Unit 21 Long-Term Care

Question 1

Medicare’s Long-Term Care

Answer 1

SNF benefit
-Medicare requires a prior 3-day hospital stay
-Medicare pays 100% for the first 20 days
-beneficiary has a daily copay for days 21-100
-no Medicare coverage after 100 days

Question 2

Medicaid’s long-term care

Answer 2

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

Question 3

long-term care insurance

Answer 3

bought from an insurance company
insured chooses the type and amounts of coverage
protects assets upon death

Question 4

benefit eligibility

Answer 4

Activities of Daily Living (ADL) - measurements to determine someone’s ability to live independently
-bathing
-dressing
-toileting
-transferring
-continence
-eating

if unable to do two items on list (# may vary), qualify for long-term care

Question 5

cognitive impairment

Answer 5

ability to perceive, reason, or remember
safety concerns

Question 6

facility based care

Answer 6

SNF 24/7
intermediate care
custodial care-ADLs

Question 7

other types of long-term care

Answer 7

home health care
adult day care
respite care
assisted living facilities

Question 8

policy provisions

Answer 8

benefit period. minimum of 12 months, usually 2-5 years. can choose lifetime. subject to lifetime maximum amount. higher premiums for longer benefit periods

benefit amount
-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 max
-higher the benefit, higher the premium

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

Question 9

optional benefits

Answer 9

guaranteed insurability
-allows the insured to raise the daily benefit
-no medical questions
-uses the insured’s attained age
-not currently receiving benefits

nonforfeiture
-cash value or return of percentage of premiums
-minus claims paid
-policy has been surrendered or has lapsed for nonpayment of premiums

inflation protection
-yearly increase in benefit coverage by a stated percentage
-in MN, by law, must be offered

Question 10

exclusions

Answer 10

war
alcohol or drug abuse
self-inflicted injuries
treatment provided without cost to the insured (family assisting)

Question 11

qualified long term care insurance

Answer 11

receives favorable tax treatment. benefits are paid tax free, premiums may be tax deductible

requirements to be a qualified policy
-coverage of only long-term care expenses
-no benefits for expenses reimbursable under Meidcare
-no cash surrender value
-any dividends or refunds of premiums must be used to offset future premiums or increase benefits
-conforms to specified consumer protection marketing and benefit standards

Question 12

state long-term care partnership programs

Answer 12

joint effort between insurance companies, state insurance department, and state’s Medicaid agency

benefits are dollar-for-dollar asset protection

Question 13

long-term care insurance marketing regulations

Answer 13

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

Question 14

long-term care insurance policy standards regulations

Answer 14

must be at least guaranteed renewable
sale must include an offer of inflation protection
pre-existing condition may not be more restrictive than a condition for which advise/ treatment was sought within 6 months before effective date
cannot condition payment of a benefit on a prior hospital stay
group coverage must offer opportunity to continue benefits in group or covert to individual coverage