Custodial Care
Care assisting with ADLs that a layperson could perform, needing no skilled medical judgment, the level of care most LTC policies primarily pay.
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Practice This Concept
An elderly insured needs help with bathing, dressing, and meal preparation at home, but requires no medical care. Under a typical major medical expense policy, this care is MOST likely to be:
Excluded because it is custodial care, not medically necessary treatment — Major medical policies cover medically necessary treatment and exclude custodial care — assistance with activities of daily living such as bathing, dressing, and feeding that does not require skilled medical services. A physician's order does not convert custodial care into a covered benefit, because the policy pays for treatment of sickness or injury, not for maintenance care. This exclusion is one reason long-term care insurance exists: major medical stops where custodial care begins. Agents must therefore distinguish skilled care, which major medical covers, from custodial maintenance, which it does not, when counseling older clients about their coverage needs.
National insurance concept
Medical expense policies typically exclude custodial care, which is care that:
Assists with daily living activities and does not require skilled medical training — Custodial care is care given mainly to help with activities of daily living, such as bathing, dressing, eating, and mobility. It does not require skilled medical or nursing training and is generally excluded from medical expense policies because it is not considered treatment of a medical condition. Skilled care, by contrast, requires trained medical personnel and is covered when medically necessary. This exclusion is a common and important limitation that agents should explain to clients.
National insurance concept
- Medical ExpenseAn elderly insured needs help with bathing, dressing, and meal preparation at home, but…
- Medical ExpenseMedical expense policies typically exclude custodial care, which is care that:
- Medical ExpenseCustodial care — help with daily living activities such as bathing and dressing that re…
- Medical ExpenseMost medical expense policies exclude custodial care primarily because...
- Medical ExpenseWhich service is generally NOT covered by Original Medicare?
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