Skilled Care
Daily medical care ordered by a physician and requiring licensed medical personnel, covered by Medicare for limited post-acute stays and by comprehensive LTC policies.
Drill all 803 terms as flip-card flashcards in the Exam Engine →
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
In addition to inpatient hospital care and skilled nursing facility care, Medicare Part A also covers:
Home health care and hospice care — Medicare Part A, the hospital insurance component of Original Medicare, covers inpatient hospital stays, skilled nursing facility care, home health care, and hospice care. Part A is the primary payer for hospice care for terminally ill beneficiaries, including symptom management, nursing, and other hospice services, and it covers home health care for beneficiaries who need skilled care and meet the homebound requirement. These benefits are the core of the Part A package, which is why Part A is described as hospital-oriented coverage. Items such as routine dental care, prescription drugs, and eyeglasses fall outside Part A entirely.
National insurance concept
- Medical ExpenseAn elderly insured needs help with bathing, dressing, and meal preparation at home, but…
- Medical ExpenseIn addition to inpatient hospital care and skilled nursing facility care, Medicare Part…
- Medical ExpenseMedical expense policies typically exclude custodial care, which is care that:
- Medical ExpenseWhich type of care does Medicare generally NOT cover?
- Accident & Health ConceptsWhich of the following correctly describes the levels of care covered by long-term care…
- Long-Term CareWhat is the primary reason long-term care insurance is recommended to older clients?
Practice all medical expense questions →