What Does Medicare Pay For Custodial Long-Term Care?

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Medicare:

Only pays for long-term care if you require skilled services or rehabilitative care:

In a nursing home for a maximum of 100 days, however, the average Medicare covered stay is much shorter (22 days).


At home if you are also receiving skilled home health or other skilled in-home services. Generally, long-term care services are provided only for a short period of time.

Does not pay for non-skilled assistance with Activities of Daily Living (ADL), which make up the majority of long-term care services.


You will have to pay for long-term care services that are not covered by a public or private insurance program

Medicare doesn't pay for:

  • 24-hour-a-day care at home

  • Meals delivered to your home.
     

Homemaker services

  • Custodial or personal care (like bathing, dressing, or using the bathroom), when this is the only care you need.

Home Health Care- Who's eligible?

All people with Part A and/or Part B who meet all of these conditions are covered:

You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.


You must need, and a doctor must certify that you need, one or more of these:

Intermittent skilled nursing care (other than drawing blood)
Physical therapy, speech-language pathology, or continued occupational therapy services. 

 

These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.

Home health services

How often is it covered?
 

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services like these:

  • Part-time or intermittent skilled nursing care

  • Physical therapy

  • Occupational therapy

  • Speech-language pathology services

  • Medical social services

  • Part-time or intermittent home health aide services (personal hands-on care)


To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.

You're not eligible for the home health benefit if you need more than part-time or "intermittent" skilled nursing care.
You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Note

 

The home health agency caring for you is approved by Medicare (Medicare certified).

You must be homebound, and a doctor must certify that you're homebound.
Home health services may also include medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

​Call Medicare at 1-800-MEDICARE.

 

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