Medicare 2

Spending down for Medicaid

A Medicaid applicants assets may not be more than $2000 for an individual or $3000 for a couple. If a person or a couple apply for Medicaid has resources of assets in excess of Medicaid requirements, here she or they will have to spend down these assets in order to qualify. Countable assets include: Cash Money in checking or savings account IRAs and other retirement plans Stocks, bonds, and other investments Cash value of life insurance policies Non-countable assets include: The recipients home (up to $820,000 of home equity may be excluded from countable assets) One automobile Household goods Clothing Jewelry Up to $1500 in otherwise countable liquid assets may be excluded as burial expenses fund

When completed a worksheet

A completed personal worksheet must be returned to the issuer prior to the issue or consideration of the applicant for coverage. It is prohibited for the insurer or producer to sell or disseminate information obtained through the personal worksheet. If the insured determines that the applicant does not meet its financial suitability standards, or the applicant has declined to provide the information, the insurer may reject the application. An insurer may issue the policy to an applicant that does not meet the financial suitability standards if the applicant signed the waiver acknowledging the suitability results

If applicable to the policy type, the summary must also include;

A disclosure of the effects of exercising other rights under the policy A disclosure of guarantees related to long-term care cost of insurance charges Current and projected maximum lifetime benefits

Information that must be included in or with the outline of coverage

A graphic comparison, or a 20 year., Of the benefit levels of a policy that increases benefits over the policy. With the benefit levels of a comparable policy that does not increase benefits Any expected premium increase or additional premium to pay for automatic or optional benefit increases

Requirements to deliver shoppers guide

A long-term care insurance shoppers guide in the format developed by the national Association of insurance commissioners, Oregon developed were approved by commissioner, must be provided to all prospective applicants of a long-term care insurance policy or certificate. In the case of: Agent solicitations, an agent must deliver the shoppers guide prior to the presentation of an application or enrollment form Direct response solicitations, the shoppers guide must be presented in conjunction with any application or enrollment form

Adult Day Care

Adult daycare is a type of community care. It is designed to provide custodial care outside the home during the day for individuals who continue to leave at home

Required disclosures..Signature requirements on riders and endorsements.

After policy issue, any riders or endorsements that reduce or eliminate coverage must be signed by the insured unless they: Were requested in writing by the insured or Are being implemented to avoid duplication of benefits with Medicare After policy issue, any riders or endorsements that increase benefits but also require A premium increase must be signed by the insured. The insured's signature of acceptance is not required if the benefit increase Is required by law

In addition to complying with all applicable requirements, the summary must also include:

An explanation of how the long term care benefit interacts with other components of the policy, including deductions from death benefits An illustration of the amount of benefits, the length of benefit, and the guaranteed lifetime benefits if any, for each covered person Any exclusions, reductions and limitations and benefits of long-term care A statement, if applicable, that any long-term care inflation protection option required by regulation is not available under this policy

Who assesses participants needs

An interdisciplinary team, consisting of professional and paraprofessional staff, assess as participants needs, develops care plans, and delivers all services (including acute care services and when necessary, nursing facility services) which are integrated for a seamless provision of total care. PHCE programs provide social and medical services primarily in an adult day health center, supplemented by an in-home and referral services in accordance with participants needs.

Childless non-disabled adults

Childless non-disabled adults of working age are not eligible for Medicaid regardless of how low their income is.

Levels of care...Home healthcare

Home healthcare is normally broken down into the following classifications of care: Home convalescent care- healthcare provided in one's home under a planned program established by his or her attending physician Residential care- living accommodations with in long-term care facilities. These facilities are commonly for the middle and upper class is because of the cost.

Notice on other health insurance policies

Any accident and sickness insurance policy or certificate, other than Medicare supplement policy or disability income policy, issued to persons eligible for Medicare must contain and noticed that the policy is not a Medicare supplement policy or certificate. The notice must either be printed or attached to the first page of the outline of coverage or to the first page of the policy or certificate. I noticed must be in no less than 12 point to type

Length of benefits.

Benefit periods vary from one year through a persons lifetime. Most policies sold today usually have three or five year benefit periods. This is largely due to the fact that currently, the average stay in a residential, full-time care facility is less than five years.

Loss ratios

Benefits under long-term care insurance policies are deemed to be reasonable in relation to premiums, provided that the expected loss ratio is at least: 60% for individual policies and. 75% for group policies

Eligibility

Medicare supplement policy's, also called Medigap insurance, our private planes are designed to supplement to Medicare by supplying coverage for gaps in Medicare benefits such as deductibles and coinsurance and downs. These plans are regulated to fit closely with Medicare coverage without duplicating Medicare benefits. To be eligible to purchase a Medigap policy, an individual must have both part a and part B of Medicare. In North Carolina, Medigap coverage must be made available to persons eligible for Medicare because of a disability as well as those eligible by reason of age. However, individuals age 65 or over may have more coverage options available to them than disabled individuals (this is covered in more detail in the next section). It is illegal to sell a Medigap policy to an individual who has a Medicare advantage plan. A Medigap plan is unnecessary for beneficiaries with Medicare advantage plan because both plants generally cover many of the same benefits.

Required disclosures...Buyers guide

Insurers who sell hospital or medical expense coverage to persons eligible for Medicare must provide applicants for Medigap coverage or other health coverage with a publication developed jointly by the NAIC & CMS entitled a guide to health insurance for people with Medicare and a type size no smaller and 12 points. Except for direct response insurers, the guy must be delivered at the time of application any written acknowledgment of each receipt must be obtained by the issuer. Direct response Insurers must deliver the guide to the applicant upon request but no later then at the time the policy is delivered.

Levels of care.... Intermediate care

Intermediate level care is also provided by a state-licensed facility. Known as Intermediate Care Facilities, they provide nursing care on a less than 24 hour basis under the supervision of an RN or a licensed practical nurse (LPN)

Contrast of Medicaid and Medicare

Medicare is: An entitlement program, funded entirely at the federal level social insurance, focusing almost entirely on the older population Medicaid is: Partially state funded (up to 50% ) Need based social protection program, rather than a social insurance program Medicaid main criteria are limited income and financial resources, neither of which have any bearing in qualify for Medicare. It covers a wider range of medical services then those Medicare, and it will pay the Medicare deductibles and copayments.

Waiver of Premium

Most long-term care policies offer a waiver of premium benefit that provides for premiums to be waived usually after 90 days of confinement or after the time of a clean, which ever is less Some long-term care insurers offer a return of premium optional benefit that provides free refund of the entire or some part of the premium paid less claims paid, either on a specified policy anniversary, and policy surrender, or death of the insured.

Notice of changes

No later than 30 days prior to the annual effective date of any Medicare benefit changes, an issue or must notify its policyholders and certificate holders of modifications it has me to Medicare supplement insurance policies or certificates. The notice must: Include a description of revisions to the Medicare program and a description of each modification me to the coverage provided under the Medicare supplement policy or certificate Inform each policyholder or certificate holder as to win any premium adjustment is to be made due to changes in Medicare Be in outline form and in clear and simple term and Not contain or be accompanied by any solicitation

PACE participant requirements

Participants must be at least 55 years old, live in the PAC e-service area, and be certified as eligible for nursing home care by the appropriate state agency. The PACE program becomes the sole source of service for Medicare and Medicaid eligible enrollees.

Renewability

Medicare supplement policies and certificates must include a renewal or continuation provision. The provision must appear on the first page of the policy under an appropriate caption. It must state notify the insured if the issuer Has reserved the right to change premiums and must disclose any automatic renewal premium increase based on the insured's age Medicare supplement policies must be guaranteed renewable. The policy cannot be canceled or non-renewed for any reason other than : Nonpayment of premium; or Material misrepresentation in the application An Issue or cannot cancel or non-renew a Medigap policy solely on the basis of the beneficiaries health status. A policy may not be written to terminate spousal coverage Soley because of deteriorating health, or a pond in shorts death, or any other events, except for nonpayment of premium's.

Pre-existing conditions

Medicare supplement policies may not exclude coverage for any pre-existing conditions that were diagnosed or treated more than six months prior to the effective date of coverage. After a Medicare supplement policy has been in effect for six months, pre-existing conditions must be covered by the policy If a Medicare supplement policy or certificate contains any limitations with respect to pre-existing conditions, those limitations must appear as a separate paragraph of the policy and be labeled as "pre-existing condition limitations"

Loss ratios

Medicare supplement policies must return, in the aggregate, at least a certain percentage of premiums to beneficiaries in form of benefits. That is, the law does not require each beneficiary to get back a certain percentage of his or her premium in the form of benefits, but for a given class of Medicare supplement policies sold by an insurer, the total payout of benefits on those policies must equal at least a certain percentage of the premium collected on those policies. This percentage is known as the loss ratio. The loss ratio is different for group and individual policies. The last raise your standards that Medicare supplement policies must meet are: 65% for individual policies and 75% for group policies

Standards for benefit payment

Medicare supplement policies or certificates may not provide for the payment of benefits based on standards described as usual and customary, reasonable and customary or words of similar import Losses resulting from accident must be paid on the same basis as losses resulting from sickness. A policy that pays benefits according to the cost sharing percentages of Medicare must automatically change to coincide with any changes in the Medicare laws

Tax qualification

Partnership policies must be tax qualified according to the 7702B of the internal revenue code

Inflation protection

Partnership policies that are purchased before the insured reaches age 61 must provide annual inflation protection on a compound basis, not just simple. Policies purchased between the ages of 61 through 75 must provide some level of inflation protection, which can be either compound or simple. Policies purchased at 876 or older male for inflation protection, but it's not required

Long term care insurance personal worksheet

People buy long-term care insurance for many reasons. Some do not want to use their own assets to pay for traditional long-term care. Some by insurance to make sure they can choose the type of care they get. Others do not want their family to have to pay for care or do not want to go on Medicaid. But long-term care insurance may be expensive, and it may not be right for everyone. The company will ask applicants to fill out the following worksheet to help them in the company decide if they should buy a long-term care insurance policy. By state law, the insurance company must fill out part of the information on the worksheet.

Marketing and selling of Madagascar policies...Premiums

Premiums may be based either on an insurance attained age or an insurance agent at issue. Premiums based on the insured's: Attained age start lower but increase each year Issue age starts higher, but remain level throughout the life of the policy Therefore, it is important that applicants understand whether they are looking at an illustration for a policy with premiums based on their attained age or their issue age.

Also

Premiums paid by individuals are treated as deductible medical costs up to certain limits. However, only medical costs in excess of 10% of the taxpayers adjusted gross income (7.5% for those 865 and over through 2016) can be deductible. Individuals have better tax treatment of long-term care premiums if they place them in a health savings account and then use the HSA to pay the LTC premiums

Minimum and maximum ages

The need for long-term care can happen at any age. The risk increases people get older, but that should not make younger people feel comfortable about delaying the purchase of long-term care insurance. AcCording to the fact sheet entitled who needs long-term care? Published by George Washington university health policy Institute: Proximately 63% of the people who need long-term care are aged 65 and older, and The remaining 37% or 64 years of age and younger UnFortunately many people did not think about the benefit of having long-term care insurance until it's too late for them to buy it. The American Association for long-term care insurance (AALTCI) reports that about 33% of the people who call their offices are looking for help to get long-term care coverage after they have had an application rejected by insurance. According to consumer reports, the average age at which most people sign up for long-term care coverage is 61. And already at that age, they are beginning to run into insurability and affordability issues: 20% of LTC policies applicants in their 60s the only required physical and 45% of people in their 70s feel Given that premiums are lower and discounts may be available for people at younger ages, it can never be too early to buy long-term care insurance. But it can be too late.

Level of care....Skilled care

Skilled care is provided any Skilled Nursing Facility.This is a licensed facility, operating according to the laws of the state, providing continuous, 24 hour nursing care by or under the supervision of a registered nurse (RN) on the written orders of a physician

Non-forfeiture

Some long-term care policies provide the following nonforfeiture options: Cash surrender value-A guaranteed lump sum that is paid to the policy owner upon the lapse or surrender of the policy Reduced paid-up- A reduced amount of daily benefit is provided for the duration of the benefit. After premium payments have been discontinued Extended term- The full amount of daily benefit is paid for a limited period of time (for as long as the cash value will purchase) after premium payments have been discontinued

Financial or suitability worksheet

Suitability Every provider of long-term care insurance must: Develop and use suitability standards to determine whether the purchase or replacement of long-term care insurance is appropriate for the needs of the applicant Train its agents in the use of a suitability standards Maintain a copy of its suitability standards and make them available for inspection upon request by the insurance commissioner

Standardize Medicare supplement plans

The omnibus budget reconciliation act of 1990 OB R a is a law that requires all Medicare supplement benefits to be standardized. The standardized benefits fall into two categories: Basic, or court, benefits that all plans must include Additional, or optional, benefits that are included in some plans and not others

Definition for Medicaid

The Medicaid program begin in 1965. It is jointly funded by the federal government and individual state governments. It is administered by the states under general federal guidelines. It is designed to provide healthcare to persons who cannot afford to pay for it themselves.

Elimination period

The elimination period is also called "waiting" period. It is the period of time that the insured will be responsible for paying for his or her own long-term care until the policy benefits begin. In principle, it is the same as a deductible on auto and property policies. Just as higher deductibles result in lower premiums, longer elimination periods to do so as well. The premiums on a policy with a 30 day elimination period Are about 15% to 20% more than one with a 90 day elimination period. Most long-term care policies sold today use either an elimination period of 90 or 100 days because many of these policies are not used until a person enters a nursing facility, for which Medicare pays the first 100 days

Compensation

The first year commission on the sale of a Medicare supplement policy must be no more than 200% of the renewal commission on that sale, renewals must be paid for five years When a Medicare supplement is replaced, the first year commission may not exceed the amount of the renewal commission

Optional benefits

The following additional, or optional, benefits are included in some Medicare supplement plans and not others: Skilled nursing facility care - payments of the beneficiaries coinsurance amounts from the 21st date to the 100th day in a benefit. For post hospital skilled nursing facility care eligible under Medicare part A. This is not custodial care Foreign travel emergency care- payment of 80% of the build charges for for an emergency care that Medicare would have covered if it was provided in the United States. Care must begin during the in shorts the first 60 days outside the US. The calendar year deductible is $250. The lifetime maximum benefit is $50,000 Part A deductible- payment of the part A per-benefit.-period Deductible for inpatient hospital stay Part B deductible- payment of the part B annual deductible that beneficiaries must meet before Medicare begins paying part B benefits Part B excess doctor charges- payment of 100% of any excess fees, which are limited to 15% above the Medicare approved amount (if most of the beneficiaries doctors take Medicare assignment, this benefit may not be needed)

What is the goal of regulating long-term care

The goal of regulating long-term care (LTC) insurance is to promote availability of long-term care coverage, as they need for it is expected to grow. Consider the following: National studies indicate that at some point 2 out of 5 people over the age of 65 will enter a nursing home The older a person, the greater the possibility he or she will need some kind of long-term care Medicare provides very limited coverage (skilled nursing) for long-term care Only certain low income individuals will qualify for assistance through Medicaid The need for LTC coverage can arise at any age

Existing conditions....6 and 6 provision

The insurer cannot more restrictively define a pre-existing condition and condition for which advice or treatment was recommended or received within six months of the effective date of coverage. After six months, pre-existing conditions must be covered by the policy

Guaranteed issue

There is an open enrollment period for Medicare policies that begins on the first day of the month that a person becomes eligible for Medicare part B and lasts for six months. Medicare beneficiaries to apply for Medicare coverage during the open enrollment period Must be issued a policy. For individuals who enroll in part B during the part B initial enrollment period, Medigap open enrollment starts on the first day of the month that they turn age 65. If individuals delay signing up for part B because they have employer group health coverage, they're open enrollment period begins on the first day of the month that they lose their employer group health coverage Medicare beneficiaries who join a Medicare advantage plan for the first time, but switch back to original Medicare within 12 months of joining have a special right to buy a medigap policy within 63 days of the date your Medicare advantage coverage ends

Levels of care.....Custodial care

This is personal care that can be provided by a person without medical training. It includes assistance with the activities of daily living (ADLs) bathing, eating, dressing, etc. And other routine activities.

Specified Low-Income Medicare Beneficiary (SLMB)

To be qualified for SLMB, a person must be eligible for Medicare part A, have an income greater than 100% plus less than 120% of the federal poverty level, and have resources less than double the SSI limit The SLMB program pays only for participants Medicare part B premiums In North Carolina, the SLMB program is referred to as MQB-B. If a person is MQB-B qualified but also meets the Medicaid "Medically Needy" standards, he or she may receive Medicaid benefits as well as Medicare part B premium benefits. If North Carolina, this is called the MQB-B Special Program

How to determine if the applicant meets the standards

To determine whether the applicant meets the standards developed by the provider, the producer and provider must develop procedures that take the following into consideration: The ability to pay the proposed coverage and other pertinent financial information related to the purchase of the coverage The applicants goals and needs with respect to long-term care and the advantages and disadvantages of insurance to meet these goals or needs The values, benefits, and costs of the applicants existing insurance, if any, when compared to the values, benefits and cost of recommended purchase or replacement

Estate Recovery

When he Medicaid recipient dies, states are required to have an estate recovery program to recoup some of the expenses paid for long-term care under Medicaid. The benefit amount paid under a partnership policy will be disregarded from the deceased recipients estate when the state seeks expense and cost recovery

Other requirements

When replacing a Medicare supplement policy, the agent must: Be sure that the replacement does not result in decreased benefits at an increase in premium Use an application containing questions that elicit information to determine if the applicant has or has had a Medicare supplement in effect or if the application is for replacement of an existing Medicare supplement Provide a notice a replacement to the applicant prior to Issuance or delivery of the new Medicare supplement policy. One copy of the notice, signed by the applicant and the agent, must be provided to the applicant. One signed copy must also be retained by the insurer

Core benefits

All Medicare supplement plans provide the following basic benefits, also known as core benefits: Payment of the Medicare part a coinsurance in hospital costs for up to an additional 365 days after Medicare benefits have been used: that is, it pays the beneficiaries daily copayment for hospitalization expenses that apply to the 61st through the 90th day of any Medicare benefit., Plus all 60 lifetime reserve days, plus the cost of another 365 days of hospital care. Payments of the hospice coinsurance for outpatient drugs and inpatient respite care. Plans generally must cover court benefits at 100%, but plans K & L cover this court benefit at a lower percentage. The beneficiary must meet Medicare's requirements, including a doctors certification of terminal illness Payment of the reasonable cost of the first 3 pints of blood, or their equivalent, under Medicare part A and B. Most plants cover the score benefit at 100%, but as with hospice coinsurance, plants K & L cover this at a lower percentage. Payments of the beneficiaries portion of the 20% part because Sherance of Medicare eligible expenses for Medicare services, including doctor bills, hospital or home health care, and specified higher payments for a certain services under prospective payment systems, after the part B deductible has been met. Covered at 100% except for plans K & L which coverage at a lower percentage.

Renewability

All long-term care policies must be guaranteed renewable or non-cancelable. The term guaranteed renewable maybe used only when the insured has the right to continue the policy by timely premium payments. The word non-cancelable maybe used only when the insured has the right to continue the policy by timely premium payments and during which period and the insured has no right to unilaterally make any changes in the policy provisions or in the premium rate rate.

If the policies premiums are based on an in shorts attained age:

All types of solicitation material must clearly indicate that a fact, meaning that those premiums will increase each year An illustration disclosure notice must state the dollar amount of the premium increase for the insured over a period of not less than 10 policy years, and display the insured's life expectancy at the beginning of the period The illustration disclosure notice must state that premiums for other Medicare supplement policies that are based on an insurance issue age do not increase as the insured ages The notice must include a statement that premium is another Medicare supplement policies that are based on insurance age at issue age should be compared to policies with the premiums based on attend age

Recommending the purchase or replacement of a Medicare supplement policy

An agent must make reasonable efforts to determine the appropriateness of the purchase or replacement

Policy Summary

At the time of policy delivery, the policy summary must be delivered for an individual life insurance policy that provides long-term care benefits within the policy or by rider. In case of direct response solicitation, the insurer must deliver the policy summary upon the applicants request, but regardless a request must make delivery no later than the time of policy delivery.

Benefits for long-term care

Daily/monthly benefit - benefits for LTC policies are described in terms of daily or monthly (or sometimes weekly) benefit amounts, or a total policy payout amount. They are three types of benefit payments.

Their requirements

Each year, every insured providing Medicare supplement assurance must report the policy and certificate numbers and issue dates for individuals who have more than one Medicare supplement If a Medicare supplement policy replaces another Medicare supplement policy that has been in force for six months or more, the replacing insurer may not impose an exclusion or limitation based on a pre-existing condition. If the original policy has been in force for less than six months, replacing insurer must waive any time. Applicable to pre-existing conditions to the extent that they have already been satisfied under the original policy.

Filing requirements for advertising

Every ensure providing Medicare supplement insurance or benefits in the state must provide a copy of any Medicare supplement advertisement intended for use in the state to the commissioner for review or approval

Exclusions

Except for the six month pre-existing condition clause describes previously, medicare supplement policies are prohibited from having limitations or exclusions and coverage that are more restrictive than those of Medicare

Qualified long-term care policies

Favorable tax treatment under section 7702B of the internal revenue code is given to long-term care contracts that meet the eligibility qualifications. These plans must meet the following requirements: The only protection in the contract is for long-term care The contract does not pay any Medicare reimbursable expenses The policy must be a guaranteed renewable contract The policy has no cash value accumulation that may be assigned as collateral, borrowed or surrendered for Value All refunds or dividends must be applied to either reduce premiums or increase benefits

PACE programs

PACE stands for the Program of All-Inclusive Care for the Elderly and features a comprehensive service delivery system with integrated Medicare and Medicaid financing. It was developed to address the needs of long-term care clients, providers, and payers. For most participants, the comprehensive service package permits them to continue living at home while receiving services rather than be institutionalized.

Required disclosures

Free look- A Medicare supplement policy must prominently contain an unconditional 30 day free look provision printed on or attached to its first page.

Any sale of Medicare supplement policy is prohibited if

If the transaction will result in coverage of more than 100% of the individuals actual medical expenses covered under all the insured's policies

Administration for Medicaid

In North Carolina, the Medicaid program is administered by the Human Resources Department, Division of Medical Assistance (DMA). Eligibility for Medicaid is determined by the county Department of Social Services (DSS) and the Social Security administration (SSA) for supplemental security income (SSI) beneficiaries. It is financed with funds from each county as well as those from the federal and state government. The Social Security act creates a federal mandate for certain groups of individuals who must be covered by Medicaid. The mandatory groups include individuals who receive, or are deemed to be receiving, cash assistance. Aid to families with dependent children (AFDC) and supplemental security income (SSI) are the major cash assistance programs. In addition, the state is mandated to cover Certain Medicare beneficiaries and pregnant women and children The Social Security act Also describes option groups the state may elect to cover. Two of the option no groups North Carolina covers are individuals described as medically needy and individual to receive special assistance.

Medicaid eligibility

In addition to the aged, blind, and disabled, Medicaid is available to the following: Pregnant women with household incomes up to 196% of the federal poverty level (FPL) Children with household incomes up to 211% of the federal poverty level (North Carolina also provides coverage for some 19 and 20-year-olds with income up to 46% of the federal poverty level) Parents with dependent children with household incomes up to 45% of the federal poverty level Persons with incomes up to 195% of the federal poverty level are eligible for the Medicaid-run family planning program Be Smart which provides free family planning and birth-control

inflation protection

Inflation protection benefit continues without regard to the insured's age, claim status, clean history, or the length of time is short has been covered under the policy. Inflation protection provisions are required to be included in any long-term care insurance policy and certificate unless the insurer obtain a written rejection of inflation and protection signed by the prospect of policyholder. Where the policy is issued it to a group, the offer of inflation protection must be made to the group policy holder or to each proposed certificate holder, depending on the type of group. The offer of inflation protection is not required for life insurance policies or writers containing accelerated long-term care benefits

inflation protection

Insurers must offer the following to each policyholder, at the time of purchase: Increases in benefit levels compounded annually at no less than 5% Inflation protection that guarantees the insured their right to periodically increase benefit levels, compounded annually at a rate of at least 5%, without providing evidence of insurability or health status as long as the option for the previous period Has not been declined Inflation protection covering a specified percentage of actual or reasonable charges The option for inflation protection is not required under life insurance policies that accelerate the death benefit.

Minimum requirements-Outline of coverage

Insurers must provide all applicants for Medicare supplement insurance with an outline of coverage at the time of application. Unless the policy is being sold by direct response, other insurers must also obtain a written acknowledgment of receipt from the applicant. The language informant of the outline of coverage is prescribed by law. The outline of coverage must be in at least 12 point tight.

Medicare-aid

Medicare aid as a free Medicaid program for Medicare recipients who also have limited income and resources. The program can help beneficiaries pay for Medicare premiums, copayments and deductibles.

State mandated benefits

Long term care insurance policies must provide benefits for at least three levels of care and provide the same duration for each level of care for a minimum of 12 months Coordination or non-duplication of benefits is permitted between true group long-term care policies only Custodial care that is a minister to help a patient performed the activities of daily living may not be denied based on the type of facility in which the care is received. Rather, such care must be provided as long as the insured is confined as an inpatient in any facility licensed by the state, regardless of whether or not that facility is commonly understood to be or is defined as a long-term care facility. No long-term care policy, contract, or certificate may use waivers to exclude, limit, or reduce benefits for specifically named or describe to pre-existing diseases or physical conditions.

Definition for long-term care

Long-term care insurance includes any individual policy, group policy, or rider that is advertised, marketed, offered, solicited, or designed to provide coverage for no less than 12 consecutive months. It may cover diagnostic, preventative, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting other than an acute care unit of the hospital.

Partnership plans

North Carolina established its long-term care partnership program in 2011. Partnership policies are essentially the same as non-partnership policies, but they do you have certain advantages, such as:

Spousal impoverishment for Medicaid

Often, one marriage partner will require full-time institutionalized care but the other does not. In such cases, the community (non-institutionalized) spouse does not have to impoverished for the other to qualify for Medicaid. Here allows the community spouse to keep an amount called community spouse resource allowance (CSRA) which depends on the amount of countable assets the couple has. The CSRA is: Up to $23,844 if the couples assets do not exceed $47,688 or One-half of the couples assets if they do not exceed 238,444 $119,220 is a couples assets exceed $238,440 The institutionalized spouse is allowed to keep up to $2000 The Community spouse income is not counted in the institutionalize spouses resource limit. In fact, the community spouse is allowed to receive a monthly income from the institutionalized spouses resources if needed. The monthly allowance is called the Monthly Maintenance Needs Alllowance (MMNA) and can range from a minimum of $1991 to a maximum of $2980

Partnership plans

Once insured begins to sell partnership policies, it must offer all existing long-term care policy owners the opportunity to exchange the policy for partnership policy. The offer must be made on one time basis, within 180 days after an insured begin to sell partnership policies. The exchange may involve underwriting and premium adjustments. And exchange policy is treated as newly issued. Endorsing an existing non-partnership policy so that it meets the requirements of a partnership policy is considered an exchange Before making a change requested by the policyholder to a qualified long-term care partnership policies that would result in the loss of the policies qualified status, the insurer must provide the policyholder with a written explanation within 30 calendar days of how this action would affect the insured. The insured must obtain the insured's signature indicating consent of his or her to the change. If he qualified long term care partnership policy subsequently losses qualified policy status,The insurer must explain to the policy charters in writing within 30 calendar days the reason for the loss of status.

Exclusions

Only the following exclusions are permitted in long-term care policies: Nervous or mental disorders which have no demonstratable organic cause (Alzheimer's disease must be covered) Alcoholism and drug addiction Injury or sickness caused by: War or an act of war, declared or undeclared Participating in a felony, right, or insurrection Military service Tensional he self inflicting injuries or Aviation activities other than as a fair paying passenger Care provided in a government hospital, or covered by any government benefit program, or provided at no charge by family members Services provided outside the United States

Requirements to provide outline of coverage

Outline of coverage must be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means that probably directly attention of the recipient to the document and it's purpose. In the case of: Agent solicitations, and agent must deliver the outline of coverage prior to the presentation of an application or enrollment form Direct response solicitation, the outline of coverage must be presented with any application or enrollment form

Other requirements for Medicaid

Regardless of someone's unique financial or medical situation, North Carolina Medicaid applicants must meet of the following requirements: Be a US citizen or have eligible immigration status Currently reside in North Carolina Have a Social Security number or have a plied for one

Also

Regardless of whether or not premiums are tax-deductible, all benefit from a tax qualified reimbursement LTC policies are non-taxable. For disability and indemnity benefits LTC policies, there is a limit on the amount of the daily benefit that can be received tax free of actual expenses for below that amount. The limit is subject to change each year (as a point of reference, it is $340 per day for 2016). Employers have far greater tax advantages because they can deduct all tax qualified LTC premiums, unless some of the premium is deemed as income to employees who are policy owners

Three types of benefit payments

Reimbursement benefit- this is the least expensive design as it pays only the expenses incurred even if a daily amount is higher. Disability benefit- this pays a daily benefit amount even if the cost of care is less. It is sometimes called a "cash" benefit because of the amount paid to the provider is less than the policies daily benefit amount, the insured may keep the difference Indemnity benefit- The insured pays a full daily benefit if and only if you're short incurs some qualified commercial cost on that day.

What must the service package include

The PACE service package must include all Medicare and Medicaid covered services, and other services determined necessary by the interdisciplinary team for the PACE participants care.

Asset Disregard

The partnership program was developed in an effort to reduce Medicare cost. Under this program, Medicaid disregards, dollar for dollar, and applicants assets and resources equal to the amount of the partnership policies benefits. If a partnership policy paid $200,000 in benefits, Medicaid will disregard that amount (plus the original $2000 allowance) from an applicant assets and resources if he or she later apply for Medicaid benefits.

Partnership policies must have disclosure statements that tell the insured:

The policy is a tax qualified, LTC partnership policy The purchase and use a partnership policy does not automatically qualify the insured for Medicaid Partnership status may be lost if you short move to a state that does not recognize North Carolina's partnership program for modifies a policy after it is issued

Also

The policy must comply with NAIC model act which has been adopted by most states. The new requirements of qualification were Stabley Sh t by the health insurance portability and accountability act and became effective January 1, 1997. The act defines qualified long-term care services as required diagnostic, preventative, therapeutic, curing, Trading and rehabilitative required by chronicle ill person and the services are provided by a licensed caregiver

Premiums

The premium charged to insured may not increase due to either of the following: The increasing age of the insured at age is beyond at 65 The duration of the insured has been covered under the policy The purchase of additional coverage is not considered a premium rate increase. The portion of the premium attribute above to the additional coverage will be added to and considered part of the initial annual premium. A reduction in benefit is not considered a premium change, but the initial annual premium will be based on the reduced benefits

Situations and guarantee Medicaid Acceptance

There are certain situations with guarantee that a Medicaid application will be Accepted. Persons Who receive benefits from one of the following federal program so I don't medically eligible for Medicaid in North Carolina: Supplement security income (SSI) Work first family assistance State/county Special Assistance for the Aged or Disabled (Adult Care Home Assistance) Special assistance to the blind

Qualified Medicare beneficiary program (QMB)

There are different levels of medical aid based on income. The qualified Medicare beneficiary (QMB) program is for persons with the lowest level of income. In North Carolina, the QMB program is called Comprehensive Medicare Aid and is referred to as MQB-Q. If an individual qualifies for Medicare part A, has household income below the federal poverty level, and resource is less than double the supplemental security income limit, Medicaid will pay the Medicare monthly premium and Medicare deductibles and coinsurance. If a person meets these requirements and also meets Medicaid "Medically Needy" financial requirements, here she may qualify for all QMB benefits as well as for Medicaid coverage for healthcare expenses. These persons are called "dual eligible's" since they qualify for both Medicare and Medicaid. In North Carolina, this is called the MQB-Q Special Program