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:
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
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.
Why the other options are wrong
- B) A physician's order cannot make custodial care medically necessary; the nature of the care, not the order, determines coverage.
- C) Meeting the deductible affects cost-sharing, not whether the service is a covered expense in the first place.
- D) Custodial care is not a preventive essential health benefit; preventive services are clinical screenings and immunizations.
Memory hook
Custodial = comfort and chores, not cures. Major medical heals; it does not do housekeeping.