Insurance for Senior Citizens, Special-Needs, and Taxes (CH 11)

Question 1

Benefit Period

Answer 1

The length of time insurance benefits will be paid.

Question 2

Chronically Ill

Answer 2

When a person is in a state of physical demise that is certifiable by a healthcare professional as unable to perform for a period of at least 90 days, without substantial assistance, at least two activities of daily living (ADLs).

Question 3

Creditable Coverage

Answer 3

Any previous health insurance coverage a person had before buying a Medi-gap policy, as long as there was no break in coverage of more than 63 days.

Question 4

Elimination Period

Answer 4

A period of time between the beginning of a disability and the date benefits begin.
Also known as a Waiting Period.

Question 5

Guaranteed Insurability

Answer 5

A rider in Life and Health Insurance contracts that permits the insured to buy additional prescribed amounts of insurance, at prescribed intervals, without evidence of insurability.

Question 6

Non-forfeiture Option

Answer 6

A legal provision whereby the policy owner may take the accumulated values in a policy as: 1. Paid up permanent insurance for a lesser amount, 2. Extended Term Insurance, or 3. Lump sum payment of cash value, less an unpaid premiums or outstanding loans.

Question 7

Original Age

Answer 7

The insured’s age when the policy was initially purchased.

Question 8

Waiting Period

Answer 8

A period of time between the beginning of a disability and the date benefits begin.
Also known as the Elimination Period.

Question 9

Medicare

Answer 9

A federal health insurance program for people age 65 and older, people of any age suffering from ALS or permanent kidney failure, and people with certain disabilities that are entitled to Disability Income coverage under Social Security.

Question 10

Home Health Care

Answer 10

less expensive option than going into a nursing home. Care is not provided by a professional, but doctor must prescribe services performed. Care is to assist with activities of daily living. Therapy, nursing services, or other medical necessary services must be provided.

Question 11

Adult Day Care

Answer 11

programs, services, and facilities designed to help physically or mentally impaired adults remain in their communities.
Meant to provide an alternative to placement in a residential institution and/or to create a respite for caregivers, often the children of the persons for whom the care is being provided.
Medical and Social Models

Question 12

Respite Care

Answer 12

gives the in-home caregiver a short vacation. It pays for a temporary substitute (a health care professional) for the opportunity to get away for a few days.

Question 13

Assisted Living

Answer 13

a halfway-type of living situation, in which a person or couple may have an independent living unit in a retirement community, yet staff members are there to assist with daily needs. The individuals in assisted living do not need the more intense care of the nursing unit. If a person needs additional care there are alternatives to assisted living that will give them the care that is needed.

Question 14

If the Insured purchases the Return of Premium rider, the insurer will return premiums paid

Answer 14

Less any claims paid out.

Question 15

If a replacement is involved in selling a Long Term Care policy the replacing insurer must notify the existing customer within

Answer 15

5 days

Question 16

Melanie recently purchased a Long Term Care policy over the internet. When must she receive an outline of coverage?

Answer 16

At the time the policy is delivered to her.

Question 17

If a Long Term Care policy contains pre-existing condition exclusions, what is the maximum time pre-existing conditions can be excluded?

Answer 17

6 months

Question 18

When an employee over age 65 continues to work for an employer who regularly employs 30 employees, who is considered the primary payor for any medical expenses?

Answer 18

Employer’s medical plan

Question 19

Which Medicare Supplement plan will have the lowest premium?

Answer 19

Medicare Select Core plan A

Question 20

Struck with a rare case of polio, Bob, age 51, now has a condition that is life-long and does NOT allow him to do any substantial work. At what point could he qualify of Medicare benefits?

Answer 20

after receiving Social Security disability insurance payments for a 24-month period.

Question 21

Coverage under Medicaid for custodial care in a nursing home is based on

Answer 21

low income and asset levels.

Question 22

The best description of Part C Medicare Advantage is

Answer 22

it’s managed care option for coverage under Part A and B.

Question 23

At what time may a federally qualified beneficiary NOT enroll in Medicare Part B?

Answer 23

any time, after reaching age 65.

Question 24

Which of the following may be a pre-requisite for home health care coverage under a long term care plan?

Answer 24

prior care in a skilled nursing facility

Question 25

Long-term care policies may require all of the following before paying benefits, EXCEPT:

Answer 25

a prior hospitalization.