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Definition of Custodial Care in Medicare

Definition of custodial care in Medicare

Medicare Custodial Care Coverage

What is custodial care?

Nonmedical Assistance – this can be at home, nursing facility, or a assisted living facility that include the daily activities such as eating, dressing, bathing, use of a toilet for those who are unable to perform these activities without the assisted help of someone.

Custodial – this means the type of care which may be 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 do 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, as well as Medicare Part C Medicare Advantage plans. Not even for short term.

Some limited custodial type services may be provided alongside with healthcare being provided for 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) There are 2 basic requirements that must be met for coverage to be provided for any type of 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.