Skilled vs Custodial Care
Skilled care requires daily licensed medical personnel under physician orders. Custodial care assists with ADLs and can be given by non-medical personnel - the level Medicare never covers and LTC primarily pays.
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Practice This Concept
Which of the following correctly describes the levels of care covered by long-term care insurance?
Skilled, intermediate, and custodial care, provided in facilities or at home — Long-term care insurance covers a range of care levels: skilled care, meaning daily, medically necessary care by licensed professionals; intermediate care, meaning occasional nursing and rehabilitative care; and custodial care, meaning help with activities of daily living such as bathing and dressing, which does not require professional medical skills. These services can be delivered in nursing facilities, assisted living facilities, adult day care centers, or the insured's home. The product addresses assistance with chronic conditions over time, not acute hospital treatment, and each level triggers different daily benefit amounts.
National insurance 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
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