Medicare does not cover custodial care
Custodial care is help with daily living tasks — bathing, dressing, eating, toileting, moving around — when you need it because of age, illness, or disability. Medicare Part A and Part B do not pay for this type of care, whether it happens at home, in an assisted living facility, or in a nursing home.
This is the single most important thing to know about Medicare and long-term care. Many people assume Medicare will cover nursing home stays or in-home aides, and then face a sudden bill they did not expect. Understanding what Medicare actually covers — and what it does not — helps you plan ahead.
Key Takeaways
- Medicare does not pay for custodial care at any setting, including nursing homes, assisted living, or your own home.
- Medicare does cover skilled nursing care for a limited time after a hospital stay, but only if you meet specific conditions.
- Medicaid, not Medicare, is the program that pays for long-term custodial care for people who meet income and asset limits.
- Long-term care insurance, savings, and family support are the main ways people pay for custodial care.
- You should ask your doctor whether you need skilled care or custodial care, because the difference determines what Medicare will pay.
What Medicare covers instead: skilled nursing care
Medicare Part A covers skilled nursing care — which is different from custodial care. Skilled care means medical or nursing services that require a trained professional: wound care, physical therapy, medication management, or monitoring after surgery. A nurse or therapist must provide it or supervise it.
To get Medicare to pay for skilled nursing care in a facility, you must meet all of these conditions: you spent at least three consecutive days in a hospital (not counting the day you left), you moved to a Medicare-certified nursing facility within 30 days of leaving the hospital, and a doctor ordered the skilled care as part of your recovery from the condition you were hospitalized for.
Medicare pays the full cost of the first 20 days. From day 21 to day 100, you pay a daily coinsurance amount (in 2024, this is $194.50 per day, though this amount changes yearly). After 100 days in the same benefit period, Medicare stops paying and you pay all costs yourself.
Why custodial care is not covered
Medicare is designed to pay for medical care — treatment, diagnosis, and recovery from illness or injury. Custodial care is support with activities of daily living that you would need whether or not you had a medical condition. If you need help bathing because you are frail, or help dressing because you have arthritis, that is custodial care. If you need physical therapy to regain strength after a stroke, that is skilled care.
The line between the two can be blurry, which is why it matters to ask your doctor directly: "Does my condition require skilled nursing care, or is this custodial care?" Your doctor's answer shapes what Medicare will and will not pay for.
Medicare also does not cover custodial care at home, even if a nurse visits for other reasons. If you need a home health aide to help you bathe and dress, Medicare will not pay for that aide's time, even if a nurse is coming to your home to manage your wound care.
Medicaid covers custodial care when Medicare does not
Medicaid is a separate program, run jointly by federal and state governments, that does pay for long-term custodial care. Unlike Medicare, Medicaid is means-tested — you must have low income and limited assets to be covered. The income and asset limits vary by state.
Medicaid pays for custodial care in nursing homes, assisted living facilities, and sometimes at home (through programs called waiver programs, which vary by state). For many people, Medicaid becomes the payer for long-term care after Medicare coverage ends or does not explore.
If you think you might need long-term care and your income is modest, it is worth learning what your state's Medicaid rules are now, before you need care. You can contact your state Medicaid office or call 211 to find local resources that explain Medicaid long-term care in your area.
Other ways people pay for custodial care
Because Medicare and Medicaid do not cover all custodial care, people use several other sources: personal savings and retirement accounts, long-term care insurance (if purchased before age 60 or so), help from family members, and in some cases Veterans benefits if you are a veteran or surviving spouse.
Long-term care insurance is a separate policy you buy while you are still healthy. It pays a daily or monthly benefit toward custodial care costs. Premiums depend on your age when you buy it, your health, and how much daily benefit you want. Most people buy it in their 50s or early 60s; it becomes expensive or unavailable if you wait longer or have health problems.
Some people plan to rely on family to provide custodial care, or a mix of family help and paid aides. This works for some families but creates financial and emotional strain for others. Having a conversation with family members about expectations, costs, and what each person can realistically do is important before a crisis forces the decision.
What to ask your doctor about your specific situation
If you are facing a hospital stay or thinking about long-term care, ask your doctor these questions: Will I need skilled nursing care after I leave the hospital, or will I need custodial care? If I need both, for how long will I need skilled care? Once skilled care ends, what kind of help will I still need?
Write down the answers. If your doctor says you will need skilled nursing care, ask which Medicare-certified facilities near you provide that care. If your doctor says you will need custodial care, ask about the timeline — how long you might need it — so you can start thinking about how to pay for it.
If cost is a concern, tell your doctor or hospital social worker. Many hospitals have social workers or discharge planners whose job is to help you understand what comes next and what programs might help pay for it.
When to contact Medicare or Medicaid directly
If you are in a nursing home and Medicare has stopped paying, but you believe you still need skilled care, you can ask the facility to request a review. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) and ask to speak with someone about a coverage decision review.
If you think you might be covered by Medicaid for long-term care, contact your state Medicaid office. You can find the phone number by calling 211 or searching "[your state] Medicaid" online. Medicaid rules are complex and vary by state, so talking to someone at your state office or a local legal aid organization can clarify what you might be covered for.
Frequently Asked Questions
If I need a nursing home after a hospital stay, will Medicare pay for all of it?
Medicare pays for skilled nursing care in a Medicare-certified facility for up to 100 days after a hospital stay, but only if you meet the three-day hospital requirement and a doctor orders skilled care. Many nursing home residents need custodial care, not skilled care, so Medicare does not pay. You pay out of pocket, or Medicaid pays if you meet income limits.
Does Medicare cover a home health aide to help me bathe and dress?
No. Medicare covers home health nursing and therapy services, but not custodial care at home. If you need an aide only for bathing and dressing, Medicare will not pay. You would pay out of pocket, use long-term care insurance if you have it, or explore Medicaid waiver programs in your state.
What is the difference between assisted living and a nursing home in terms of Medicare coverage?
Medicare does not cover custodial care in either setting. If you are in an assisted living facility receiving only help with daily living, Medicare does not pay. If you are in a nursing home receiving only custodial care, Medicare does not pay. Medicare only covers skilled nursing care in a nursing home after a hospital stay.
Can I use my Medicare Advantage plan to pay for custodial care?
No. Medicare Advantage plans (Part C) cover the same services as Original Medicare — they do not cover custodial care. Some Medicare Advantage plans offer supplemental benefits like transportation or meal delivery, but these are not the same as custodial care coverage.
How do I know if I should buy long-term care insurance?
Long-term care insurance is most useful if you have assets to protect and buy it before age 60. Talk to a financial advisor or insurance agent about whether it makes sense for your situation. If you have low income, Medicaid may eventually cover custodial care, so insurance may not be necessary.