| Tue, Mar 05, 2013 @ 09:00 AM

A Key Expense Medicare Won’t Cover

Posted by Medicare Made Clear

Medicare custodial care coverageYou may never need it. And like many Americans, you may believe that if you do Medicare will pay for it.

What is it? It’s help with daily personal tasks when you are unable to do them for yourself.

The official name for it is “custodial care.” Custodial care includes:

  • Bathing

  • Dressing

  • Eating

  • Using the toilet

  • Transferring, such as to or from a bed or chair

  • Caring for incontinence

Skilled Versus Non-Skilled Care

Medicare helps pay for medically necessary skilled care. By definition, skilled care must be provided by a licensed professional with medical training, such as a registered nurse.

Custodial care is non-skilled care. Medicare does not cover it except in select situations when short-term rehabilitative care is required after a hospitalization. In this case, the care is part of treating a medical condition, such as re-learning to speak or care for oneself after a stroke.

Medicare will pay for the cost of this care, including custodial care provided in a skilled nursing facility, for a limited time if:

  • You had a recent prior hospital stay of at least three days.

  • You are admitted to a Medicare-certified nursing facility within 30 days of your prior hospital stay.

  • You need skilled care, such as skilled nursing services, physical therapy or other types of therapy.

For older adults, short-term skilled care can morph into the need for long-term non-skilled care. Or an individual may simply become less able to perform daily tasks as time goes by. It’s during this process that many families start to realize that Medicare is not going to help pay for the ongoing assistance their loved one may need.

Planning for Long-Term Care

Long-term care can be very expensive, depending on the kind of care that’s needed. It’s often more than most people can afford without some advance planning.

Many people put off planning for long-term care until the need is imminent. This may limit your options. You may not have the money to pay for the needed services. Or you may not be able to get the information you need or make decisions for yourself. So it’s a good idea to think about long-term care while you are healthy.

Your long-term care planning should consider the following topics:

  • How likely are you to need long-term care? What kind of care might you need?

  • Do you have family or friends who can provide a level of care for you?

  • Where do you want to live? Will your home meet your needs?

  • Do you have the financial resources to pay for long-term care?

  • How likely are you to qualify for public assistance, such as Medicaid, to help pay for long-term care?

You can get a good idea of the planning you may need to do and suggestions for getting started by taking the Long-Term Planning IQ Quiz from the US Department of Health and Human Services.

According to the US Department of Health and Human Services, about 70 percent of people over age 65 will need some type of long-term care services in their lifetime. It makes sense to plan ahead so that you’re ready should the need arise.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Medicare.gov: Visit the official U.S. government site for Medicare.

LongTermCare.gov: Get information about long-term care and tolls to help you plan for it.

Original Medicare Coverage: Learn what is and isn’t covered by Parts A and B.


Y0066_130131_084337 CMS Accepted