A family member provides daily custodial care to an elderly relative who needs help bathing and dressing but has no acute medical condition. Under a typical major medical policy, this care is generally:
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Major medical policies cover care that is medically necessary and directed at treating an illness or injury. Custodial care — help with the activities of daily living such as bathing, dressing, and eating when no skilled treatment is being provided — is a standard exclusion because it is maintenance rather than medical treatment. The distinction is deliberately drawn to keep comprehensive medical insurance focused on acute care. This is exactly why long-term care insurance exists as a separate product: it pays for the custodial and maintenance care that major medical policies do not cover. The exam tests this boundary between medical care and custodial care.
Why the other options are wrong
- B) Custodial long-term care is not an essential health benefit; the EHB categories center on medical services such as hospitalization and physician care, so no plan is required to cover it.
- C) Custodial care is generally excluded entirely rather than reimbursed at the skilled nursing level, which requires active medical treatment by skilled professionals.
- D) Even when ordered or rendered by a health professional, non-medical custodial care remains outside typical major medical coverage because the service itself is maintenance rather than treatment.
Memory hook
Custodial care keeps a person comfortable; major medical treats a disease. Different jobs, different policies.