State RegulationsMI specificDifficulty 2/5
A Flint resident is reviewing when a long-term care policy will begin paying benefits. Under Michigan long-term care policies, eligibility for benefits is generally determined by:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Michigan's long-term care chapter (M.C.L. 500.3901 to 500.3955) governs policies whose benefit triggers are defined in the contract — typically the inability to perform a specified number of activities of daily living without substantial assistance, or the need for substantial supervision because of cognitive impairment. Private long-term care eligibility rests on these defined triggers, not on insurer discretion or federal Medicare criteria.
Why the other options are wrong
- A) Benefit payments depend on the policy's defined triggers, not on insurer discretion.
- B) Medicare hospital admission criteria govern the federal program, not private long-term care benefit triggers.
- D) Need-based income tests belong to Medicaid eligibility, not to private long-term care policies.
Memory hook
LTC triggers = ADLs or cognition, spelled out in the policy.