Unit 21: Long-Term Care

Question 1

Medicare’s LTC

Answer 1

• requires prior 3-day hospital stay
• Medicare pays 100% for first 20 days
• Beneficiary has a daily co-pay days 21-100
• No Medicare coverage after 100 days

Question 2

Medicaid’s LTC

Answer 2

• only for the poor
• Income paid to Medicaid
• may take assets from the person’s estate upon death

Question 3

LTC Insurance

Answer 3

bought from an insurance company

insured chooses type and amounts of coverage

protects assets upon death

Question 4

skilled nursing care

Answer 4

24/7 care

can only be performed by licensed nurses under a doctor’s orders

Question 5

intermediate care

Answer 5

only 7

less than round-the-clock care performed by licensed nurses nursing under a doctor’s orders

Question 6

custodial care

Answer 6

help in performing ADLS and can be performed by someone without medical training

Question 7

other types of ltc

Answer 7

home health care
adult day care
respite care
assisted living facilities

Question 8

Benefit Periods

Answer 8

• minimum 12 months
• usually two to five years
• may choose lifetime
• subject to lifetime maximum amount
• longer the benefit period-higher the premium

Question 9

Benefit Amount

Answer 9

• indemnity-stated dollar amount per day
• reimbursement -lesser of actual expense or daily benefit
• home care-if covered usually 50% of facility amount
• policy may have a lifetime maximum
• higher the befit, higher the premium

Question 10

Elimination Period

Answer 10

• time deductible
• insured qualifies for befits
• benefits not paid until end of period
• longer the elimination period, lower the premium

Question 11

Optional Benefits - Guaranteed insurability

Answer 11

allows insured to raise daily benefit

no medical questions

uses insured’s attained age

not currently receiving benefits

Question 12

Optional Benefits - nonforfeiture

Answer 12

cash value or return of percentage of premiums

minus claims paid

policy has been surrendered or has lapsed for nonpayment of premiums

Question 13

Optional Benefits - Inflation protection

Answer 13

yearly increase in benefit coverage by a stated percentage

simple

compound

Question 14

qualified LTC insurance

Answer 14

there are rules for a policy to be considered “qualified”
receives favorable tax treatment
benefits are paid tax free and premiums may be tax deductible

requirements to be ______:

• benefit triggers: inability to perform at least two ADLs for at least 90 days or cognitive impairment requiring substantial supervision, certified by a physician
• guaranteed renewability
• coverage of only long-term care expenses
• no benefits for expenses reimbursable under Medicare
• no cash surrender value
• any dividends or refunds of premiums must be used to offset future premiums or increased benefits
• conforms to specified consumer protection marketing and benefit standards

Question 15

state LTC partnership programs

Answer 15

joint effort between state and insurance companies

dollar for dollar asset protection

Question 16

LTC Marketing Regulations

Answer 16

• provide applicants with a shopper’s guide and outline of coverage
• considered whether the purchase is suitable for the applicant’s needs, objectives, and circumstances
• determine whether the sale will involve replacement = notice regarding replacement
• 30 day free look period
• advertising is not misleading
• describe the policy’s renewal conditions on it’s first page

Question 17

LTC Standards Regulations

Answer 17

• the policy must be at least guaranteed renewable
• a sale must include an offer of inflation protection
• a pre-existing condition may not be defined more restrictively than a condition for which medical advice or treatment was sought within six months before the policy’s effective date
• LTC policies cannot condition payment of benefit on a prior hospital stay
• group LTC insurance policies must give insureds the opportunity to continue befits if membership in the group ceases or to covert to individual coverage if coverage terminates
• insureds must be protected against unintentional lapse by giving the insurer the names of another individual to whom a premium due notice will be sent if the policy enters its grace period.