Medicare Part B functions as medical insurance, primarily covering outpatient services, doctor visits, and durable medical equipment. It is not a long-term care insurance policy. Part B generally does not cover non-medical, long-term caregivers, which are the services most people seek when asking this question. Understanding what Part B excludes is necessary to navigate the complexities of Medicare’s home health benefit, as coverage hinges entirely on separating medical necessity from personal assistance.
Defining Custodial Care and the Part B Exclusion
Medicare Part B specifically excludes coverage for “custodial care,” the non-medical help often associated with a caregiver. Custodial care involves providing assistance with routine daily needs, known as Activities of Daily Living (ADLs). These activities include bathing, dressing, eating, using the toilet, and moving around.
These services are considered custodial because they can be safely provided by non-licensed caregivers or aides, and do not require the specialized skills of a medical professional. Since Medicare focuses on medically necessary treatment and rehabilitation, it will not pay for this type of long-term personal assistance. This exclusion applies regardless of the patient’s medical condition or where the care is provided.
If an individual only requires help with these non-medical daily activities, Part B will not provide coverage. This limitation reflects that the program is designed to cover acute medical events and skilled services, not ongoing long-term support. The cost of long-term non-medical care must be covered by other means, such as personal funds, long-term care insurance, or Medicaid for eligible individuals.
Specific Home Health Services Covered by Part B
While Part B does not cover non-medical caregivers, it does cover certain medically necessary services delivered in the home setting as part of the overall home health benefit. The coverage focuses on services requiring a licensed professional, known as skilled care. These services are typically short-term, rehabilitative, or provided to manage a specific medical condition.
Part B covers 100% of the approved costs for skilled care, provided the patient meets specific eligibility criteria. This includes:
- Intermittent skilled nursing care.
- Physical therapy (PT), which helps restore movement and function.
- Occupational therapy (OT), which assists patients in performing daily activities more easily after an illness or injury.
- Speech-language pathology (SLP), which addresses communication and swallowing disorders.
Part B also covers 80% of the Medicare-approved amount for durable medical equipment (DME) necessary for home care. This equipment includes items like wheelchairs, walkers, hospital beds, and oxygen equipment.
Medicare covers the services of a home health aide, but only on a part-time or intermittent basis. This coverage is strictly contingent on the patient simultaneously receiving covered skilled nursing or therapy services. If the skilled care ends, the coverage for the home health aide services, which include help with ADLs, will also cease.
How Medicare Part A Coordinates Home Health Coverage
The full home health benefit involves a coordination between Medicare Part A and Part B to cover a single episode of care. Eligibility requires a physician’s order and certification that the patient needs intermittent skilled nursing care or therapy services.
A major requirement for coverage under either part is that the patient must be certified as “homebound.” This means it is difficult and requires significant effort to leave the home without assistance. Brief absences for medical appointments or religious services are generally permitted.
For patients who have had a qualifying hospital or skilled nursing facility stay, Part A covers the initial period of home health care, coordinating the intermittent skilled nursing and overall plan. If the need for skilled care continues, or if the patient did not have a prior hospital stay, the home health services are typically covered under Part B.
Regardless of whether Part A or Part B is paying for the episode, the patient pays nothing for the covered home health services, except for the 20% coinsurance on durable medical equipment. This combined structure ensures that the home health benefit is available for medically necessary, short-term recovery.