Long Term Care Flashcards
In a community or residential setting long term care services are provided by ___________ & ______________.
Long term care is not typically provided by nursing homes who usually only provide ____________________.
Adult Day Care
Assisted Living Communities
Institutional Care
What is the average stay in a nursing home?
835 Days
Long term care needs can vary based on the family demographic and type/location of care received. List the highest to lowest cost of LTC options.
Nursing Home - Private Nursing Home - Semi Private Assisted Living Home Health Aide (In-Home) Homemaker/Companion Adult Day Services
What are the 4 common methods for paying for LTC services?
- Medicare
- Medicaid
- Personal Assets and Savings
- Long Term Care Insurance
Is a federal program that pays for healthcare for persons age 65 and over and for people under age 65 with disabilities.
Medicare
Does medicare generally cover long term care services?
No
Medicare will help pay for a short stay in these three places if you meet certain conditions:
1) Skilled Nursing Facility
2) Hospice Care
3) Home Health Care
Medicare will help pay for a short stay in a skilled nursing facility, for hospice care, or for home health care if the recipient meets the following conditions up to 100 days:
- Has had a recent prior hospital stay of at least 3 days
- Is admitted to a Medicare certified nursing facility within 30 days of the prior hospital stay
- Needs skilled care as a result of some medical condition that caused the hospital stay
Entitlement program that pays for medical assistance for certain individuals and families with low incomes and resources.
Medicaid
Provides medical insurance for children under age 19 in families whose income is too high to qualify for medicaid.
(CHIP) Children’s Health Insurance Program
Who funds the Medicaid program?
Federal and State Governments Jointly Fund
This formula has resulted in the Federal Govt. paying a higher percentage to states with lower per capita income and a smaller percentage of states with higher per capita income.
(FMAP) Federal Medical Assistance Percentage
The minimum percentage that states can be required to pay is _______ % of the Medicaid expenses. But, states with lower incomes per capita may receive up to _________% of their Medicaid expenditures from the federal government.
50%
Up to 75%
Consists of medical care provided in the home by trained professionals such as doctors and nurses.
Home Health Services
Personal care provided by family members or paid caregivers.
Home Care
There are both General and Financial requirements to be eligible to receive Medicaid. What are the five general requirement that individuals must meet at least one of?
1) Age 65 or older
2) Have a permanent disability as that term is defined by the social security administration
3) Be blind
4) Be a pregnant woman
5) Be a child, or the parent or caretaker of a child
The amount of income a person can have to be eligible for Medicaid varies by __________ .
State
This is usually the best resource to determine the eligibility requirements for Medicaid within a specific state.
(Each State’s) Medical Assistance Office
Countable income for Medicaid eligibility purposes includes: (7 Sources)
1) Regular benefit payments (SS or SSDI)
2) Veterans Benefits
3) Pensions
4) Salaries
5) Wages
6) Interest from bank accounts and CDs
7) Dividends (from stocks and bonds)
Medicaid generally does not include these sources of funds when determining eligibility:
1) Food Stamps
2) Federal Housing Assistance
3) Home Energy Assistance
What is a common income standard for Medicaid eligibility?
133% of the Federal Poverty Level
When applying for medicaid in most states a person can retain about __________ in countable assets, and married couples still living in the same house can retain ________ in countable assets.
Single $2000
Married $3000
Assets that are usually counted for Medicaid eligibility include:
1) Checking/Savings Accounts
2) Stocks/Bonds
3) CDs
4) Real property other than primary residence
5) Additional Motor Vehicles
6) Retirement Plan assets (IRAs, 401(k)s)
Assets that do not usually get counted for Medicaid eligibility include the following:
1) Primary Residence
2) Personal Property/Household belongings
3) One motor vehicle
4) Life insurance with FV under $1,500
5) Up to $1,500 for burial expenses
6) Assets in trusts
7) Retirement Plan assets that cannot be withdrawn in a lump sum (ie. Pension Plan)
In 2020, the equity limit in excess of $ ______ in a home, Medicaid must deny benefits above this limit.
$595,000
A communtiy spouse that does not need care gets to retain a “community spouse resource allowance.” The couples assets are counted the day that the applicant enters the nursing home and the spouse is entitled to retain what?
1/2 of the couples assets up to $137.400 (2022)
This medicaid law provides special protection to prevent spousal impoverishment should the other spouse have to go into a home.
Community Spouse Resource Allowance
Allowable spend down options to qualify for Medicaid?
1) Paying off debts
2) Purchase of a new exempt asset (car, home)
3) Home Improvements
4) Pre-Payment for burial or funeral expenses
5) Payments for services under caregiver agreements (even when child or sibling is the caregiver)
6) Purchase of certain annuities (Medicaid-compliant annuities)
Program designed for middle income individuals who generally cannot qualify for Medicaid and generally do not have enough resources to self insure.
Partnership Programs
How long is the medicaid “look back period?”
5 years
How is the penalty period calculated for spenddown?
Dividing the value of property transferred by the average monthly cost of a nursing home in the state
The following transfers can be made without causing a period of medicaid eligibility:
1) Transfer to Spouse
2) Transfer to blind or disabled child
3) Transfer to trust of person under age 65 and disabled
4) Transfer of a home to child under age 21 OR a child who has lived in the home for at least 2 years before applicant moved to nursing home and provided care allowing applicant to stay in the home during that time
5) Transfer of a home to a sibling who has an equity interest in it and who lived in it at least a year before the applicant has moved to a nursing home
Specific type of trust that is used to provide benefits to persons or beneficiaries with special needs.
Special Needs Trusts
Special needs trusts and Pooled trusts are ignored for Medicaid purposes, but require that assets remaining in the trust be available for state recovery to the extent that _________ ?
State funds were used to care for the beneficiary
For an annuity to avoid being treated as an impermissible transfer it must meet the following requirements:
1) Must be irrevocable and non-assignable
2) Must be actuarily sound (payments at least equal what was paid for in the annuity)
3) If there is “term certain” it must be shorter that community spouses life expectancy
4) The state must be named the remainder beneficiary up to the amount of Medicaid payments made for spouse
A state may waive recovery of assets and not try to collect repayment where it would be cause for ____________________.
Undue hardship to deceased’s heirs
The federal government requires states to try to recover Medicaid costs for LTC. States generally pursue two approaches to cost recovery which are:
1) From the the deceased individual’s estate
2) Liens on the individuals property
Who is more likely to need Long Term Care, women or men? Why?
Women, because they have longer life expectancies
Benefits of purchasing Long Term Care
1) Having a choice in care provider
2) Higher Quality of Care
3) Preserving Assets for Family Members
4) Avoiding Taxes
Age as measured by health and function
Physiological Age
Number of years since birth
Chronological Age
When working with married clients shopping for Long Term Care it is important to ask the insurer whether ___________________.
Discounts for “shared benefits” is available
Health care for those admitted to a hospital or skilled nursing facility.
Inpatient Care
A level of care that includes services that can only be performed safely and correctly by a licensed nurse.
Skilled Nursing Care
Non-Skilled personal care such as help with activities of daily living.
Custodial Care
What are the 6 Activities of Daily Living?
1) Bathing
2) Eating
3) Dressing
4) Toileting
5) Continence
6) Transferring
Name 3 services not covered by long term care insurance:
1) Pre-existing conditions
2) Mental and Nervous Disorders
3) Care provided by family members or loved ones
Illness or disability for which an insured has received previous medical advice or treatment usually within 6 months prior to application for coverage.
Pre existing conditions
Pre existing conditions are an illness or disability for which an insured has received previous medical advice or treatment usually within _______ months prior to application for coverage.
6 months
Care provided that gives primary caregiver a break…
Respite Care
Although Long Term Care does not cover most mental and nervous disorders, it must cover serious biologically based mental disorders and other diseases such as…
Schizophrenia, major depression disorders, Alzheimers, and other age related disorders.
Although Long Term Care does not pay for care provided by family or loved ones many policies will provide _________________ .
Respite care (giving primary caretaker a break)
Two optional features with Long Term Care that must be offered but will likely cost more. For the insureds to reject these benefits it must be done ______________ .
1) Inflation protection
2) Nonforfeiture Benefit
In Writing
The insurer must offer a guarantee that the insured will receive some of the benefits for which the premium was paid even upon cancellation or lapse of the policy.
Non-Forfeiture Benefit
To receive benefits under a long term care insurance policy an insured individual must be classified as _______________ .
Chronically Ill
Defined as being unable to perform, without substantial assistance from another individual at least 2 activities of daily living.
Physical Impairment
Requiring substantial supervision to prevent the insured from posing a danger to himself, herself or others.
Cognitive Impairment
4 biggest determinants in the cost of a long term care policy?
1) Level of benefits
2) Elimination Period
3) Length of benefit period
4) Age of insured when coverage takes effect
Some individuals selecting period of coverage for Long Term Care will chose _____ years based on the idea that if they transfer all of their assets to family on the day that they begin receiving care, they can overcome the Medicaid look-back rules.
5 year
Three ways benefits are paid for Long Term Care…
1) Expense Incurred Method
2) Indemnity Method
3) Disability Method
This method of benefit payment pays for the actual expense up to a dollar limit, whichever is less, paid to the providers or the insured.
Expense Incurred Method
This method of Long Term Care benefit payment is a set dollar amount paid to the insured for each period he qualifies.
Indemnity (Per Diem) Method
Method of payment of benefits for Long Term Care in which the insured only needs to meet the eligibility period once. Once criteria is met, insured receives full daily benefit until death.
Disability Method
What is the most common LTC benefit paid method?
Expense incurred (Reimbursement) Method
Four risks to a standalone LTC Policy include:
1) Expensive
2) No cash value accumulation
3) Premiums may increase
4) Underwriting can be time consuming
Long term care should be considered by a client who…
1) Wishes to retain ability to choose service providers
2) Who has bequest motives
3) Reduce Subject-ability to higher gift/estate taxes
Refers to medical services performed on an outpatient basis, without admission to a hospital or other facility.
Ambulatory Center
What type of LTC poloiicis are deductible
LTC and major medical
About _____% of persons over age 65 will require some long-term care service during their remaining lifetimes.
70 percent
Risk of outliving funds
Superannuation
The premiums for Long Term Care are ____________ .
Deductible but the amount is limited depending on the age of the covered person.
Damages that injure someone else due to negligent behavior.
Punitive
