Medicare Custodial Care Coverage

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What is Custodial Care?

Custodial care is a type of home-based service that helps you with day-to-day tasks, such as cooking, cleaning or doing laundry. It also includes companionship and emotional support for those who are elderly or disabled. The goal of custodial care is to help the caregiver maintain their independence by providing them with the assistance they need to live safely at home. In addition, many people choose this option instead of moving into an assisted living facility because it provides more privacy and allows them to maintain their lifestyle.

Custodial care is safely performed by people who don’t have any nursing, medical, or other types of professional training. This type of care may come from a specific physical condition or general frailty due to age, a mental incapacity like Alzheimer’s and dementia.

What is Covered for Custodial Care?

No custodial coverage is available under Medicare Part A or Medicare Part B and Medicare Part C Medicare Advantage plans. Some limited custodial type services may be provided alongside healthcare being offered to patients qualifying for Short-term Medicare Part A or B, short-term home care found under a Medicare Part C, “Medicare Advantage plan,” or in-home healthcare.

What does Medicare Pay?

Medicare does not pay for any custodial care services under Medicare Part A or B or a Medicare Part C Medicare Advantage Plan.

Important Note: (regardless of the rules) 2 basic requirements must be met for the coverage to be provided for any care under Medicare Part A, Part B, or a Medicare Part C Medicare Advantage Plan:

  1. Any care needed must be “medically necessary.” The care has to be prescribed or ordered by an authorized medical provider or a licensed physician. Medicare or Medicare Part C Plan has to agree the care is needed, necessary, proper.
  2. Any care given must be delivered or performed by providers participating in Medicare.
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