Long-Term Care

Front 1

When will Medicare cover a nursing home

Back 1

Only if it is part of the treatment for a covered injury or illness and only up to 100 days. It does not covered nursing care due to old age.

Front 2

Early long-term care policies are

Back 2

more restrictive than current policies

Front 3

LTC coverage has key issues that include:

Back 3

1. benefit period of at least 1 year

2. most policies now guarantee renew-ability

3. standards for covering preexisting conditions

4. a free-look period

5. prohibition of exclusion for Alzheimer disease

Front 4

Proceeds of qualified long term care policies are generally received

Back 4

income tax-free and

premiums may be deductible as a medical expense

Front 5

One of the most important reasons for purchasing LTC insurance

Back 5

protection of personal assets (financial assets and retirement income)

Front 6

Rating Factors are different from health plans to LTC policies:

Back 6

Health plans rate by health and health conditions; LTC rates on ADL (activities of daily living) and the degree of proficiency of these ADL's.

Front 7

ADL's include;

Back 7

dressing

bathing

eating

walking

activities to care for ones self

Front 8

5 types of LTC are:

Back 8

Skilled Nursing Care

Intermediate Care

Custodial or Residential Care

Home Health Care

Adult Day Care

Front 9

Which of the 3 types of LTC is the most common

Back 9

Custodial or residential care is the type of LTC most elderly people will requires at some time in their later years and is also the type that is not covered by Medicare

Front 10

Eligibility

Back 10

Most minimum ages are in the 50-60 range but few include some as low as 18. Upper age limits are from 69-89

Front 11

Renew-ability of LTC

Back 11

Virtually all of the current LTC policies are guaranteed renewable and cannot be canceled except for nonpayment of premiums. They can however reserve the right to increase policy premiums on specified classes of policies (not on individual policies).

Front 12

Factors considered in premiums

Back 12

Generally based on when an individual purchases the insurance. Premiums fluctuate according to elimination and benefit periods and finally from underwriting considerations

Front 13

Waiver of premium

Back 13

takes effect after the insured has been confined for a specified period of time - 90 days to 180 days. The premium payment generally resumes when care ceases (disability ends).

Front 14

Is prior hospitalization required

Back 14

not anymore

Front 15

What does Care level refer to in an LTC policy

Back 15

when the policy pays based on the care level: some policies only pay if intermediate or skilled care is involved, whereas custodial care, the most common type required by the elder, may not be included.

Front 16

What is Hospice Care

Back 16

A facility whose purpose is to help terminally ill patients die with dignity, the expenses incurred are usually room and board and medication for pain - and can be offered as an optional benefit under LTC policies

Front 17

What is the common benefits period for an LTC policy

Back 17

3-5 years / some also contain a benefit period per stay plus a lifetime maximum benefit period.

Front 18

What are common exclusions for LTC policies

Back 18

Now most cover Alzheimer. However exclusions remain: war, acts of war, alcohol or drug dependency, self-inflicted injuries, mental illness and nervous disorders without an organic cause, and treatment provided without cost such as VA hospital stays

Front 19

Do pre-existing conditions exist for TC

Back 19

Most but not all do not cover conditions that existed during the 6 months before the policy effective date.

Front 20

What are the common elimination periods on LTC policies

Back 20

Generally you see a 30 day waiting period (elimination period (time deductible). The longer the waiting period the lower the premiums. The waiting period can be viewed as the deductible in an LTC policy.

Front 21

In order to qualify for LTC benefits, certain benefit riggers must be activated. Those are:

Back 21

ADL's (daily living skills)

Cognitive Impairment (deficiency in the ability to think, perceive, reason or remember)

Medical Necessity - diagnostic, therapeutic, rehabilitative, maintenance or personal care services

Front 22

Qualified Plans for LTC usually stipulate:

Back 22

1. Insured incapable for performing at least 2 ADL without assistance for 90 days;

2. Cognitively impaired must require substantial supervision;

3. Physician must certify the insured is chronically ill and provide a plan of care

Front 23

For a non-qualified plan you do not have to conform to federal standards. What must you weight:

Back 23

the tax consequences

Front 24

Nursing home care is generally covered by

Back 24

Long-term care policies - not Medicare or medicare supplements