Final Exam Review

An insured has Medicare Supplement Plan A. How much will the insured have to pay for a 60-day stay hospital care? $0 $389 $778 $1,556

$1,556 Medicare Supplement Plan A covers only core or basic benefits. It does not pay the inpatient hospital deductible. For each benefit period, the insured pays a total of $1,556 deductible and no coinsurance for a hospital stay of 1-60 days.

A Medicare patient has a hospital stay of 100 days. How much would the patient have to pay for the hospital stay? $0 $4,815 $16,234 $21,006

$21,006 The patient would have to pay $21,006, based on 2022 Medicare amounts. First, he'll have to meet the inpatient hospital deductible of $1,556. Then he'll pay $389 per day for days 61-90 ($11,670); and after that, $778 a day for the remainder of the stay ($7,780). The total bill is $1,556 + $11,670 + $7,780 = $21,006.

What is the minimum length of benefit period that a long-term care policy must provide? 6 months 12 months 18 months 24 months

12 Months

If an individual went without prescription drug coverage for 12 months after becoming eligible for Medicare Part D, what would be the late enrollment penalty? 1% 10% 12% No penalty

12%

An issuer may provide compensation to a representative for the sale of a Medicare Supplement policy only if the compensation for the first year is NO more than what percent of the compensation provided in the second year? 20% 50% 100% 200%

200%

What percentage of an agent's renewal commissions on a Medigap policy can the agent receive on the first-year commission? 50% 60% 100% 200%

200%

What is the maximum number of days of Medicare-covered inpatient hospital care paid for by the Plan A deductible? 30 45 60 90

60

A cancer patient has Medicare Parts A and B. He has applied to a private insurance company in North Carolina for the purchase of a Medigap Policy. He applied 6 months after the effective date of Medicare Part B and he is age 65. What are the insurance company's options? Issue the policy with an exclusion for cancer treatment only Accept the application and issue the policy without any coverage reduction or exclusions Issue the coverage with a significant premium increase Deny coverage because the applicant has cancer

Accept the application and issue the policy without any coverage reduction or exclusions

How is home health care covered under Medicare? On reimbursement basis As 80/20 coinsurance As fee for service As first-dollar coverage

As first-dollar coverage

A Medicare Part B patient is transported to a hospital in an ambulance during a non-emergency situation. Under what circumstances will Medicare Part B benefits for ambulance coverage be paid? Ambulance benefits are not paid under Part B. Unless the patient is unconscious, Medicare Part B will not cover ambulance transportation. The ambulance service must be provided to a hospital outside of the local area. Benefits will be paid only when other transportation would be dangerous to the patient's health.

Benefits will be paid only when other transportation would be dangerous to the patient's health.

A Medicare patient is beginning a long hospital stay. Under Medicare Part A, when will her daily copayment start? Day 60 Day 61 Day 75 Day 90

Day 61

For what reason would premiums increase on an issue age Medigap policy? Health care costs increase. The policy is up for renewal. The policy has been in place for less than 6 months. The insured ages.

Health care costs increase.

Which of the following is a lab test ordered by a doctor for patients with diabetes that measures how well the blood sugar has been controlled over the past 3 months? Hemoglobin A1c Tests Diabetes Screening Insulin Pump Glaucoma Testing

Hemoglobin A1c Tests

Skilled nursing care is used to Prevent a patient's condition from getting worse. Improve a patient's condition or prevent it from getting worse. Monitor a patient's condition. Improve a patient's condition.

Improve a patient's condition or prevent it from getting worse.

An individual signed up for Medicare Part B in January 1, 2022, during the general enrollment period. When would the coverage begin? January 1, 2022 January 10, 2022 February 1, 2022 July 1, 2022

July 1

When can lifetime reserve days in Medicare Part A be renewed? Once the patient's hospital stay enters day 300 Lifetime reserve days are not renewable. At any time at the patient's request After the patient has been home for 60 consecutive days

Lifetime reserve days are not renewable.

Which of the following is the most a doctor or supplier who does not accept assignment may charge for Medicare-covered services? Medicare approved amount Limiting charge Excess charge Actual charge

Limiting charge

Which of the following is known as a payer of last resort? Medicare Supplement Plan Medicaid Long-term care Medicare

Medicaid

The Original Medicare insurance that helps pay for doctors' services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A is Hospital Insurance. Medicare Advantage. Medicare Prescription Drug Insurance. Medical Insurance.

Medical Insurance.

A man has Medicare Part A, but he does not have Medicare Part B. He enters the hospice care program and is cared for at home. What are his Medicare payment options? Medicare Part A will pay for hospice care after a deductible is paid. Medicare Part A will pay for hospice care. Medicare Part A will pay for room and board if the patient lives in a nursing home or hospice facility. Medicare Part A will not pay for hospice care. The patient must have Medicare Part B.

Medicare Part A will pay for hospice care.

All of the following are types of Medicare Advantage (MA) plans EXCEPT Medicare Preferred Provider Organizations. Medicare Private Fee-For-Service Plans. Medicare Special Service Plans. Special Needs Plans.

Medicare Special Service Plans.

Which of the following is the fee set by Medicare as reasonable for a covered medical service? Actual charge Coinsurance limit Annual premium Medicare approved amount

Medicare approved amount

A man was hospitalized for complications from a heart condition in January. He signed up for a long-term care policy that went into effect in April, and the heart condition was considered a pre-existing condition. What is the earliest that the heart condition will be covered by his policy? June April Next January October

October

Which of the following is made up of two parts: Hospital Insurance (Part A) and Medical Insurance (Part B)? Medicare Managed Care Plan Medigap Insurance Medicare Modernization Act of 2003 Original Medicare Coverage Plan

Original Medicare Coverage Plan

The term Original Medicare refers to which of the following? Part A only Part B only Part A and Part B Parts A - D

Part A and Part B

Which of the following is true in guaranteed renewable long-term care policies issued in this state? Premiums can be raised by class. Premiums can be raised only based on the insured's increased age. The insured guarantees continued insurability. Policies must be noncancellable.

Premiums can be raised by class.

What must a hospice medical director or hospice doctor do before the start of every period of hospice care? Ask the patient or the patient's guardian if they still want hospice care Determine the best hospice worker for the case Recertify that the patient is terminally ill Re-examine the patient's diagnosis

Recertify that the patient is terminally ill

Which of the following reviews applies AFTER the services have been performed? Retrospective Retroactive Prospective Concurrent

Retrospective

A North Carolina resident has Medicare Part A. He has limited income and limited resources and needs help to pay his monthly Medicare Part B premium. What program would you suggest that this individual investigate? SLMB PPO QI QMB

SLMB The Specified Low-income Medicare Beneficiary (SLMB) program pays Medicare monthly premiums for qualified Medicare beneficiaries.

An enrollee in a Medicare HMO may see a specialist without a referral from a primary care physician in all of the following cases EXCEPT when Visiting an out-of-the-area urgent care. Given a pre-approved referral to a doctor outside the network. The primary care doctor is on vacation. Seeking emergency care.

The primary care doctor is on vacation.

What is the primary function o the Quality Improvement Organizations (QIOs)? To ensure patients receive quality care, and the right care at the right time To handle Medicare claims and bills and to make sure those are paid on time To assist with enrollments into Medicare and Medicare Supplements To prevent Medicare fraud

To ensure patients receive quality care, and the right care at the right time

When would an insured under Medicare Part A have to pay a deductible? When a new benefit period starts When receiving inpatient hospital care for 30 consecutive days After the lifetime reserve days are exhausted During the open enrollment period

When a new benefit period starts

Which of the following services will be covered under Medicare Part B? Custodial care Outpatient prescription drugs Yearly wellness visit. Private duty nursing

Yearly wellness visit.