Long-Term Care

Question 1

How long is average nursing home stay?

Answer 1

2.5 years

Question 2

Cost range for LTC per year

Answer 2

$80,000-$120,000 or more

Question 3

How is underwriting done with LTC? physical exam or questionnaire?

Answer 3

Questionnaire

Question 4

2 Govt programs to help pay for LTC

Answer 4

medicaid, medicare

Question 5

Who must authorize you for skilled nursing care under medicare?

Answer 5

Physician and Medicare

Question 6

Medicare LTC benefits comprehensive or restrictive?

Answer 6

Restrictive

Question 7

How many day of skilled nursing are covered 100% by Medicare?

Answer 7

20

Question 8

How many total days of skilled nursing can you get through medicare?

Answer 8

100

Question 9

What population does medicaid help re: LTC

Answer 9

indigent and impoverished

Question 10

What act created the medicaid look back?

Answer 10

The Balanced Budget act of 1997

Question 11

What assets does the look back period go after?

Answer 11

Assets transferred for less than FMV

Question 12

What is the lookback period for gifts on/after Feb 2 09?

Answer 12

5 years

Question 13

What was the lookback period pre Feb 2 2009?

Answer 13

36 months for outright transfers and 60 months for trusts

Question 14

How does lookback period work re: ineligible coverage?

Answer 14

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

Question 15

How do you qualify to use your LTC benefits?

Answer 15

Either chronically ill (unable to do 2 of 6 daily activities) OR substantial cognitive impairment

Question 16

Who selects the elimination period on ltc policy?

Answer 16

the applicant

Question 17

Most LTC policies don’t pay for inability to do ADLS unless that inability is expected to last how long

Answer 17

90 days

Question 18

Facility only policy only covers people living where

Answer 18

Nursing home

Question 19

Home health care policy covers people where

Answer 19

outside an institutional setting - can be used as compliment to facility only policy

Question 20

How does reimbursement policy work

Answer 20

it reimburses the actual expenses up to a daily limit

Question 21

Tax qualified LTC policies that provide benefits on a reimbursement basis must be coordinated with whom

Answer 21

Medicare, except when medicare is the secondary payor of benefits

Question 22

LTC Reimbursement basis

Answer 22

reimburses for actual expenses up to a daily limit

Question 23

LTC Per-diem basis

Answer 23

benefits paid regardless of actual cost of care. say amount is $200, will still pay $200 even if cost of care is less

Question 24

What is the free look period on LTC

Answer 24

30 days

Question 25

2 ways LTC policies are issued

Answer 25

guaranteed renewable or noncancellable

Question 26

What can you do to guarantee premiums don’t lapse on an LTC policy

Answer 26

name a third party trusted contact- application must give you this option

Question 27

If a LTC policy is a replacement policy, the insurer must do what

Answer 27

waive the time period regarding preexisting conditions

Question 28

LTC policy limitations and exclusions within the last 6 months are prohibited except for

Answer 28

preexisting conditions: mental disorders, alcohol and drug addiction, war, terrorism, felony, attempted suicide, aviation

Question 29

Provisions re:LTC policies

Answer 29

-words must be defined and applications clear and understandable
-procedures for fair and accurate comparisons established

Question 30

Tax favorable treatment of LTC contract must re:LTC Contracts must not pay for expenses that are reimbursable under medicare except for what

Answer 30

unless Medicare is a secondary payor of benefits or benefits are payable on a per-diem basis

Question 31

Guaranteed renewable means what re:cancellation

Answer 31

coverage cannot be cancelled except for nonpayment of premiums

Question 32

Tax favorable treatment of LTC contract must re:How could premiums be raised on an LTC policy

Answer 32

can’t raise premiums on an individual basis, only on an entire Class

Question 33

Tax favorable treatment of LTC contract must re: refunds of premiums

Answer 33

refunds of premiums and policyholder dividends must be applied as future reductions in premiums or to increase future benefits

Question 34

Tax favorable treatment of LTC contract must re:cash surrender

Answer 34

contract does not provide cash surrender value or other money that can be borrowed or assigned as collateral for a loan

Question 35

HIPPA Act defines qualified LTC expenses as

Answer 35

necessary diagnostic, preventative, therapeutic, caring, treating and rehabilitation services and maintenance or personal care services required by chronically ill and prescribed by a doctor

Question 36

Shared Benefits LTC

Answer 36

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

Question 37

Does LTC paid for by a policy have to take place in a hospital or skilled nursing?

Answer 37

No it can be at home

Question 38

What is the length of time coverage must be provided for in a LTC policy?

Answer 38

Coverage must be provided for 12 months

Question 39

LTC free look period

Answer 39

30 days