Chapter 13: Long Term Care

Question 1

____-____ ____policies are intended to help individuals, especially those with advanced ages, with activities of daily living, such as dressing, bathing or eating, when individuals can no longer perform such activities themselves.

Answer 1

Long-Term Care (LTCs)

Question 2

TF:LTC is provided at an individual’s home or in a nursing facility.

Answer 2

True

Question 3

All LTC policies must provide coverage for at least ____ consecutive months (in some states this may be longer, such as ____ months).

Answer 3

12
24

Question 4

Long-term care policies can be issued in several forms, including.

Answer 4

Individual policies,
Group policies, and
As a rider on life insurance policies.

Question 5

TF” LTC benefits are available through Medicare.

Answer 5

False - they are NOT

Question 6

TF: Medicare, Medicare Supplement, and Medicaid do not cover long-term custodial or nursing home care, and only provide limited skilled nursing coverage if medically needed for treatment, not advanced age.

Answer 6

True

Question 7

Medicaid’s coverage of nursing home care is only available to those who qualify because of limited ____ and ____

Answer 7

income
assets

Question 8

Aging populations often require care because of old age, not due to sickness or accident. ____-____ ____ coverage fulfills this need.

Answer 8

Long-Term Care

Question 9

TF: LTC insurance is especially suitable for people who have significant financial income and assets, and would not qualify for Medicaid. LTC insurance prevents individuals from depleting financial resources to pay the high cost of LTC out-of-pocket, and allows individuals to independently manage their need for LTC without relying on family members.

Answer 9

True

Question 10

TF: Paying premiums for an LTC policy is financially more efficient than simply putting funds in a savings account for future LTC needs.

Answer 10

True

Question 11

Insureds must be incapable of performing some of the activities of daily living to receive LTC benefits.

Activities of daily living, or ADLs, include:

Answer 11

Bathing,
Dressing,
eating,
Mobility,
Transferring,
Toileting, and
Continence.

Question 12

Most LTC policies specify that an insured must be unable to perform at least _____ ADLs, or be cognitively impaired. Policies also include ____ limits.

Answer 12

two
age

Question 13

Each policy is different, but many have a minimum age of ____ and a maximum of ____ for purchasing an LTC policy. LTC policies cannot require that the insured undergo a hospital visit prior to LTC nursing home coverage.

Answer 13

50
89

Question 14

TF: Levels of care are the types of care covered by an LTC policy. Some policies cover all levels of care, while others only cover a specific level of care. LTC policies that cover all levels of care are more advantageous to the insured.

Answer 14

True

Question 15

Nursing care and rehabilitation needed on a daily basis. A medical professional under a physician’s orders performs _____ _____. This care is traditionally performed in a medical facility.

Answer 15

Skilled care

Question 16

Nursing care and rehabilitation needed occasionally. A medical professional under a physician’s orders performs ____ ___.

Answer 16

intermediate care

Question 17

Care provided to assist an individual with ADLs. _____ ____ can be performed by a medical non-professional, but must be performed under physician’s orders.

Answer 17

Custodial Care

Question 18

Care provided in an individual’s home. ____ ___ ____ usually includes intermediate or custodial care. This may include physical therapy, assistance with one ADL, but generally the individual is capable of functioning independently. This type of care typically follows a nursing home stay.

Answer 18

Home Health Care

Question 19

Care provided to an individual who does not need 24-hour care. ____ ___ ___ may be provided in the home or at a facility. This case allows an individual’s primary caregiver to continue working while the individual receives medical care and is socially engaged.

Answer 19

Adult Day Care

Question 20

____ ____ allows an individual’s primary caregiver to have a break from caregiving duties. It may be as short as a couple of hours to several days. This period allows the primary caregiver to run errands, sleep, or take a weekend vacation.

Answer 20

Respite Care

Question 21

For LTC, Longer elimination periods have lower premiums.

Answer 21

true

Question 22

For LTC, Longer benefit periods will have more expensive premiums.

Answer 22

True

Question 23

The ____ _____of an LTC policy is the maximum period that benefits will be paid to an insured. Many LTC policies have an _____ _____ similar to that found in a disability income policy, after which LTC benefits begin.

Answer 23

Benefit Period
Elimination Period

Question 24

In the case of LTC, the elimination period is usually ___ days or longer, during which period the insured must be confined to a nursing facility.

Answer 24

30

Question 25

Most policies have a maximum benefit period of ____ to _____ years; however, some policies do not have a limit.

Answer 25

3 to 5

Question 26

The _____ _____ is the maximum daily benefit for nursing home care or home health care. LTC policies with larger daily benefits have more expensive premiums.

Answer 26

BEnefit amount

Question 27

The daily benefit is typically a fixed dollar-per-day amount ranging in amount from ____ to ____ per day,

Answer 27

$75 to $200

Question 28

TF: Benefit triggers are the conditions that must be met for LTC policy benefits to begin. These include:

Activities of Daily Living (ADL)
Cognitive Impairment
Medical Necessity

Answer 28

True

Question 29

_____ _____ is the inability of an individual to perceive, rationalize or recall. It prohibits an individual from properly taking care of their self, and such individuals require assistance from others.

Answer 29

Cognitive Impairment

Question 30

_____ _____ is the inability of an individual to perceive, rationalize or recall. It prohibits an individual from properly taking care of their self, and such individuals require assistance from others.

Answer 30

Cognitive Impairment

Question 31

____ ____ is the need for LTC based on physician recommendation and may include rehabilitation or personal care.

Answer 31

Medical Necessity

Question 32

____ of ____: Benefit levels increase without the insured needing to prove insurability. The benefit increase is typically limited to 5% per year.

Answer 32

Guarantee of insurability

Question 33

___ of ____: A portion of the premiums paid will be returned if an LTC policy is lapsed, or an insured dies before benefits are paid out.

Answer 33

Return of premium

Question 34

TF: Some LTC policies may provide care for hospice, which focuses on providing pain management and comfort, rather than curing an individual’s ailments. Hospice care is typically for individuals with terminal illnesses. LTC benefits for hospice care may cover the cost of room and board and pain medication at a hospice facility.

Answer 34

True

Question 35

Only qualified LTC plans are required to provide _____ ______ by federal law. This prevent policyholders from forfeiting policy cash values or benefits if the policy lapses.

Answer 35

Nonforfeiture Protection

Question 36

LTC nonforfeiture options include the following 3 things:

Answer 36

Cash Surrender Value: lump sum payable when the policy is surrendered
Reduced paid-up: daily benefit is reduced and no further premiums are required
Extended term insurance: coverage is extended for a limited period and no further premiums are required

Question 37

TF:Qualified LTC policies are not required to provide inflation protection by federal law.

Answer 37

False - They ARE

Question 38

TF: Non-qualified LTC plans must also offer inflation protection, but it does not have to be “included” in the policy itself

Answer 38

True

Question 39

TF: Inflation protection allows the policy benefits to increase annually without requiring the insured to provide evidence of insurability. Inflation protection prevents LTC policies from providing insufficient benefits caused by inflation. The minimum inflation protection is 5% annually.

Answer 39

True

Question 40

How can a long-term care policy be written?
Select one:
a. Stand-alone policy only
b. Rider only
c. Both stand-alone policy and rider
d. None of the above

Answer 40

C

Question 41

All of the following are ways long-term care coverage may be offered, EXCEPT:
Select one:
a. AD&D rider
b. Life insurance rider
c. Individual plan
d. Group plan

Answer 41

A

Question 42

Which of the following statements about long-term care coverage is CORRECT?
Select one:
a. Medicare supplement policies provide a significant amount of long-term care coverage.
b. Medicaid provides long-term care coverage for individuals, regardless of income levels.
c. Medicare and Medicaid are designed to cover a significant portion of the costs of long-term custodial or nursing home care.
d. Long-term care insurance provides a broad range of coverage for services rendered at home, at adult care centers, or in nursing homes.

Answer 42

D

Question 43

Notes: Although Medicare and Medicare supplement policies protect the elderly against the costs of medical care, neither covers a significant portion of long-term custodial or nursing home care. Although Medicaid provides some long-term custodial care coverage, only individuals who are almost destitute are eligible to receive benefits. Long-term care insurance provides a broad range of coverage for services rendered at home, at adult care centers, and in nursing homes.

Question 44

Most long-term care policies require the insured be unable to perform at least:
Select one:
a. 1 ADL
b. 2 ADLs
c. 4 ADLs
d. 10 ADLs

Answer 44

B

Question 45

Long-term care insurance differs from Medigap in which of the following ways?
Select one:
a. Long-term care insurance must be guaranteed renewable.
b. Long-term care insurance provides custodial care.
c. Long-term care insurance may impose a 6-month pre-existing condition exclusion.
d. Long-term care insurance must provide a 30-day free look period.

Answer 45

B

Question 46

Which of the following statements about the respite care provision under a long-term care policy is CORRECT?
Select one:
a. It pays a benefit for a family caregiver to get away from their duties for a short period of time.
b. It pays a benefit for the insured to return home for short visits.
c. It pays a benefit for the insured to take a break at an approved day spa or adult day care.
d. It pays a benefit to reimburse other family members who provide care for the insured.

Answer 46

A

Question 47

TF: Respite care pays the cost of either bringing a substitute provider into the insured’s home or moving the insured to a care facility for a period of time. Its purpose is to give an unpaid caregiver (e.g., a spouse or family member) relief from their daily duties.

Answer 47

True

Question 48

Diane is 75 years of age and needs some assistance with preparing meals and bathing. She is the wife of a multi-millionaire. Which of the following policies would you recommend to her?
Select one:
a. Medicaid
b. Long-term care
c. Medigap
d. Medicare

Answer 48

B

Question 49

Which of the following is not a benefit trigger under long-term care policies?
Select one:
a. ADLs
b. Financial need
c. Cognitive impairment
d. Medical necessity

Answer 49

B

Question 50

Which of the following is an optional benefit under long-term care policies?
Select one:
a. Guarantee of insurability
b. Nonforfeiture options
c. Inflation protection
d. All of the above

Answer 50

D

Question 51

TF: Optional benefits under long-term care (LTC) plans include: guarantee of insurability, return of premium, hospice care, nonforfeiture options, and inflation protection.

Answer 51

True

Question 52

What level of long-term care is provided to assist an individual with ADLs?
Select one:
a. Skilled care
b. Intermediate care
c. Custodial care
d. Respite care

Answer 52

C