BenefitScout

Financial & benefits reality check

The #1 caregiver confusion: what Medicare covers vs what it doesn’t. Use this guide to prepare calls — then confirm with SHIP, Medicaid, or VA counselors. Not an eligibility calculator.

The big myth

Medicare does not pay for 24/7 custodial home care or long-term assisted living rent

It covers skilled/medical care under specific rules. Custodial help (bathing, meals, supervision) and monthly facility “rent” are usually private-pay, long-term care insurance, Medicaid (if eligible), or VA benefits.

What Medicare covers vs. what it doesn’t

Often covered (with rules)

  • Hospital stays (Part A) and doctor visits (Part B)
  • Short-term skilled nursing after a qualifying hospital stay
  • Home health when medically necessary and intermittent (nurse/therapist — not round-the-clock aide)
  • Durable medical equipment (when ordered and criteria met)
  • Hospice benefit (Part A) for eligible terminal care
  • Some outpatient rehab / PT / OT with limits

Typically not covered

  • 24/7 custodial in-home aides (companionship, bathing, meals only)
  • Long-term assisted living or memory-care monthly rent
  • Ongoing nursing-home “room and board” without a skilled need
  • Most dental, hearing aids, and routine vision (plan-dependent)
  • Family caregiver wages (Medicare does not “hire” you)

Ask a free SHIP counselor before changing plans or assuming “Medicare will pay for the aide.”

Medicare · Medicaid · VA — quick map

Question
Medicare
Medicaid
VA (if eligible)
What is it?
Federal health insurance for 65+ (and some under 65 with disability).
Joint federal–state program for people who meet income/asset rules — can cover long-term care.
Benefits for eligible veterans and sometimes surviving spouses (e.g. Aid & Attendance).
Home aides / custodial care?
Limited; skilled/intermittent home health only — not full-time custodial.
Often yes via HCBS waivers or state programs if eligible — waitlists common.
Possible via Aid & Attendance or VA home care — apply; don’t assume.
Assisted living / nursing home?
Does not pay long-term rent; short skilled SNF stays only.
May pay after spend-down / eligibility — state rules; house protection varies (ask elder law).
May offset costs for eligible veterans/spouses; not automatic.
Can family caregivers get paid?
No Medicare wage for family caregivers.
Some states allow consumer-directed / family caregiver pay — ask your state Medicaid office.
Aid & Attendance is a pension add-on to the veteran/spouse — not a “hire your kid” program, but funds can help pay for care.

Reality-check checklist

Tap items you’ve clarified. Print the 1-pager for your SHIP / Medicaid / VA call.

Who to call next

  • SHIP — free Medicare counseling in every state (search “SHIP + your state”).
  • Area Agency on Aging (AAA) — local aging services, assessments, caregiver programs.
  • State Medicaid / HCBS waiver office — long-term care and possible family-pay programs.
  • VA benefits / accredited VSO — Aid & Attendance and related claims if veteran or eligible spouse.
  • Elder-law attorney — Medicaid planning and protecting the house (do not rely on internet forums alone).

BenefitScout is educational and organizational only. It does not determine eligibility, file claims, or provide legal, tax, or benefits advice. Coverage rules change — verify with official sources.

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