Chapter 15 Flashcards
Look-Back Period
A specific time period prior to Medicaid eligibility during which Medicaid benefits are reduced (or onset postponed) if the individual
s assets were disposed of at less than their fair market value
Continuing Care Retirement Community
A facility that provides lifetime care for older adults. Initial Occupancy is in an independent living unit, but a resident must move to an assisted-living or nursing home unit if health deteriorates.
Long-Term Care Insurance
A form of health insurance that usually provides coverage for custodial care, intermediate care, and skilled-nursing care. Benefits may also be available for home health care, adult day care, and assisted living.
Qualified Long-Term Care Insurance Contract
A long-term care contract that meets specified standards and qualifies for favorable tax treatment under the HIPAA. Also called tax-qualified policy.
Qualified Long-Term Care Services
Services that must be provided by a qualified long-term care insurance contract. These include necessary diagnostic, preventive, therapeutic, curative, treatment, and rehabilitative services and maintenance or personal care services that are required by a chronically ill individual and provided by a plan of care prescribed by a licensed health care practitioner.
Chronically Ill Individual
A person who, for purposes of long-term care insurance, is expected to be unable to perform at least 2 of the 6 ADLs for at least 90 days or who needs substantial services to protect the individual from threats to health and safety due to substantial cognitive impairment
Activities of Daily Living (ADLs)
Activities such as eating, bathing, and dressing. The inability to perform a specified number of these activities triggers eligibility for benefits in a long-term care insurance contract.
Nursing Home Care
A term that encompasses skilled-nursing care, intermediate care, and custodial care in a licensed facility
Custodial Care
Nursing home care given to help with personal needs, such as walking, bathing, dressing, eating, or taking medicine. Such care can usually be provided by someone without professional medical skills or training. Sometimes called personal care.
Bed Reservation Benefit
A benefit under a long-term care insurance policy that continues to pay a long-term care facility for a limited time if a patient must temporarily leave because of hospitalization. Without a continuation of benefits, the bed might be rented to someone else and unavailable upon the patient’s release from the hospital.
Assisted Living Care
Care provided in facilities that provide for the frail elderly who are no longer able to care for themselves but who do not need the level of care provided in a nursing home
Adult Day Care Center
Day care at centers specifically designed for the elderly who live at home but whose spouses or families cannot stay home to care for them during the day.
Care Coordinator
A licensed health care practitioner who assesses a person’s condition, evaluates care options, and develops an individualized plan of care that provides the most appropriate services
Respite Care
Occasional full-time care at home for a person who is receiving home health care. Coverage for such care under a long-term care insurance policy enables family members (or other persons) who are providing much of the home care to take a needed break
Facility-Only Policy
A long-term care insurance policy that provides benefits for care in a nursing home and other settings, such as an assisted-living facility and hospice
Home-Health-Care-Only Policy
A long-term care insurance policy designed to provide benefits only for care outside an institutional setting, although some policies may provide benefits for care in assisted-living facilites.
Comprehensive Long-Term Care Insurance Policy
A long-term care insurance policy that combines benefits for facility care and benefits for home health care services into a single contract. Also known as an integrated policy.
Reimbursement Basis
The method of paying long-term care insurance benefits that reimburses the insured for actual expenses incurred up to the specified policy limit
Per Diem Basis
A method of paying under long-term care insurance policies in which the insured receives a specified daily or weekly benefit amount, regardless of the actual cost of care
Disability-Based Policy
A long-term care insurance with a per diem basis payment that provides benefits even if no care is being received as long as the insured satisfies the policy’s benefit trigger.
Pool of Money
Long-Term Care insurance approach to benefits in which a sum, based on the daily benefit amount times days in the benefit period, can be used to make benefit payments as long as the pool of money lasts, subject to the daily benefit limit.
Shared Benefit
Long-Term Care insurance approach to benefits in which a husband and wife are insured under the same policy or with the same insurer and can access each other’s unused benefits
