Long-Term Care Flashcards
How long is average nursing home stay?
2.5 years
Cost range for LTC per year
$80,000-$120,000 or more
How is underwriting done with LTC? physical exam or questionnaire?
Questionnaire
2 Govt programs to help pay for LTC
medicaid, medicare
Who must authorize you for skilled nursing care under medicare?
Physician and Medicare
Medicare LTC benefits comprehensive or restrictive?
Restrictive
How many day of skilled nursing are covered 100% by Medicare?
20
How many total days of skilled nursing can you get through medicare?
100
What population does medicaid help re: LTC
indigent and impoverished
What act created the medicaid look back?
The Balanced Budget act of 1997
What assets does the look back period go after?
Assets transferred for less than FMV
What is the lookback period for gifts on/after Feb 2 09?
5 years
What was the lookback period pre Feb 2 2009?
36 months for outright transfers and 60 months for trusts
How does lookback period work re: ineligible coverage?
You take the gift amount divided by the monthly cost so if the gift was 100k and monthly cost was 5k you’re ineligible for 20 months of coverage
How do you qualify to use your LTC benefits?
Either chronically ill (unable to do 2 of 6 daily activities) OR substantial cognitive impairment
Who selects the elimination period on ltc policy?
the applicant
Most LTC policies don’t pay for inability to do ADLS unless that inability is expected to last how long
90 days
Facility only policy only covers people living where
Nursing home
Home health care policy covers people where
outside an institutional setting - can be used as compliment to facility only policy
How does reimbursement policy work
it reimburses the actual expenses up to a daily limit
Tax qualified LTC policies that provide benefits on a reimbursement basis must be coordinated with whom
Medicare, except when medicare is the secondary payor of benefits
LTC Reimbursement basis
reimburses for actual expenses up to a daily limit
LTC Per-diem basis
benefits paid regardless of actual cost of care. say amount is $200, will still pay $200 even if cost of care is less
What is the free look period on LTC
30 days
2 ways LTC policies are issued
guaranteed renewable or noncancellable
What can you do to guarantee premiums don’t lapse on an LTC policy
name a third party trusted contact- application must give you this option
If a LTC policy is a replacement policy, the insurer must do what
waive the time period regarding preexisting conditions
LTC policy limitations and exclusions within the last 6 months are prohibited except for
preexisting conditions: mental disorders, alcohol and drug addiction, war, terrorism, felony, attempted suicide, aviation
Provisions re:LTC policies
-words must be defined and applications clear and understandable
-procedures for fair and accurate comparisons established
Tax favorable treatment of LTC contract must re:LTC Contracts must not pay for expenses that are reimbursable under medicare except for what
unless Medicare is a secondary payor of benefits or benefits are payable on a per-diem basis
Guaranteed renewable means what re:cancellation
coverage cannot be cancelled except for nonpayment of premiums
Tax favorable treatment of LTC contract must re:How could premiums be raised on an LTC policy
can’t raise premiums on an individual basis, only on an entire Class
Tax favorable treatment of LTC contract must re: refunds of premiums
refunds of premiums and policyholder dividends must be applied as future reductions in premiums or to increase future benefits
Tax favorable treatment of LTC contract must re:cash surrender
contract does not provide cash surrender value or other money that can be borrowed or assigned as collateral for a loan
HIPPA Act defines qualified LTC expenses as
necessary diagnostic, preventative, therapeutic, caring, treating and rehabilitation services and maintenance or personal care services required by chronically ill and prescribed by a doctor
Shared Benefits LTC
husband and wife insured under same policy/insurer - each spouse can access others benefit. One spouse has 4 years of benefits and uses that up can use spousal benefits
Does LTC paid for by a policy have to take place in a hospital or skilled nursing?
No it can be at home
What is the length of time coverage must be provided for in a LTC policy?
Coverage must be provided for 12 months
LTC free look period
30 days
