Medicare supplement insurance policies are sold by
private
insurance companies to cover medical costs not covered by
the government in Medicare Parts A and B
Medicare supplements are designed for
individuals who are enrolled in Medicare,
however there is no minimum age requirement
As of June 2010, there are how many standardized medicare supplement plans
10. each plan has a letter designation of A, B, C, D, F, G, K, L, M, or N
Medicare supplement insurance policies were standardized by
the National Association of Insurance Commissioners
(NAIC) to help consumers understand and compare them and make informed buying decisions
Medicare Supplement policies sometimes provide
preventative medical care benefits such as
annual physical exams
A Medicare Supplement policy must NOT contain benefits which
duplicate Medicare benefits
Individuals over 65 who have just enrolled in Medicare Part B for the first time cannot be refused what
a Medicare Supplement policy and cannot be rated if they apply for coverage within 6 months of Part B enrollment (in other words, Medicare Supplements must be guaranteed issue during open enrollment)
All Medicare supplement policies must be
guaranteed renewable
Hospice care is included in
most standard Medicare Supplement insurance policies
Medicare Supplement policies typically provide
foreign travel emergency health care coverage as a core benefit when you travel outside the U.S.
what are the six minimum standards apply to all policies designated as Medicare Supplement
Insurance.
� The policy must supplement both Part A and Part B of Medicare
� The policy must automatically adjust its benefits to reflect statutory changes in Medicare
� The policy must cover all expenses not covered by Part A from the 61st to the 90th day.
Furtherm
The Medicare Select plan (sometimes called
Medicare Advantage or Medicare Part C) is a type of Medicare
Supplement that works like an HMO. You have to choose providers that belong to a network (except in cases of emergencies).
With a Medicare Select plan, the insured agrees to
use preferred providers, and in exchange, pay
a lower premium
Medicare Part C does NOT cover
long-term care
Medicare Part D is
a prescription drug plan administered by one of several private insurance
companies, each offering a plan with different costs and lists of drugs that are covered. Participation in
Part D requires payment of a premium and a deductible.
What is Long-Term Care?
You'll often see nursing home care referred to as this. it refers to a broad
range of medical, personal, and environmental services designed to assist individuals who have lost their ability to
remain completely independent in the community.
refers to car
Long Term Care policies require
that in order for an insured to be qualified for benefits they
must be unable to perform a minimum of two Activity of Daily Living (ADL's)
Activities of Daily Living (ADL's) are considered
the basic tasks of everyday life, such as dressing,
eating, bathing and mobility
In long-term care insurance, the benefit period is
the length of time for which claims will be paid
Depending on the severity of the impairment, assistance may be given where
at home, at an adult
care center, or in a nursing home
� Most long-term care policies also pay benefits for
cognitive impairment" such as Alzheimer's disease or
other dementia
Long-Term Care Insurance pay the insured how
in a fixed dollar amount for each day the policy covers,
regardless of what the care costs
the cost of a long-term care policy is based on
age, health condition, and level of benefits provided
An
acute illness is
a serious condition, such as pneumonia or influenza, from which the body can
fully recover with proper medical attention.
A comprehensive long term care policy will typically
not cover
expenses associated with acute care provided in a hospital
Each application for long-term care insurance shall contain
clear and unambiguous questions to
determine the health condition of the applicant EXCEPT applications for guaranteed issue
� Long-term care coverage typically offers
inflation protection which allows for a periodic increase in policy benefits
due to inflation
and have a free-look (right to return) period of 30 days after its delivery
The guarantee of insurability option provides the insured with the ability to
purchase additional insurance
at a later date without evidence of insurability.
Most long-term care policies pay on what basis
on a reimbursement (or expense-incurred) basis, up to the policy limits
long term private insurance plans Benefits are usually excluded or limited for what
addictive behavior rehabilitation (alcohol, drugs)
Most long-term care policies may only exclude losses due to?
a pre-existing condition for up to 6 months following the effective date of coverage
Skilled nursing care is
continuous, around-the-clock care provided by licensed medical
professionals under the direct supervision of a physician. Skilled nursing care is usually
administered in nursing homes.
Intermediate nursing care is
provided by registered nurses, licensed practical nurses, and
nurse's aides under the supervision of a physician. Intermediate care is provided in nursing
homes for stable medical conditions that require daily, but not 24-hour supervision.
Custodial care provides
assistance in meeting Activities of Daily Living (ADL)
requirements, such as bathing, dressing, walking, eating, and toileting
Home and Community-Based Services . home health care is?
care provided in the insured's home, usually on a part-time basis. It can include
skilled care (e.g., nursing, rehabilitative, or physical therapy care ordered by a doctor) or unskilled
care (e.g., help with cooking or cleaning).
Adult day care is
designed for those who require assistance with various activities of daily living,
while their primary caregivers (usually family or friends) are absent
Respite care is
designed to provide a short rest period for a family caregiver
Continuing Care is designed to what
to provide a benefit for elderly individuals who live in a continuing care retirement
community
Assisted Living is what
Housing for elderly or disabled people that provides nursing care, housekeeping, and prepared
meals as needed. This would suit an individual who needs some nursing care supervision but
NOT full-time care.
assisted living facility is what
When individuals are in need of assistance with one or two activities of daily living. they may be eligible
Qualified LTC insurance contracts are treated how?
in the same manner as accident and health
insurance contracts
Amounts received under an LTC contract are
excluded from income because they are
considered amounts received for personal injuries and sickness
There is a limit on these amounts and these limits are adjusted for inflation annually
Qualified long-term care insurance premiums paid by an employer are generally
excluded from an employee's gross income
The Long-Term Care Partnership Program is
a Federally-supported, state-operated initiative that allows individuals who purchase a qualified long term care insurance policy or coverage to protect a portion of their assets that they would typically need to spend down prior to qualifying for Medicai