Insurance for senior citizens (disability)

Part C: Medicare Advantage

- 1997 - Medicare Part C brings into the program managed care providers, such as HMOs and PPOs. - By enrolling in Part C of the Medicare program, a person chooses to receive his or her health care from a Medicare-sanctioned HMO or PPO

Federal law ensures that people who qualify for Medicare are entitled to purchase a Medicare supplement policy regardless of their health condition, as long as they

- 65 years old and apply for a Medicare supplement policy within six months of enrolling in Medicare Part B.

Paying for Medicare

- A premium is required for those who enroll between their 65th birthday and full retirement age. The premium disappears at full retirement age. (free if you are the retirement age) - Part A coverage is also free to those under age 65 who have qualified for Social Security disability benefits for a minimum of two years, have been diagnosed with permanent kidney failure, or have been diagnosed with ALS. Parts B, C, and D, if elected, require the payment of monthly premiums that may be deducted automatically from one's Social Security retirement benefits.

Standard medigap plans

- A thru N - all plans have whatever A has - 65 before 2020: Plans A, B, D, G, K, L, M, N

Benefit Periods and Benefit Amounts

- An elimination period is defined in terms of service days or calendar days. - calendar days: doesnt pay until 30 days passed - service days: doesn't pay unless 30 service pasy passed

who is eligible for medicaid

- Children in families whose income is less than a federal poverty threshold are generally eligible for Medicaid coverage under the Children's Health Insurance Program (CHIP). - Those who are blind or disabled or age 65 and older are eligible for Medicaid if they meet income and financial resource requirements. - old people because if they need long term care or nursing, it can run through their Medicare benefits and savings.

The Part A hospitalization benefit period, deductible, and coinsurance look like this:

- Days 1-60: All eligible hospital costs are covered after the Medicare beneficiary pays a deductible ($1,484 in 2021). - Days 61-90: Recipient pays a daily coinsurance ($371 in 2021), and Medicare pays the daily balance. - 60-day lifetime reserve: Recipient pays a daily coinsurance ($742 in 2021), and Medicare pays the daily balance.

LTC Insurance Suitability (consider this before getting LTC)

- Don't buy more insurance than needed. Evaluate income and assets to determine if the customer can pay a portion of care costs. Determine if family members are willing and able to supplement care needs. - Don't buy too little insurance. How would the customer feel if it became necessary to spend down assets to provide complete coverage? Or, how would the customer feel if some benefits could not be provided when needed? Customers should be reminded that while it may be possible to scale back coverage later on, the opposite may not be true—especially if the customer becomes uninsurable. - Look carefully at each policy. There is no "one-size-fits-all" policy. - If the customer is interested in a policy that only pays for room and board in a care facility, consider other expenses (such as supplies, medications, linens, and other items and services) that the policy may not cover. - Make sure the customer can truly afford the LTC policy under consideration.

Enrollment Periods: Initial Enrollment Period (IEP)

- Enrollment in Medicare is permitted up to three months before or up to three months after the month the enrollee first becomes eligible for Medicare, which for those who are not disabled is age 65. (equals a seven-month period including the month in which the recipient turns 65) - Those who delay enrollment in Medicare Part A are also subject to a late enrollment penalty of 10 percent of the applicable premium for twice the period of time enrollment was delayed, unless they qualify for enrollment during a special enrollment period. - Failure to enroll in Medicare B when a person is first eligible for it, or dropping Medicare Part B and then re-enrolling later, can also incur a late enrollment penalty that is imposed for as long as the person has Medicare. The monthly premium may be increased 10 percent for each 12-month period that the person was eligible for Part B but delayed enrollment. - Enrollment may be delayed when a person's coverage under an employer's health plan is primary coverage, due to the person remaining employed at age 65. Furthermore, a person can defer enrollment without a penalty if he or she is covered by an employer-sponsored health plan.

(LTC) Which of the following accurately describes differences between tax-qualified and non-tax-qualified long-term care insurance plans?

- Medical necessity cannot be a benefit trigger under tax-qualified LTC plans.

No Prescription Drug Coverage

- Medicare supplement plans sold today cannot include prescription drug coverage (part D)

Medigap core benefits

- Part A hospital coinsurance - Additional Part A hospital benefits - An extra 365 days of inpatient hospital care after depletion of the Original Medicare hospital benefits - Part B coinsurance after meeting the annual deductible - Part A and B blood coverage...Coverage for the first three pints of blood per calendar year

Part D: Prescription Drug Insurance

- Part D is optional and is available to anyone covered under Part A or B. - Part D requires a monthly premium that varies from plan to plan. These plans may or may not involve an annual deductible but normally require beneficiaries to pay a certain amount of coinsurance. - Furthermore, most Medicare drug plans have a coverage gap (informally called the Medicare donut hole) that requires the plan beneficiary to pay all drug costs out-of-pocket after the beneficiary and the plan have spent a certain amount for covered drugs during the year. Once the beneficiary has reached the plan's out-of-pocket limit during the coverage gap, drug coverage resumes. For the balance of the calendar year, the beneficiary is required only to pay a small coinsurance amount for prescription drugs.

Benefit Triggers

- The benefit triggers under a tax-qualified plan are more stringent than those for a nonqualified plan. - The insured must meet either the ADL or cognitive impairment requirement to qualify for benefits.

Qualified LTC Policy Premiums

- With a tax-qualified LTC plan, premium payments are considered a qualifying medical expense for federal income tax purposes. - The amount of premium that may be deducted is subject to maximum limits based on the taxpayer's age

2 forms of LTC

- a so-called indemnity contract or a reimbursement contract

LTC - Guarantee of Insurability

- aka guarantee purchase option (GPO) - enables the policyowner to increase the daily benefit with no additional underwriting. The option to increase benefits becomes available every two or three years, depending on the contract. If an option is exercised, the premium increases based on the insured's age at the time of the increase.

Common LTC exclusions include:

- alcohol and drug dependency -self-inflicted injuries, including attempted suicide - conditions resulting from war (declared or undeclared) - conditions arising from criminal activity - injury or illness for which workers' compensation will pay benefits

Guaranteed Renewable

- all medigap policies are renewable - cannot be cancelled because of the policy owners health - premiums can go up tho

Part A covers hospice care for terminally ill Medicare beneficiaries who

- are eligible for benefits under Part A; - have been certified by a doctor as terminally ill (with a life expectancy of six months or less); - file a statement choosing to waive all other Medicare coverage for care from hospice programs other than the one chosen; and - choose not to receive other services related to the treatment of the terminal condition.

LTC policies generally cover the following types of long-term care:

- assisted living care - nursing home services - home health care services - hospice care - adult day-care services - residential community living services - respite care services (providing temporary respite for a family member who has assumed caregiving responsibilities)

Medicaid Eligibility

- based on financial need

who does medicaid protect

- children, young people, old people

LTC Pool of Money Concept

- concept that effectively treats the total amount available as a sum of money available to cover all types of long-term care for however long the "pool" lasts. - the insurer gives a daily amount, if you don't use it all in that day, it will rollover - this mainly effects the length of the policy

Purpose of Medicare Supplement Plans

- designed solely to supplement Original Medicare. - not for plan C - provides emergency medical care in a foreign country.

Long-term care insurance recognizes six basic activities of daily living:

- dressing - eating - transferring (moving from a bed to a chair, for example) - bathing - toileting - continence (the ability to control urinary and bowel functions)

Medicare Part D

- drugs - Provided through Medicare-approved commercial insurers, Part D adds prescription drug coverage to Medicare Parts A and B.

Underwriting Considerations

- individual LTC mainly for ages 40-85 - older = higher premium -LTC underwriters assess how well or for how long applicants will continue to maintain their ability to perform their daily activities without needing personal or physical help.

(LTC policy riders) A few of the more popular LTC benefit options are

- inflation protection - guarantee of insurability - return of premium - nonforfeiture benefit

Waiver of Premium Provision (LTC)

- provision that waives the policy's premiums if the insured becomes eligible to collect benefits. - no additional premium for this benefit

Return of Premium

- returns a part of the premium paid for the LTC coverage to the insured's estate or to a named beneficiary when the insured dies - The amount of the premium returned is based on whether the insured used the policy's benefits and if so, to what extent.

Nonforfeiture Benefit LTC rider

- states that if the policyowner cancels the LTC policy, a minimal amount of paid-up LTC benefits will remain in force. The amount of paid-up coverage is typically equal to the sum of premiums that were paid to fund the policy

Part B Premiums and Deductibles

- the insured must pay an annual deductible ($203 in 2021). After paying the deductible, Part B pays 80 percent of Medicare-approved health care charges. -Medicare recipients pay their portion of what they owe for the deductible and coinsurance directly to the provider. The provider bills Medicare for its portion of the charges, and Medicare reimburses the provider directly. If Medicare denies payment for any treatment or service the recipient receives, he or she can appeal the decision directly to Medicare.

LTC benefit triggers

- the insured's inability to perform two or more activities of daily living (ADLs); - the insured's loss of cognitive ability such that it limits his or her ability to care for himself or herself without help or supervision (cognitive abilities include the ability to think, reason, perceive, or remember); or - medical necessity.

what happens when you don't want part B

- when you sign up for SS retirement, you are automatically enrolled in part A and B. B has a premium. to opt out, you have to contact SS administration

Part A Benefit Period

-Part A covers eligible hospital costs for up to 90 days in any single benefit period. A benefit period ends 60 days after release from the hospital. - As long as a subsequent hospitalization benefit period is separated by at least 60 days from the previous hospitalization benefit period, a new 90-day benefit period will apply for the subsequent hospitalization. - if any single hospitalization benefit period exceeds 90 days the Medicare patient may tap into this reserve period (60 days)

Medicare Medical Savings Accounts (MSA)

-available to seniors who are covered under Medicare -Medicare MSA funds can be used to pay for deductibles and coinsurance, but they cannot be used to pay for prescription drugs that are covered under Medicare Part D (prescription drug plan). -A senior who owns a Medicare MSA and who needs prescription drugs must enroll in a Part D (prescription drug) plan.

While each state sets its own Medicaid eligibility rules, in general health coverage is provided to

-children in families earning less than the federal poverty threshold (generally eligible for CHIP); -pregnant women with family incomes below a special federal level; -people who are blind or disabled whose incomes are less than a specified federal level; and -people who are age 65 and older whose income and financial resources are less than their state's qualifying limit.

LTC reimbursement contract

-contract limits daily benefits to the actual expense and does not exceed the maximum daily benefit amount specified in the policy.

Insureds have two options for LTC inflation protection:

1. Simple inflation protection: increases the original benefit on a simple interest basis, usually by 5 percent per year. This option is generally recommended for insureds in their 60s or older. 2. Compound inflation protection: increases the original benefit on a compound interest basis, usually by 5 percent per year. This option is generally recommended for insureds younger than age 60.

Most LTC policies have benefit limits, defined in terms of

1. benefit amount: the dollar amount that will be paid for qualifying care, typically expressed as a daily amount, and 2. benefit period: the length of time for which benefits will be paid.

Eligibility for Medicaid is determined by state requirements in three areas:

1. disability or age 2. income limitations 3. asset limitations

Levels of Long-Term Care

1. skilled nursing care: This is continuous, 24-hour care delivered by licensed medical professionals, under the direct supervision of a doctor or physician. Skilled nursing care is usually delivered in a nursing home. 2. intermediate care: This is ongoing care necessary to address a person's condition but not needed 24 hours a day. Intermediate care is delivered by registered nurses, licensed practical nurses, and nurses' aides, who are being supervised by a doctor .patients who are recovering from acute medical conditions 3. custodial care: Custodial care is provided to help a person meet daily living requirements, like bathing, dressing, or eating.

when was medicaid established

1965

LTC indemnity contract

A long-term care indemnity contract pays the full daily benefit even if the cost of the care is less; in this respect it more accurately constitutes a valued contract. - bad tax consequences

how is an applicants need for assistance evaluated

A person's need for assistance is based on his or her state's formula for calculating the maximum allowable income and assets. The calculation excludes certain assets.

Adam is a Medicare beneficiary who is also eligible for his state's Medicaid program. For Adam, what does Medicaid serve as?

Adam's secondary insurer, with Medicare as his primary insurer

plan c and f

All companies selling Medicare supplement policies must sell Plan A and either Plan C or Plan F.

The states are allowed, within limits, to make their own rules about what is and is not covered by Medicaid. As a result, which of the following statements is true?

Eligibility for Medicaid assistance is based only on financial need.

what kind of policy is medigap

Indemnity

Medicare Advantage Open Enrollment Period

Individuals who wish to switch from a Medicare Advantage plan to another Medicare Advantage plan or to Original Medicare and Part D may do so during a Medicare Advantage Open Enrollment period that runs from January 1 through March 31 each year.

LTC benefits

LTC insurance benefits that reimburse qualifying care expenses are not subject to federal income taxation. -This means that reimbursement policies do not face the possibility of taxable benefit payments. - However, tax-qualified LTC policy benefits that derive from an indemnity contract are subject to a federally established daily benefit cap ($400 a day in 2020) . - anything more than the cap are subject to income taxation

what is long term care insurance (LTC)

Long-term care insurance provides financial protection against the cost of medical services associated with long-term care

who funds medicaid

Medicaid is jointly funded by the federal and state governments, but it is administered by the states. The federal government pays for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP), which averages 57 percent but varies by state based on criteria such as per capita income.

Part A Skilled Nursing Facility Coverage

Medicare Part A pays the full cost for care in a skilled nursing facility for the first 20 days of such care. - Skilled nursing care continues to be covered beyond the first 20 days. - However, the patient must pay a coinsurance amount of $176 per day (2020). - No Medicare benefits are available for skilled nursing facility care that extends beyond 100 days.

changing plan d

Medicare beneficiaries may enroll in, or change, their Plan D coverage during the annual enrollment period (AEP, sometimes called the open enrollment period), which runs from October 15 through December 7. New coverage becomes effective the following January 1.

Which of the following best describes the long-term care services covered by Medicare?

Medicare covers up to 100 days of nursing home care and unlimited home health care

medicare coverage on long term coverage

Medicare only covers the first 100 days of care in a skilled nursing home facility and requires that a person first be hospitalized. A Medicare supplement policy covers the daily co-payments for nursing home expenses, but not beyond Medicare's 100-day benefit period.

another name for Medicare Supplement Plans

Medigap

For Medicare Supplement plans K and L, which of the following statements is true?

Plans K and L pay 100 percent of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached.

MIPPA

The Medicare Improvements for Patients and Providers Act of 2008

What are the tax implications of owning LTC insurance?

The answer is provided by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which created two categories of long-term care insurance beginning January 1, 1997: tax-qualified policies non-tax-qualified policies

Medicare supplement policies were designed mainly as supplements to reimbursements under Medicare. In practice, which of the following statements is true?

They help pay for the hospital, medical, or surgical costs of persons eligible for Medicare and provide funds to pay deductibles and coinsurance.

formulary tiers

Tier 1: Generic drugs, which are usually the least inexpensive to the consumer Tier 2: Preferred brand name drugs Tier 3: Non-preferred brand name drugs Tier 4: Specialty drugs, which are usually the most expensive brand name drugs

who sells Medicare supplement policies

Underwritten and sold by commercial insurance companies

Fred has a long-term care policy. Once he has triggered the policy's benefits, when will they most likely begin?

after any elimination period

Medigap plans that cover part B deductible

c and f - also include the part d dedutible

Part A Home Health Care Coverage

covered by medicare: - part-time or intermittent skilled care - home health aide services - durable medical equipment and supplies - certain other services --No prior hospitalization is required for these services to be covered, nor is there a maximum number of allowable home health care visits. Medicare Part A pays 100 percent of the approved amount for services. It also pays 80 percent of the approved amount for durable medical equipment, such as wheelchairs.

Part A: Hospital Insurance

covers: - inpatient hospital costs - skilled nursing facility costs - home health care costs - hospice costs

What must the recipient pay after the Medicare Part A deductible is paid?

daily hospital coinsurance or co-payment for the 61st to the 90th day

who sets Medicaid eligibility rules

each state sets them for themselves

what is MIPPA for

enacted to extend expiring provisions under Medicare, to improve beneficiary access to preventive and mental health services, to enhance low-income benefit programs, and to maintain access to care in rural areas, including pharmacy access.

Qualified LTC Plans: tax-qualified LTC policy

meets HIPAA requirements for benefits; a nonqualified plan does not meet these requirements. A tax-qualified LTC policy has tax advantages not available to nonqualified policies. In return, tax-qualified policies must adhere to a stricter code of requirements. Insurers can sell both qualified and nonqualified LTC policies.

A person who wants to enroll in Medicare at age 65 but chooses to defer Social Security retirement

must take steps to enroll in Medicare. In other words, Medicare enrollment is not automatic if done before a person applies for Social Security retirement benefits.

Plan K and L

premiums are lower than other plans because coverage of the first three pints of blood, Part B coinsurance, and Part A hospice care cost-share is less than with other plans, including the Plan A core plan.

determining costs for TLC

services vary from one geographic locale to another, but they are high regardless of where one lives. Depending on the type of service required and rendered, the annual median cost in the United States ranges from about $20,000 to over $100,000—easily enough to exhaust most people's assets.

Which of the following levels of long-term care provides continuous, 24-hour care delivered by licensed medical professionals, under the direct supervision of a doctor or physician?

skilled nursing care

why get LTC inflation protection

to protect yourself from LTC rising in years to come

Part A Deductibles and Coinsurance

- Before Medicare Part A pays benefits, the insured must first pay a deductible at the beginning of each benefit period. That deductible increases each year. - Medicare pays fully for the benefits for the first 60 days of hospitalization. Medicare also pays benefits for the remaining time in the benefit period, from the 61st day to the 90th day, but the Medicare beneficiary must pay a daily coinsurance amount during that period. - Medicare beneficiary can receive 150 continuous days of hospital coverage, if necessary (90 days of one benefit period plus the one-time 60-day reserve). However, a coinsurance payment requirement begins at day 61 and jumps sharply with reserve days.

skilled nursing necessary and covered by medicare

- For care in a skilled nursing facility to be considered "necessary" and thereby covered by Medicare, it must meet certain criteria. - For one, the care must be preceded by a hospital stay for the same or related condition and admission to the skilled nursing facility must be within 30 days of the time the patient leaves the hospital. - Second, the stay in the hospital must be at least three days long.

Medicare Part A

- Hospital insurance - covers institutional medical care, including inpatient hospital care, skilled nursing home care, post-hospital home health care, and hospice care.

Special Enrollment Period (SEP)

- Individuals who are working and covered under their employer medical plan may defer coverage of Medicare Part B until they actually retire. - special enrollment period (SEP) allows them to sign up for Part B after their IEP without penalty. The SEP is available any time during the eight-month period that begins the month after the employment or the group health plan coverage ends, whichever happens first. A late enrollment penalty is typically not required for beneficiaries who enroll during an SEP.

LTC Available Three Ways

- LTC can be group or individual - 3 ways for group: 1. employer groups 2. associations (such as alumni groups). 3. an endorsement (rider) to a life insurance policy.

MIPPA provisions

- MIPPA increased the subsidy for Medicare Part D, the prescription drug benefit program, to ensure that needy seniors and people with disabilities have affordable prescription drug coverage. - Coinsurance rates for mental health services were being phased down from 50 percent to 20 percent by 2014. - Payments to Medicare Advantage plans offered by private insurers were decreased through 2013. - Consumer protections have been added with respect to the marketing of Medicare Advantage plans. Sales tactics such as door-to-door sales, cold calling, providing free meals, and cross-selling non-health-related products are prohibited. - Financial incentives have been added for physicians who use a qualified e-Prescribing system approved by Medicare.

Medicare Part B

- Medical Insurance - covers physicians' services, outpatient hospital care, physical therapy, ambulance trips, medical equipment, and some preventive services. - Part B provides supplemental coverage to Part A.

Medicare Part C

- Medicare Advantage - managed care plan alternative to original Medicare. Provided through commercial insurance companies, this all-encompassing plan combines the coverage of Parts A and B in managed care format similar to a PPO.

Creditable Coverage

- Medicare Part D-eligible individuals who are covered under their employer's group health plans may decline Medicare Part D. If they choose to become covered under Part D later, they may be subject to a late enrollment penalty. - If the employer's health plan does not provide creditable coverage, then individuals would need to enroll in Medicare Part D when they become eligible to avoid the late enrollment penalties. - Failure to maintain creditable coverage for prescription drugs after age 65 may result in a lifetime penalty of one percent per month on the premium for each month that such coverage was delayed.

Part C Eligibility

- Medicare advantage - anyone who qualifies for A and B - They must reside in the plan service area they select when enrolling in the Part C plan.

Medicare Eligibility

- Medicare coverage under Parts A, B, C, and D is available to U.S. citizens and certain permanent residents (live here for 5 years) who (1) are age 65 and older; or (2) have been receiving Social Security disability checks for at least two years; or (3) have end-stage renal disease (ESRD, which is kidney disease requiring a transplant or dialysis); or (4)have Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig's disease).

Covered Drugs

- Medicare provides guidelines as to what types of conditions must be adequately treated by a prescription drug plan, but it does not specify the brands of drugs a plan must cover. - The list of drugs covered by a plan is called the plan's "formulary.

Coverage for Active Workers

- Persons over age 65 who continue working and are covered under an employee group plan can also be covered under Medicare. - Medicare coverage does not affect the amount of their future Social Security benefits. - If they file a claim, then the employee group plan is the primary payor and Medicare is the secondary payor. In other words, Medicare will only cover eligible expenses that were not covered by the group medical plan.

Enrollment Periods: General Enrollment Period (GEP)

- Qualified individuals who did not sign up for Part A or Part B during the IEP when they were first eligible can sign up during a general enrollment period (GEP) between January 1 and March 31 each year. Coverage will begin July 1. It may be necessary to pay a higher premium for late enrollment.

Medicare Enrollment

- Those who apply for Social Security retirement benefits at age 65 become automatically enrolled in Medicare Parts A and B - you can choose part c instead if you want

What if you're are not fully insured (with at least 40 quarters of coverage, or work credits) under Social Security

- You have to pay a monthly premium for Medicare Part A - Those with 30-39 quarters of coverage pay a monthly premium of $259 (in 2021) - Those with 0-29 quarters of coverage pay a monthly premium of $479 (in 2021).

Medicare SELECT plans are sold through

- a managed care provider or - an insurance company that offers the policy's benefits through a network of doctors, hospitals, and health care service providers. -less expensive because participants must obtain covered services through the plan's network.

what does long term care insurance include

- diagnostic services - preventive services - therapeutic services - curative services - treatment and rehabilitative services - personal care

Medicare Coverage Overview

- divided into ABCD - A + B: "Original Medicare", provide complete medical care coverage that is subject to deductibles and coinsurance - C + D: care plan and drugs

The general types of coverage that Medicaid may provide, depending on the state, include:

- doctor and surgeon fees - emergency care - hospital care - vaccinations - dental care - podiatry - prescription drug costs - vision and hearing care - mental health services - medical supplies and equipment - prostheses - x-ray and lab services - hospice care - transportation to services - long-term care

Part B: Medical Insurance - whats covered

- doctors' services - inpatient and outpatient medical and surgical services and supplies - physical and speech therapy - occupational therapy - outpatient diagnostic tests and X-rays - medical supplies - home health care and hospice care not covered under Part A

Medicare Savings Program (MSP)

- each state has one to help reduce costs of part b - Four Medicare Savings Programs are available: (1) Qualified Medicare Beneficiary (QMB) (2) Specified Low-Income Medicare Beneficiary (SLMB) (3_ Qualifying Individual (QI) (4) Qualified Disabled & Working Individual (QDWI)

Medicare

- federal health insurance program, administered by the Centers for Medicare & Medicaid Services (CMS) - 65+ and certain disabled people - a social security program - started in 1965 - pay as you go, funded by payroll taxes - providers charge medicare, there are no claim forms

Medicare SELECT

- more affordable than medigap - a managed care plan that requires seniors to receive their care exclusively from the provider network established by the Medicare SELECT plan.

Covered hospice services include:

- nursing care - medical social services counseling - short-term inpatient care and respite care (temporary relief given to those caring for family members at home) - medical appliances and supplies - services of a home health aide - homemaker services drugs - physical and occupational therapy --The benefit period for hospice care consists of two 90-day periods and an unlimited number of 60-day extensions of benefits. The hospice benefit can be extended beyond the 240-day limit if the beneficiary is recertified as terminally ill.

Part A 60 day reserve time

- one in a lifetime 60 days to go over - A Medicare beneficiary can draw upon the reserve one day at a time until the 60 days are depleted. Once the lifetime reserve is used up, Medicare beneficiaries are responsible for all hospital costs that they incur beyond any subsequent 90-day benefit periods.

Appropriateness of Recommended Purchase

- only can choose one Medicare supplement policy (medigap) - cant get medigap is already in plan c

Private Fee-for-Service Plan (PFFS)

- operates as a Medicare-approved private insurance plan - In addition to the standard Medicare Advantage plan, two related forms of the plan are available. - Medicare pays the private plan for traditional Medicare-covered services, and the PFFS plan determines which additional services it will cover and what share of expenses the Medicare beneficiary will pay toward those services.

Part B Eligibility

- part of original medicare - voluntary and available if you only if you qualify for part A - monthly premium - not available if covered by part C (bc it has both a and b)

Part D Eligibility

- prescription drug plan - anyone covered under A+B (original medicare) - available to anyone participating in a Medicare medical savings account

Excluded from Part B coverage are:

- prescription drugs vaccinations - routine eye care and eyeglasses - hearing aids and hearing exams - dental care - health care received outside the United States - skilled nursing facility care - cosmetic surgery - personal comfort items

Medicare Assignment and Participating Providers

- refers to the agreement between a health care provider and Medicare. - Participating Medicare providers agree to always "accept assignment," which means they've agreed to charge no more than Medicare-approved amounts for specific treatments and services. - Nonparticipating providers can elect to accept assignment on a case-by-case basis.

Special Needs Plan (SNP)

- second alternative form of Medicare Advantage - SNPs are available only to special-needs individuals who fit one of three categories: (1) institutionalized (2) dually eligible for both Medicare and Medicaid (3) have severe or disabling chronic medical conditions

Life Policy Rider

- the LTC endorsement is considered a "living benefit" because it provides financial support for the costs of medical care, nursing home care, and assisted living care while the insured is alive. - becomes eligible for its benefit when he or she kicks in when policyowner is diagnosed as chronically ill (cant perform 2 activities daily or cant be left without supervision for mental).

LTC is the ideal solution for seniors who want

- the freedom to choose where they receive their long-term care and - the peace of mind that comes with knowing they will not have to spend down their hard-earned assets to qualify for benefits.

Which of the following statements best describes the Medicaid benefit program?

Medicaid provides a range of health services for beneficiaries, but services vary from state to state.

purpose of medicaid

Medicaid provides health care coverage and health-related services to people with low incomes and other needy individuals.

insurance with medicare and medicaid

Medicaid serves as the secondary insurer. Medicare is the primary insurer.

medicaid on long term care

Medicaid, the "provider of last choice," does cover extended nursing home costs. However, to qualify for these benefits, a person must spend down personal assets to near poverty levels.

Enrollment Periods: Annual Election Period (AEP)

Qualified individuals who wish to change Medicare Advantage plans, switch from a traditional Medicare plan to a Medicare Advantage plan, or change Part D prescription drug plans may do so during an annual election period (AEP). The AEP runs from October 15 through December 7; new coverage becomes effective the following January 1.

Open Enrollment for medigap

Regardless of their health status, people may purchase a Medicare supplement policy if they are 65 and apply within six months after enrolling in Medicare Part B. - during this period, insurers can also sell any medigap plan

After the deductible is paid, Medicare Part A pays full benefits for the first 60 days of hospitalization. What else does Medicare pay benefits for?

the remaining time in the benefit period from the 61st day to the 90th day

When a person applies for Medicaid, the limits and the types of income and assets counted vary depending on which of the following?

whether the applicant has a spouse who requires support