies for Medicare Part A or Part B coverage of short-term, in-home healthcare or short-term home care under a Medicare Part C Medicare Advantage plan, the certified home healthcare agency can provide some limited custodial-type services alongside the healthcare it provides.
What Medicare Pays
Neither Medicare Part A, Medicare Part B, nor a Medicare Part C Medicare Advantage plan pays anything for custodial care services.
Important: Regardless of the rules regarding any particular type of care, in order for Medicare Part A, Medicare Part B, or a Medicare Part C plan to provide coverage, the care must meet two basic requirements:
The care must be "medically necessary." This means that it must be ordered or prescribed by a licensed physician or other authorized medical provider, and that Medicare (or a Medicare Part C plan) agrees that the care is necessary and proper. For help getting your care covered, see FAQ: How Can I Increase the Odds That Medicare Will Cover My Medical Service?
The care must be performed or delivered by a healthcare provider who participates in Medicare.
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