A 68-year-old client says she plans to rely on Medicare to pay for long-term care if she ever needs help with daily living. Which statement should the agent make?
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Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Medicare is designed to pay for acute medical care, not long-term custodial care. Under Original Medicare, custodial care — help with bathing, dressing, eating, and other activities of daily living that does not require skilled medical services — is generally not covered, whether delivered in a nursing home or at home. Skilled nursing facility care is covered only under limited conditions, generally following a qualifying hospital stay, and for a limited period. This coverage gap is a primary reason long-term care insurance exists: it funds the custodial and chronic-care services that Medicare does not cover. An agent must not imply that Medicare will pay for custodial LTC, because doing so misleads the client about a central limitation of the program.
Why the other options are wrong
- B) Medicare Part A covers skilled nursing facility care only under strict conditions, generally after a qualifying hospital stay, and only for a limited number of days; it does not cover all nursing home care after age 65.
- C) Medicare Advantage plans must cover at least everything Original Medicare covers, but they are not required to cover custodial long-term care; an Advantage plan is not a substitute for LTC insurance.
- D) Medicare Part B covers only medically necessary home health care under defined conditions; coverage stops when the care needed is purely custodial, and there is no unlimited home health benefit.
Memory hook
Medicare pays for acute care, not for help getting dressed. Custodial care is an LTC insurance job.