I Can No Longer Care for Myself: What Can I Expect From Medicare?

There have been a lot of changes in healthcare benefits over the last few years. One benefit that has not changed is the limited role Medicare plays in paying for custodial care.

What is custodial care?

The Centers for Medicare and Medicaid Services (CMS) defines custodial care as services of any non-medical care that can reasonably and safely be provided by non-licensed caregivers.

Examples of this type of care could be assistance with bathing, dressing, toileting, transferring, eating or cognitive loss. These types of personal services make up more than 90% of the care needed when personal independence has been diminished.

Will Medicare cover the cost of my care?

Today someone turning 65 has a 70% chance of needing some type of long-term care service and support in their years to come, according to the U.S. Department of Health and Human Services. Will Medicare cover the cost of care? It depends — if the necessary care is considered “acute” and the patient is showing signs of recovery, then Medicare may cover a hospital stay, rehabilitative care or doctor’s visit.

Do I have other options?

Medicaid or ALTCS (Arizona Long Term Care System) may be available to those who meet certain requirements, including low income and minimal asset levels set by the state. Once financially qualified, the state will determine if someone qualifies for services, and whether they will receive care at home or in a nursing home.

How likely is it that my costs will be covered?

For most seniors, the need for custodial care is not going to fall under the definition of “acute.” Also, there is a good chance they will not qualify for low-income assistance, which means that they will need to pay 100% of the cost. The other option is to purchase private long-term care insurance.

Where can I get help?

Desert Financial Insurance Services has been assisting thousands of members (and individuals who aren’t members) with their options for Medicare and long-term care planning for many years. We are here to help you if you are:

  • Nearing eligibility for Medicare
  • Need a review of your current benefits
  • Interested in learning about long-term care options to help pay for custodial care

We are passionate about helping people coordinate their Medicare benefits to reduce risks and help the retirement healthcare dollar go so much further.

We’re here to help Medicare or other long-term care options work for you.

Get the coverage you need with monthly payments you can afford. An appointment with one of our experienced insurance advisors is free!


The material presented here is for educational purposes only, and is not intended to be used as financial, investment, or legal advice.