LTC

Question 1

MEDICAID – ELIGIBILITY

Answer 1

Physical:
* Aged 65 or older
* Permanently disabled as that term is defined by the Social Security Administration
* Blind
* A pregnant woman
* A child or the parent or caretaker of a child
Financial:
Limited income and limited assets

Question 2

Medicaid generally does not count these as Income:

Answer 2

• nutritional assistance
  (food stamps).
• housing assistance
  provided by the
  federal government.
• home energy
  assistance.

Question 3

What is the Equity limit for Medicaid in a primary residence?

Answer 3

$713k in 2024

Question 4

Medicaid generally does not count the following assets:

Answer 4

• Primary residence*
• Personal property and household belongings
• One motor vehicle
• Life insurance with a face value under $1,500
• Up to $1,500 in funds set aside for burial
• Certain burial arrangements such as pre-need burial agreements
• Assets held in specific kinds of trusts

Question 5

What is the Medicaid lookback period?

Answer 5

(DRA) is 60 Months (Years).
The penalty for transferring assets is a delay in receiving benefits.

Question 6

Chronic illness – defined

Answer 6

Prevents the insured individual from
performing at least two of the six
activities of daily living for at least a 90
day period, or
Requiring substantial supervision to
prevent the insured from posing a
danger to himself, herself, or others.
To be considered chronically ill, the
insured individual must be certified as
such by a qualified health professional
within the previous 12 months.

Question 7

What are the 6 ADLs (Must list them all)

Answer 7

Eating, Bathing, Dressing, Transferring, Toileting, and Continence

Question 8

SERVICES NOT COVERED BY LONG-TERM CARE INSURANCE

Answer 8

Policies typically exclude coverage for
* pre-existing conditions.
* mental and nervous disorders.
* care provided by family members or loved ones.
* self-inflicted injuries.
* alcohol or drug addiction.

Question 9

OPTIONAL FEATURES OF LONG-TERM CARE INSURANCE (REQUIRED)

Answer 9

Inflation Protection, Guaranteed Purchase Option, Nonforfeiture Benefit

Question 10

Long-term care contracts cannot be provided as a benefit under cafeteria plans.

Question 11

TAX-QUALIFIED LONG-TERM CARE CONTRACTS

Answer 11

1. must provide benefits that are limited to long-term care services.
2. does not provide a cash surrender value or access to funds that can be paid, assigned, borrowed, or pledged as collateral for a loan.
3. provides that refunds may be used only to reduce future premium
   payments or increase future policy benefits.
4. must meet consumer protection standards defined in the Health
   Insurance Portability and Accountability Act of 1997 (HIPAA)
5. must coordinate benefits with Medicare.