It depends entirely on the type of benefit plan you have and what kind of care you need. Most traditional group health plans (the kind employers offer through BUCA carriers like Blue Cross, UnitedHealthcare, Cigna, or Aetna) do not cover long-term custodial care, such as help with bathing, dressing, or eating. But they may cover skilled home healthcare under specific, medically necessary conditions. This gap is exactly the kind of broken system WellthCare™ aims to fix: it shifts the focus to prevention and wealth-building, which reduces the risk of needing costly long-term care down the road.
You need to understand the difference between two categories: skilled home healthcare (sometimes covered) and custodial long-term care (almost never covered).
What Employer Health Plans Typically Cover
Most employer-sponsored plans, whether fully insured or self-funded, cover home healthcare services if they meet strict medical necessity criteria. This usually includes:
- Skilled nursing care from an RN or LPN: wound care, IV therapy, monitoring vital signs.
- Physical, occupational, or speech therapy prescribed by a doctor as part of recovery.
- Home health aide services that support skilled care, but only temporarily and not just for bathing or meal prep.
But there are major limits. Coverage requires a doctor-certified plan of care, the care must be part-time or intermittent (not full-time), and most plans require prior authorization and cap visits or days. Specific criteria vary by plan.
What Health Plans Don't Cover: Custodial Long-Term Care
This is where the system fails most employees. Long-term custodial care (help needed for months or years due to aging, chronic illness, dementia, or disability) is not covered by standard medical insurance. This includes:
- Help with activities of daily living (ADLs) like bathing, dressing, toileting, eating, and transferring.
- Supervision for someone with Alzheimer's or cognitive decline.
- Full-time or round-the-clock home care.
- Assisted living or nursing home care that isn't skilled nursing care.
Medicare (Parts A and B) also doesn't cover custodial long-term care. It does cover skilled home health care, but only when the care is part-time or intermittent, a doctor certifies a plan of care, and the patient is homebound. Only Medicaid covers custodial care, and only for people who meet strict income and asset limits. Most middle-class Americans must spend down savings first. Private long-term care insurance is the only private way to cover these costs, but about 3% of Americans own any type of it, according to LIMRA.
What Long-Term Care Actually Costs
The coverage gap matters because the care is expensive. CareScout's 2025 Cost of Care Survey puts the national median for a semi-private nursing home room at $315 a day, or $114,975 a year. A private room runs $355 a day, or $129,575. In-home care is not much cheaper: non-medical caregiver services median $35 an hour, about $80,080 a year at 44 hours a week. Assisted living communities median $6,200 a month, or $74,400 a year.
None of this is covered by a standard group health plan, and Medicare covers only limited skilled care. Someone who needs help for years faces six-figure annual costs, paid out of pocket or through Medicaid after spending down assets. That is the gap WellthCare is built to narrow: keep people healthier so they need less of this care, and build savings they can draw on if they do.
Why This Creates a Crisis and How WellthCare Fixes It
The lack of long-term care coverage is a huge financial risk. WellthCare, the first Health-to-Wealth™ Benefit System, uses a patent-pending platform to track verified preventive actions and fund WellthCare Store™ reward dollars, while savings the employer commits fund automatic retirement contributions. That turns everyday health choices into long-term financial security. Employees delay preventive care because they can't afford deductibles, which leads to chronic conditions that eventually require expensive care, often custodial care that the employer's plan can't cover. Meanwhile, employers face rising premiums driven by claims from preventable illnesses.
WellthCare tackles this. Instead of waiting for employees to get sick, it combines preventive health actions with employer-level reporting to:
- Fund automatic retirement contributions, building wealth that can later help pay for long-term care.
- Provide $0-co-pay care used before their primary plan, so employees get preventive services without financial barriers.
- Deposit reward dollars into the WellthCare Store, where employees can buy FSA-approved, health-supporting products.
- Generate a WellthCare Readiness Index™ that shows employers, with their own data, when expanding to WellthCare Medicare™ would save money.
The Bottom Line for Employers
If you're evaluating benefits for your team, keep these points in mind:
- Standard health plans cover only skilled, short-term home healthcare, not custodial long-term care.
- Long-term care insurance is a separate product that most employees don't have.
- Prevention lowers the risk of the chronic conditions that drive long-term care costs. A system that rewards employees for staying healthy, like WellthCare, reduces the risk they'll need expensive custodial care.
- WellthCare's automatic retirement contributions and Store reward dollars give employees financial resources for future care needs.
See what a WellthCare Plan would look like for your team.
This article is for general information only and is not legal, tax, or medical advice. Employers should consult their own advisors.