When it comes to what Medicare does and doesn’t cover, the distinction between skilled care and custodial care is important. In short, Medicare covers skilled care, but not custodial care.
Skilled care generally is provided by a licensed medical professional in a medical facility. The care is usually provided in response to a specific medical condition. Another distinctive feature of skilled care is that it is general only provided for a relatively short period of time while the patient recovers from their medical condition. Typically, skilled care is provided in hospitals and similar medical facilities, but can also include short-term stays in a nursing home. The average nursing home stay covered by Medicare is only 22 days long, while the maximum length of a stay covered by Medicare is capped at 100 days.
Custodial care need not be provided by a licensed medical professional. Care that involves assistance with daily activities, such as getting dressed, eating, or bathing, would be considered custodial care. For individuals who have a chronic condition that is not expected to get better, care that merely assists a person in living with their condition is considered custodial care. Custodial care often entails professional in-home care or long-term stays in a nursing home or specialized care facility. Custodial care is generally not covered by Medicare or private health insurance.
Under certain circumstances, Medicaid can cover the costs of custodial care in nursing homes and care facilities. However, in order to be eligible for Medicaid nursing home coverage, an individual’s assets must be under a certain level. An elder law attorney can help individuals plan for Medicaid eligibility, and, in certain circumstances, protect assets from the Medicaid asset cap.
To help protect your assets and plan for a potential nursing home stay, please call Martha C. Brown & Associates at (314) 962-0186.