Unit 2 Health insurance providers

How does one become eligible for Part D: Prescription Drug coverage? Must meet certain underwriting guidelines Must have a valid prescription Must have Medicare coverage Must have Medicaid coverage

Must have Medicare coverage

Which of these is NOT a qualifying event for Medicare? On Social Security disability for over 2 years Kidney failure Age 65 or older Falling below the federal poverty level

Falling below the federal poverty level

The waiting period before qualifying for social security disability benefits is how many months?

5

Social security disability benefits begin after a waiting period. Generally, benefits begin after the: 3rd month of disability 5th month of disability 9th month of disability 18th month of disability

5th month of disability

Not all disabilities are covered by Social Security Disability benefits. To be covered, a disability must be serious enough to be expected to be fatal, or to last at least: 6 months 12 months 18 months 24 months

12 months

At what age will a person normally enroll with an insurance carrier under a Part C Medicare Advantage Plan? Age 59 1/2 Age 60 Age 62 Age 65

Age 65

Which of the following statements pertaining to health maintenance organizations is correct?

An insurance company may sponsor an HMO or assist an HMO by providing contractual services

Which of the following organizations would make reimbursement payments directly to the insured individual for covered medical expenditures?

Commercial insurer

Which of the following reimburses its insureds for covered medical expenses? Health maintenance organizations Preferred provider organizations Commercial insurers Service providers

Commercial insurers

Which type of treatment is considered a major service in an indemnity dental plan? Diagnostic X-rays Restorative fillings Teeth cleaning Dentures

Dentures

Which of these will typically authorize treatment from a specialist? Administrator Policyowner Insurance company Gatekeeper

Gatekeeper

How is Medicare Part B funded? Employer taxes Payroll taxes User premiums General tax revenue and user premiums

General tax revenue and user premiums

Marty just received his first Social Security disability payments. From this, we can assume

His disability is expected to last at least 12 months

Which of the following statements pertaining to Medicaid is NOT correct? A. It provides a federal matching funds to states for medical public assistance plans B. Its purpose is to help eligible needy persons with medical assistance C. Medicaid benefits may be used to pay the deductible and coinsurance amounts of Medicare. D. It limits financial assistance to persons are 65 or over who are in need of medical services they cannot afford

It limits financial assistance to persons are 65 or over who are in need of medical services they cannot afford

The open enrollment period for Medicare Part B is: January 1 through March 31 January 1 through April 30 January 1 through May 31 January 1 through June 30

January 1 through March 31

Which of the following individuals would probably qualify for social security disability benefits?

John who experiences serious early onset Alzheimer's and is unable to remember how to get to work

HMOs are known for stressing

Preventive medicine and early treatment

If a patient with a preferred provider organization (PPO) chooses to use a non-PPO, the patient usually can expect: To have higher out-of-pocket expenses To pay the full cost of care 100% reimbursement for the service provided A one year waiting period before re-enrolling in the PPO

To pay the full cost of care

An individual can enroll in a Part C Medicare Advantage Plan at what time? When becoming eligible for Medicaid At age of retirement Age 59 1/2 When becoming eligible for Medicare

When becoming eligible for Medicare

A 70-year old insured individual has suffered from kidney failure for the past 24 months. She is covered by her spouse's large-group employer plan. How will Medicare be utilized in this situation? Will be the primary insurer and pay for 100% of covered expenses Will be the secondary insurer and pay for claims not fully covered by the group plan Will not pay for any of the covered expenses Will be the primary insurer and the group plan will be secondary

Will be the secondary insurer and pay for claims not fully covered by the group plan

Medicare Part B covers long-term care hospital room and board doctor's charges prescription drugs

doctor's charges

Medicaid is a government-funded program designed to provide health care to: all individuals over the age of 65 all individuals who carry Medicare supplemental insurance anyone who does not have a proper caregiver poor people

poor people

Medicaid is intended for: people with kidney failure people aged 65 and older unemployed people poverty stricken people

poverty stricken people

The role of the federal government was expanded when Medicaid was established by allowing the state to: -form a large PPO on a statewide level -purchase health insurance from the federal government -receive matching funds to expand public assistance programs -defer all costs to the federal government for public assistance programs

receive matching funds to expand public assistance programs

An individual covered under a Blue Cross Blue Shield plan is called a(n): participant subscriber policyowner insured

subscriber