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On what basis are benefits payable under a long-term care insurance policy typically triggered? A) the diagnosis of an acute medical condition B) the number and types of medications prescribed C) the inability to perform of medications prescribed D) all of the above - Answer C) The inability to perform defined ADLs The inability to perform defined ADLs. Benefits payable under a long-term care policy are typically based on (or "triggered" by) the inability to perform a certain number of activities of daily living (ADLs) as specified in the policy. Another common benefit trigger is cognitive impairment. What is a primary goal of long-term care? A) to maintain functionality B) to find a permanent cure for the affliction C) to prolong life D) to prevent the spread of disease - Answer A) to maintain functionality Long-term care is chronic care with the aim of management and control of symptoms and maintenance of function. Long-term care occurs only in nursing facilities. A) True B) False - Answer B) False Long-term care can occur in a variety of places, including in an individual's home, at community sites and centers, and in care facilities. Which of the following most precisely defines the fundamentals of self-care and
the basic tasks of everyday life? A) instrumental activities of daily living B) activities of daily living C) self-awareness D) mental activity - Answer B) Activities of daily living Activities of daily living are the fundamentals of self-care. They are the basic tasks of everyday life, which include eating, bathing, dressing, toileting, and transferring. Instrumental activities are those that are associated with interacting with one's community or home. Which level of care has as its chief characteristic assistance with ADLs? A) Custodial B) Intermediate C) Skilled D) Managed - Answer A) Custodial The primary characteristic of which is to provide assistance with the activities of daily living, helps meet personal rather than medical needs. All of the following are examples of formal caregiving EXCEPT: A) home health aides B) intermediate care facilities C) volunteer charitable groups D) daily transportation to a senior center provided by a neighbor - Answer D) daily transportation to a senior center provided by a neighbor Formal caregiving is paid, or volunteer care is provided through a service system. Informal care is delivered by family or friends. All of the following are services commonly offered by assisted living residences EXCEPT: A) health care management B) help with medications
coverage as part of the plan, and the plan's premium would likely include this coverage.) Enrollment in Part D is voluntary. Which of the following only covers inpatient hospital care and hospice? A) Medicare Part A B) Medicare Part B C) Medicare Part C D) Medicare Part D - Answer A) Medicare Part A Part A helps pay for inpatient care in a hospital or skilled nursing facility (following a hospital stay), some home health care, and hospice care. Which of the following is a correct statement about Medicare? A) Medicare is available only to those 65 and older. B) Medicare pays all of the costs of health care for those 65 and older. C) Medicare does not cover long-term care. D) Medicare covers custodial care in the home whenever help with ADLs is needed. - Answer C) Medicare does not cover long-term care. Medicare helps with the cost of health care, but it does not cover all medical expenses or the cost of long-term care. With regard to Medicare and long-term care, which of the following statements is true? A)Medicare covers long-term care for as long as necessary, but only if the individual requires skilled nursing care in an institution. B) Medicare covers long-term care for as long as necessary, but only if the care is delivered in the individual's home. C) Medicare covers care in a skilled nursing facility for a limited time, but only if the care follows an admitted hospital stay and is ordered by a physician. D) Medicare covers custodial care for up to one year regardless of whether the custodial care is delivered in a facility or in the individual's home. - Answer C) Medicare covers care in a skilled nursing facility for a limited time, but only if the care follows an admitted hospital stay and is ordered by a physician. How much of a community spouse's own income must be spent on care for an
institutionalized spouse who is receiving Medicaid assistance? A) All of it B) 50% C) 25% D) None of it - Answer D) None of it. None of the income that a community spouse receives in his or her name, such as wages of Social Security or a pension, must be diverted to the cost of care for the institutionalized spouse. Under current Medicaid rules, what is the look-back period for the transfer of assets? A) 12 months B) 24 months C) 36 months D) 60 months - Answer D) 60 months For purposes of determining Medicaid eligibility, the look-back period is 60 months. This period was extended from 36 months to 60 months under the Deficit Reduction Act of 2005. The federal government: A) has no role in state-run Medicaid programs B) tells states how much they can pay for LTC services and supplies C) gives states flexibility in administering their Medicaid programs D) shares equally in Medicaid expenses with each state - Answer C) gives states flexibility in administering their Medicaid programs. States have flexibility to design and implement their own programs, but funding is not shared equally by the federal and state governments. Annually, a determination is made comparing states' average per capita income to the national average. States with higher per capita incomes receive less federal funding; states with lower per capita incomes receive more federal funding A burial plot is exempt when determining Medicaid eligibility. A) True
A) True B) False - Answer B) False
Group long-term care insurance is a contract between an insurer and a group sponsor, such as an employer on behalf of its employees. Members in a group plan do not receive insurance on behalf of its employees. Members in a group plan do not receive insurance policies; they receive certifications of insurance as evidence of their coverage.
Most LTC insurance policies are issued as guaranteed renewable. As such, which statement is true?
A) Policy premiums cannot be increased for any reason. B) The insurer must renew the policy as long as premiums are paid. C) The insurer must renew the policy as long as the insured continues to be insurable. D) Premiums can be increased selectively for individual policies, based on the insured's health. - Answer B) The insurer must renew the policy as long as premiums are paid.
For the insured, a policy that is issued as guaranteed renewable 1) the policy must be renewed as long as premiums are paid 2) the policy cannot be canceled or nonrenewed because of the insured's age or health and 3) premiums cannot be increased, except on a class basis.
An insurance company can increase the premiums on its LTCI policies after policy inception if the insured's health declines.
A) True
B) False - Answer B) False
However, while companies cannot increase premiums because of individual circumstances such as age or health, they can increase premiums for an entire class of insureds.
All of the following may deduct the full cost of their qualified LTCI premiums, subject to the age-based limits, EXCEPT: A) sole proprietors B) members of a partnership C) employees whose premiums are paid by the employers D) LLC owners - Answer C) employees whose premiums are paid by their employers
Sole proprietors, partners, and LLC owners can deduct all of the premiums for their qualified LTCI policies, subject to the age-based limits. Employees who are insured under a group plan and whose premiums are paid by the employer cannot deduct the premiums; however, the premiums paid on their behalf are not included in the incomes.
Long-term care insurance policies are easy to compare and contrast. A) True B) False - Answer B) False
Although some standardization of policies has occurred, especially with respect to state LTC partnership policies, the ability of consumers to compare among LTCI policies is hindered by the complexity of the product.
Marcus purchases a long-term care insurance policy at age 45. Which of the following will give him the most protection against the rising cost of long-term
The benefit period is the length of time, usually measured in years, over which a policy will pay for LTC services.
Drake is the owner/insured under a long-term care insurance policy. He purchased the policy at age 58 and included a guaranteed purchase option that enables him to add more coverage to the policy every three years. Under which condition would Drake's ability to purchase additional coverage end?
I. if he were to utilize the option more than once II. once the policy begins paying its benefits
A) I only B) II only C) both I and II D) neither I nor II - Answer B) II only
As a general rule, once a policy begins paying its benefit, future purchase options are no longer available.
Which of the following best describes the elimination period in an LTCI policy? A) It is a means of disqualifying unsuitable LTCI applicants. B) It is a way to restore benefits to the original amount available. C) It is a waiting period before benefits begin. D) It is a way for the insured to cancel a policy if he or she is not satisfied with it. - Answer C) It is a waiting period before benefits begin.
The elimination period begins when LTC services are first necessary and lasts for the time specified in the policy, such as 30, 60, 90, or 120 days. During this time, the policy will not pay benefits. Benefits begin once the elimination period has
expired.
As defined by the Deficit Reduction Act of 2005, an insured who participates in a new state partnership program may be eligible for an exemption to Medicaid's asset spend-down rule equal to what amount?
A) the sum of premiums paid for an LTC partnership policy. B) the total benefits paid in the first year by the LTC partnership policy C) the total lifetimes benefits payable through the LTC partnership policy D) the total value of the insured's estate when the LTC partnership policy is issued - Answer C) the total lifetime benefits payable through the LTC partnership policy
Who (or what) pays the largest share of total long-term care expenses in the U.S.? A) consumers B)Medicaid C) Medicare D) Insurance companies - Answer B) Medicaid
Medicaid pays about half the cost of long-term care in the U.S. Medicare accounts for 24%, consumers pay 20%, and private LTC insurance pay 7%.
After being effectively frozen in place for a number of years, state LTC partnership programs were allowed to expand as a result of what legislation? A) Tax Reform Act of 1986 B) OBRA ' C) HIPAA ' D) DRA 2005 - Answer D) DRA 2005
premiums.
All of the following statements regarding minimum standards for partnership-qualified long-term care insurance policies are correct EXCEPT: A) Post-claims underwriting is prohibited. B) Some form of nonforfeiture option must be offered when a policy is lapsed or surrendered by the insured. C) Policies must use the benefit triggers that have been established for tax-qualified long-term care insurance contracts. D) Inflation protection is optional for all applicants. - Answer D) Inflation protection is optional for all applicants.
DRA requires inflation protection for all applicants under the age of 76.
Gerald purchased a partnership-qualified LTCI policy that provides coverage for both nursing facility care and home and community-based care. The daily nursing facility care benefit is $150. The total benefit available for home and community care under this policy must be at least what amount? A) $27, B) $54, C) $41, D) $82,125 - Answer A) $27,
The total benefit under a qualified LTC partnership policy for home and community -based care must be equal to at least half of the benefit payable for skilled nursing facility care for one year. In this case, because the benefit for nursing facility care for one year would be $54,750 ($150 a day x 365 days), the home and community-based care benefit must be at least $27,375.
At a minimum, what must partnership-quality long-term care insurance policies
be? A) cancelable B) optionally renewable C) guaranteed renewable D) noncancelable - Answer C) Guaranteed renewable
Regarding renewability, the minimum requirement is that partnership policies must be guaranteed renewable. Alternatively, they may be issued as noncancelable, which would prevent the insurer from raising premiums for any reason.
What federal law defined tax-qualified long-term care insurance policies?
A) Tax Reform Act of 1986 B) Omnibus Budget Reconciliation Act of 1993. C) Health Insurance Portability and Accountability ACt of 1996 D) Deficit Reduction ACt of 2005. - Answer C) Health Insurance Portability and Accountability Act of 1996.
HIPAA's creation of the tax-qualified long-term care insurance (QLTCI) policy laid the foundation for partnership-qualified policies today.
Which of the following refers to the sale of an in-force life insurance policy by a terminally ill insured to a third party for an amount less than the policy's death benefit? A) viatical settlement B) life settlement C) accelerated death benefits
as a reimbursement.
In a reverse mortgage, a homeowner receives money from the lender. A) True B) False - Answer A)True
The homeowner receives money from the lender based on the home's appraised value. Collateral has already been established by the equity in the home.
All of the following are sound reasons for purchasing life insurance EXCEPT: A) Ensuring the financial security of a spouse, children, and other family members B) preserving an estate C) funding anticipated LTC expenses D) clearing up outstanding debt owned by the decedent - Answer C) Funding anticipated LTC expenses
An LTCI policy is more appropriate for meeting long-term care expenses than purchasing a life insurance policy, which is better suited for providing financial security for surviving family members
Because taking a withdrawal from the cash value of a life insurance policy is always a taxable event, this technique should NOT be used to fund long-term care needs. A) True B) False - Answer B) False
As long as the insurance policy meets the definition of an insurance policy meets the definition of an insurance policy and not a MEC, a policy withdrawals are not taxable unless and until the withdrawn amount exceeds premiums paid.
A hybrid annuity combines a fixed deferred annuity product with which of the following? A) life insurance B) an HSA account C) a long-term care rider D) a tax-free - Answer C) A long-term care rider
A hybrid annuity combines a tax-deferred fixed annuity with a long-term care rider.
What is the basic purpose of a suitability letter sent from an insurance company to a long-term care policy applicant? A) to obtain personal information that will help the insurer determine if the applied-for is suitable for the applicant B) to inform the applicant that the insurer has deemed the policy to be unsuitable and is therefore terminating the underwriting process and returning premium deposits (if any) C) to inform the applicant that the insurer is questioning the suitability of the applied-for policy, briefly explaining why, and asking the applicant to advise the insurer on whether it should proceed with the underwriting and issue process. D) to inform the applicant that the insurer has reviewed the facts of the case and has determined that the applied-for policy is well-suited for the applicant's goals, needs, and personal circumstances. - Answer C) to inform the applicant that the insurer is questioning the suitability of the applied-for policy, briefly explaining why, and asking the applicant to advise the insurer on whether it should proceed with the underwriting and issue process.
If a review of the facts suggests that the policy being applied for is not suited to the applicant's needs or goals, the insurer should send a suitability letter to applicants explaining its findings and stating that it will suspend review until the applicants inform the insurer that they are sure they want the policy.
Misrepresentation can also occur by failing to disclose information necessary to prevent a reasonable expectation or belief from being misleading.
Land held in joint tenancy is NOT to transfer of asset rules in Florida. A) True B) False - Answer B) False
In cases where resources are held with others in a joint tenancy, tenancy in common, or similar arrangement, the individual is considered to have transferred resources when action is taken that reduces or eliminates the individual's ownership
In Florida, what are the three basic groups eligible for Medicaid? A) SSI recipients, children and families, and the disabled B) children and families, the disabled, and the elderly C) SSI recipients, children and families, and the aged, blind, and disabled D) the disabled, blind, and institutionalized - Answer C) SSI recipients, children and families, and the aged, blind, and disabled
In Florida, the three basic groups eligible for Medicaid are supplemental security insurance recipients, children and families, and the aged, blind, and disabled, including people needing institutional care.
What is the function of the CARES unit in Florida? A) to assess applicants before they can receive Medicaid services B) to provide home and community-based services C) to provide respite care for providers of LTC
D) to provide hospice - Answer A) to assess applicants before they can receive Medicaid services.
The CARES provides onsite assessments of applicants by a registered nurse and/or a social worker. The assessment evaluates the activities of daily living of the individual as well as the emotional, cognitive, medical, and psychosocial state.
Periods of ineligibility for Medicaid may be waived in cases of hardship. A) True B) False - Answer A) True
A transfer penalty will not be imposed if the denial of eligibility would create an undue hardship.
Individuals are ineligible for Medicaid to pay for long-term care services if the equity interest in their home exceeds what amount?
A) $250,000, indexed B) $500,000, indexed C) $1 million, nonindexed D) $1.5 million, nonindexed - Answer B) $500,000, indexed
Individuals are ineligible for Medicaid to pay for long-term care services if the equity interest in their home exceeds $500,000. This amount is indexed; as of 2020, the limit had increased to $595,000.
