Medicare Covers Skilled Nursing but Not Custodial Care Aides
Medicare Part A and B cover home health services when medically necessary, such as visits from a registered nurse or physical therapist. However, the program does not pay for custodial care—help with bathing, dressing, toileting, or meals—which is often provided by private aides at an average cost of $30 per hour in most metropolitan areas. This distinction between skilled and non-skilled (custodial) services creates a significant financial burden on families. For example, four hours of aide care daily can amount to over $3,600 monthly, with none of that expense covered by Medicare or counted toward out-of-pocket limits. Additionally, hospital observation stays do not count as inpatient days under Medicare rules, potentially leaving skilled nursing facility costs entirely uncovered. The article also highlights the growing cost of home care services and how wages for aides are rising faster than inflation. This financial strain is compounded when retirees rely on outdated retirement strategies like the 4% rule, which may lead to premature depletion of savings if not adjusted with a more stable income-first approach.
Topics: costs home healthcare Medicare policy