ch 5 private insurance plans for seniors test

Medicare supplement insurance policies are sold by

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

� 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.

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

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

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