Unit 20 - Medicare and Medicaid

What is the maximum number of days of skilled nursing facility care for which Medicare will pay benefits?

100 DAYS Part A covers the costs of care in a skilled nursing facility as long as the patient was first hospitalized for 3 consecutive days. Medicare will cover treatment in a skilled nursing facility in full for the first 20 days. Form the 21st to the 100th day, the patient must pay a daily co-payment. There are no Medicare benefits provided for treatment in a skilled nursing facility beyond 100 days.

Lynn is insured under Medicare Part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that Medicare will pay for her hospital bills?

150 DAYS After an initial deductible is met, Medicare pays for all covered hospital charges fo 4th first 60 days of hospitalization. The next 30 days are also covered, but the patient will be required to contribute a certain day co-payment amount. If, after these first 90 days, the patient is still hospitalized, he can tap into a 60-day lifetime reserve and pay a higher level of daily co-payments. Consequently, a patient who has not yet tapped into the lifetime reserve days could have up to 150 days of Medicare coverage for a single hospital stay.

Lynn is insured under Medicare Part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that Medicare will pay for her hospital bills?

150 DAYS After an initial deductible is met, Medicare pays for all covered hospital charges for the first 60 days of hospitalization. The next 30 days are also covered, but the patient will be required to contribute a certain daily co-payment amount. If, after these first 90 days, the patient is still hospitalized, he can tap into a 60-day lifetime reserve and pay a higher level fo daily co-payments. Consequently, a patient who has not yet tapped into the lifetime reserve days could have up to 150 days of Medicare coverage for a single hospital stay.

Lynn is insured under Medicare Part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that Medicare will pay for her hospital bills?

150 DAYS After an initial deductible is met, Medicare pays for all covered hospital charges for the first 60 days of hospitalization. The next 30 days are also covered, but the patient will be required to contribute a certain daily co-payment amount. If, after these first 90 days, the patient is still hospitalized, he can tap into a 60-day lifetime reserve and pay a higher level of daily co-payments. Consequently, a patient who has not yet tapped into the lifetime reserve days could have up to 150 days fo Medicare coverage for a single hospital stay.

Under Medicare Part B, the participant must pay

20% OF COVERED CHARGES ABOVE THE DEDUCTIBLE Part B participants must pay a monthly premium and are responsible for an annual deductible. After the deductible, Part B will pay 80% of covered expenses, subject to Medicare's standards for reasonable charges.

Medicare Part A covers

80% OF THE COST OF DURABLE MEDICAL EQUIPMENT Medicare Part A covers 80% of the cost of durable medical equipment such as wheelchairs and hospital beds. The follow gin are specifically excluded: private duty nursing, non-medical services, intermediate care, custodial care, and the first three pints of blood.

Medicare Part A covers

80% OF THE COST OF DURABLE MEDICAL EQUIPMENT Medicare Part A covers 80% of the cost of durable medical equipment such as wheelchairs and hospital beds. The following are specifically excluded: private duty nursing, non-medical services, intermediate care, custodial care, and the first three pints of blood.

A Medicare supplement policy that contains restricted network provisions is known as

A MEDICARE SELECT POLICY A Medicare select policy or Medicare select certificate mean, respectively, a Medicare supplement policy or certificate that contains restricted network provisions.

Tom is covered under Medicare Part A. He spends 1 week in the hospital for some minor surgery and returns home on July 10. It was his first hospital stay in years. Which of the follow gin statements regarding his Medicare coverage is CORRECT?

AFTER TOM PAYS THE DEDUCTIBLE, MEDICARE PART A WILL PAY 100% OF ALL COVERED CHARGES. Medicare Part A pays 100% of covered services for the first 60 days of hospitalization after the deductible is paid.

Which of the following is NOT covered by Medicare Part A?

AN OUTPATIENT MEDICAL FACILITY An outpatient medical facility is covered by Medicare Part B. Skilled nursing facilities, home health care and hospice are covered under Medicare Part A.

Which of the following is NOT covered by Medicare Part A?

AN OUTPATIENT MEDICAL FACILITY An outpatient medical facility is covered by Medicare Part B. Skilled nursing facilities, home health care and hospice are covered under Medicare Part A.

Which of the following is a mandatory minimum benefits for Medicare supplement policies?

COVERAGE FO MEDICARE PART A-ELIGIBLE HOSPITAL EXPENSES TO THE EXTENT NOT COVERED BY MEDICARE FROM THE 61ST THROUGH THE 90TH DAY IN ANY MEDICARE BENEFIT PERIOD The benefits in Plan A, which is known as the core plan, must be contained in all other plans sold. Among the core benefits is coverage of Medicare Part A- eligible expenses for hospitalization, to the extent not covered by Medicare, from the 61st day through the 90th day in any Medicare benefit period.

The core policy (Plan A) developed by NAIC as a standard Medicare supplement policy includes all of the following EXCEPT

COVERAGE FOR THE MEDICARE PART A DEDUCTIBLE The Medicare Plan A supplement policy does not provide coverage for the Medicare Part A deductible. All the other answer choices are included in the core benefits that all Medicare supplement policies must provide, including Medicare Plan A supplement policies.

Which of the following is a mandatory minimum benefit for Medicare supplement policies?

COVERAGE OF MEDICARE PART A - ELIGIBLE HOSPITAL EXPENSES TO TH EXTENT NOT COVERED BY MEDICARE FORM THE 61ST THROUGH THE 90TH DAY IN ANY MEDICARE BENEFIT PERIOD The benefits in Plan A, which is known as the core plan, must be contained in all other plans sold. Among the core benefits is coverage of Medicare Part A - eligible expenses for hospitalization, to the extent not covered by Medicare, form the 61st day through the 90th day in any Medicare benefit period.

The core policy (Plan A) developed by NAIC as a standard Medicare supplement policy includes all of the following EXCEPT

CPVERAGE FPR TJE ,EDOCARE [ART A DEDUCTIBLE The Medicare Plan A supplement policy does not provide coverage for the Medicare Part A deductible. All the other answer choices are included in the core benefits that all Medicare supplement policies must provide, including Medicare Plan A supplement policies.

Which of the following statements about Medicare supplement policies is CORRECT?

EACH STANDARDIZED MEDICARE SUPPLEMENT POLICY MSUT COVER THE BASIC BENEFITS Each standardized Medicare supplement policy must cover the basic benefits. Medicare Plan A is the basic core plan. Medicare Plan B covers the basic benefits plus the Part A deductible for hospitalization. Neither Plan A nor Plan B covers skilled nursing facility care or at-home recovery care.

A Medicare supplement policy must offer coverage of Medicare Part A - eligible expenses for hospitalization.

FOR DAYS 61 THROUGH 90 Medicare supplement policies must offer certain minimum benefits. For example, they must offer coverage of Medicare Part A - eligible expenses for hospitalization not covered by Medicare from days 61 through 90 in any Medicare benefit period.

A Medicare supplement policy must offer coverage of Medicare Part A - eligible expenses for hospitalization

FROM DAYS 61 THROUGH 90 Medicare supplement policies must offer certain minimum benefits. For example, they must offer coverage of Medicare Part A - eligible expenses for hospitalization not covered by Medicare from days 61 through 90 in any Medicare benefit period.

With regard to medical benefits available through the federal government, Medicaid provides

FUNDS TO STATES TO ASSIST THEIR MEDICAL PUBLIC ASSISTANCE PROGRAMS Medicaid provides funds to states to assist their medical public assistance programs. Medicare provides health benefits for the aged and disabled.

Medicaid provides

FUNDS TO STATES TO ASSIST THEIR MEDICAL PUBLIC ASSISTANCE PROGRAMS Medicaid provides matching federal funds to states for their medical public assistance programs to help needy persons, regardless of age.

Medicare Plans K and L are characterized by which of the following features.

HIGHER COINSURANCE CONTRIBUTIONS Medicare Plans K and L require higher co-payments and coinsurance contributions from Medicare beneficiaries. They also have a limit on annual out-of-pocket expenditures incurred by the policyholders. However, once the out-of-pocket limit on annual expenditures is reached, the policy covers 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year.

Medicare Plans K and L are characterized by which of the following features?

HIGHER COINSURANCE CONTRIBUTIONS Medicare Plans K and L require higher co-payments and coinsurance contributions from Medicare beneficiaries. They also have a limit on annual out-of-pocket expenditures incurred by the policyholders. However, once the out-of-pocket limit on annual expenditures is reached, the policy covers 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year.

A 65-year-old employee of a company with 90 employees suffers a heart attack and, as a result, becomes totally disabled. Which of the following statements describes how his health benefits will be paid?

HIS EMPLOYER IS THE PRIMARY PAYER AND MEDICARE PAYS THE REMAINING ELIGIBLE EXPENSES. The employer has more than 20 employees and the individual is still an employee. Therefore, the employer-sponsored health insurance will be primary and Medicare will cover the remaining eligible expenses.

Which of the following statements about Medicare Part D is CORRECT?

IT IS AVAILABLE TO ANYONE ENROLLED IN MEDICARE PART A AND PART B Medicare Part D helps cover the cost of prescription drugs. It is available to anyone enrolled in Medicare Part A and B. Benefits are available through private prescription drug plans or Medicare Advantage plans. All plans must offer basic drug coverage.

Which of the following statement bout Medicare Part D is CORRECT?

IT IS AVAILABLE TO ANYONE ENROLLED IN MEDICARE PART A AND PART B Medicare Part D helps cover the cost of prescription drugs. It is available to anyone enrolled in Medicare Part A and Part B. Benefits are available through private prescription drugs plans or Medicare Advantage plans. All plans must offer basic drug coverage.

Which of the following statements about Medicare Part D is CORRECT?

IT IS AVAILABLE TO ANYONE ENROLLED IN MEDICARE PART A OR Medicare Part D helps cover the cost of prescription drugs. It is available to anyone enrolled in Medicare Part A or Benefits are available through private prescription drugs plans or Medicare Advantage plans. All plans must offer basic drug coverage.

Which of the following statements regarding Medicare Part B is NOT true?

IT PAYS FOR SKILLED CARE PROVIDED IN THE HOME LIKE SPEECH, PHYSICAL, OR OCCUPATIONAL THERAPY Medicare Part A pays for skilled nursing after a hospital stay lasting at least 3 days. The other routine preventive items are covered by Part B.

Monica is covered under Medicare Part A. She spends 9 days in the hospital for back surgery and is released on August 22nd. it was the first time she ever had to stay overnight in the hospital. When the bill arrives, she pays her deductible, and Medicare pays the balance. She is admitted to the hospital again on November 14th fo that same year for additional surgery. Which of the following statements is CORRECT?

IT WILL BE CONSIDERED THE START OF A NEW BENEFIT PERIOD The second hospitalization is part of a new benefit period, since it begins more than 60 days after the first hospitalization started. The new benefit period will require payment of the deductible again, but another hospital period fo 60 days with 100% coverage of benefits is available.

Monica is covered under Medicare Part A. She spends 9 days in the hospital for back surgery and is released on August 22nd. It was the first time she ever had to stay overnight in the hospital. When the bill arrives, she pays her deductible and Medicare pays the balance. She is admitted to the hospital again on November 14th of that same year for additional surgery. Which of the following statements is CORRECT?

IT WILL BE CONSIDERED THE START OF A NEW BENEFIT PERIOD The second hospitalization is part of a new benefit period, since it begins more than 60 days after the first hospitalization started. The new benefit period will require payment of the deductible again, but another hospitalization period fo 60 days with 100% coverage of benefits is available.

Monica is covered under Medicare Part A. She spends 9 days in the hospital for back surgery and is released on August 22nd. It was the first time she ever had to stay overnight in the hospital. When the bill arrives, she pays her deductible, and Medicare pays the balance. She is admitted to the hospital again on November 14th of that same year for additional surgery. Which of the following statements is CORRECT?

IT WILL BE CONSIDERED THE START OF A NEW BENEFIT PERIOD. The second hospitalization is part of a new benefit period, since it begins more than 60 days after the first hospitalization started. The new benefit period will require payment of the deductible again, but another hospitalization period of 60 days with 100% coverage of benefits is available.

Charles signs up for Medicare Part B on March 21, during the open enrollment period. His coverage will become effective

JULY 1 Medicare Part B coverage for those who sign on during the open enrollment period always becomes effective the following July 1.

The core policy (Plan A) developed by the NAIC as a standard Medicare supplement policy includes all of the following EXCEPT

LONG-TERM CARE INSURANCE DEDUCTIBLES This plan includes coverage for Part A co-payment amounts; 365 additional (lifetime) days fo Medicare-eligible expenses once the Medicare lifetime reserve days are exhausted; the 20% Part B co-payment amounts (for Medicare-approved services); and the first 3 pints of blood each year. At a minimum, all Medicare supplement policies must contain these core benefits.

Which of the following individuals would be eligible for Medicare?

MARTA, WHO IS 59 AND HAS RECEIVED SOCIAL SECURITY DISABILITY BENEFITS FOR THE LAST 36 MONTHS. Marta is the only one who would be eligible for Medicare coverage. Eligibility is based on being 65 years of age or older; receiving Social Security disability benefits for at least the previous 24 months; or having end-stage renal disease (kidney failure).

Which of the following statements pertaining to Medicare is CORRECT?

MEDICARE PART A IS AUTOMATICALLY PROVIDED WHEN A QUALIFIED INDIVIDUAL APPLIES FOR SOCIAL SECURITY BENEFITS Medicare Part A is available when an individual turns 65 and is automatically provided when he applies for Social Security benefits. Medicare Part B pays 80% of medical expenses after the insured pays the deductible.

Which of the following statements pertaining to Medicare is CORRECT?

MEDICARE PART A IS AUTOMATICALLY PROVIDED WHEN A QUALIFIED INDIVIDUAL APPLIES FOR SOCIAL SECURITY BENEFITS. Medicare Part A is available when an individual turns 65 and is automatically provided when he applies for Social Security benefits. Medicare Part B pays 80% of medical expenses after the insured pays the deductible.

Which fo the following statements regarding Medicare is CORRECT?

MEDICARE PART B IS VOLUNTARY. Medicare coverage has 2 distinct parts: Hospital Insurance (Part A) and Medical Insurance (Part B). Medicare Part A is automatically available to persons who have turned 65 and have applied for Social Security benefits. Part B is voluntary and may be elected or rejected as the recipient wishes.

Which of the following required provisions is INCORRECT?

MEDICARE SUPPLEMENT POLICIES MUST HAVE A 10DAY FREE LOOK PERIOD. Medicare supplement policies must have a 30-day (not 10-day) free look period.

Individuals claiming a need for Medicaid must prove that they cannot pay for their own nursing's home care. In addition, the potential recipient must

NEED THE TYPE OF CARE THAT IS PROVIDED ONLY IN A NURSING HOME To qualify for Medicaid nursing home benefits, an individual must be at least 65 years old, blind, or disabled; be a US citizen or permanent resident alien; need the type of care that is provided only in a nursing home; and meet certain asset and income tests.

Under Medicare Part A, the participant must pay his deductible

ONCE PER BENEFIT PERIOD For Medicare Part A, the participant must pay his deductible once per benefit period. A benefit period starts when a patient enters the hospital and ends when the patient has been out fo the hospital for 60 consecutive days. Once 60 days have passed, any new hospital admission is considered to be the start of a new benefit period. Thus, if a patient reenters a hospital after a benefit period ends, a new deductible is required and the 90-day hospital coverage period is renewed.

Under Medicare Part A, the participant must pay his deductible

ONCE PER BENEFIT PERIOD For Medicare Part A, the participant must pay his deductible once per benefit period. A benefit period starts when a patient enters the hospital and ends when the patient has been out of the hospital for 60 consecutive days. Once 60 days have passed, a new hospital admission is considered to be the start of a new benefit period. Thus, if a patient reenters a hospital after a benefit period ends, a new deductible is required and the 90-day hospital coverage period is renewed.

Undere Medicare Part A, the participant must pay his deductible

ONCE PER BENEFIT PERIOD For Medicare Part A, the participant must pay his deductible once per benefit period. A benefit period starts when a patient enters the hospital and ends when the patient has been out of the hospital for 60 consecutive days. Once 60 days have passed, any new hospital admission is considered to be the start of a new benefit period. Thus, if a patient reenters a hospital after a benefit period ends, a new deductible is required and the 90-day hospital coverage periods is renewed.

The abbreviation PDP refers to which part of Medicare?

PART D PDP stands for prescription drug plan. Medicare Part D makes prescription drug coverage available to people covered by Medicare Part A and Part B.

In the standardized Medicare supplement policy, Plan A is characterized by

PROVIDING THE LEAST COMPREHENSIVE COVERAGE In the 12 standardized Medicare supplement plans, Plan A provides the least coverage and is referred to as the core plan. Plan J has the most comprehensive coverage. Plans K and L provide basic benefits similar to plans A through J, but cost sharing is at different levels.

Skilled nursing care differs from intermediate care in which of the following ways?

SKILLED NURSING CARE MSUT BE AVAILABLE 24 HOURS A DAY, WHEREAS INTERMEDIATE CARE IS DAILY, BUT NOT 24-HOUR, CARE Unlike intermediate care, skilled nursing cares is continuous, around-the-clock care provided by licensed medical professionals under the direct supervision of a physician. It is usually administered in nursing homes. Intermediate care is provided under the supervision of a physician by registered nurses, licensed practical nurses, and nurse's aides. Intermediate care is provided in nursing homes for stable medical conditions that require daily, but not 24-hour, supervision.

Skilled nursing care differs from intermediate care in which of the following ways?

SKILLED NURSING CARE MUST BE AVAILABLE 24 HOURS A DAY, WHEREAS INTERMEDIATE CARE IS DAILY, BUT NOT 24-HOUR, CARE Unlike intermediate care, skilled nursing are is continuous, around the clock care provided by licensed medical professionals under the direct supervision of a physician. It is usually administered in nursing homes. Intermediate care is provided under the supervision of a physician by registered nurses, licensed practical nurses, and nurse's aides. Intermediate care is provided in nursing homes for stable medical conditions that require daily, but not 24-hour, supervision.

All Medicare supplement policies must cover 100% of the Part A hospital coinsurance amount for each day used from

THE 61ST THROUGH THE 90TH DAY IN ANY MEDICARE BENEFIT PERIOD All Medicare supplement policies must cover the core basic benefits that Plan A covers. This includes covering 100% of the Part A hospital coinsurance amount for each day used form the 61st through the 90th day in any Medicare benefit period and 100% of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used forms eh 91st through the 150th day in any Medicare benefit period.

According to the National Association fo Insurance Commissioners' standardized model Medicare supplement policy, insurers must offer coverage for all of the following core benefits EXCEPT

THE MEDICARE PART A DEDUCTIBLE All Medicare supplement policies must provide certain core benefits, including coverage for Medicare Part A - eligible hospital expenses not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period, the coinsurance amount of Medicare Part B - eligible expenses, and coverage under Medicare Parts A and B for the first 3 pints of blood. Although Plan A does not provide coverage for the Medicare Part A deductible, other Medicare supplement policies (Plans B through J) cover this deductible.

According to the National Association of Insurance Commissioners' standardized model Medicare supplement policy, insurers must offer coverage for all of the following core benefits EXCEPT

THE MEDICARE PART A DEDUCTIBLE All Medicare supplement policies must provide certain core benefits, including coverage for Medicare Part A -eligible hospital expenses not covered by Medicare form teh 61st day through the 90th day in any Medicare benefit period, the coinsurance amount of Medicare Part B- eligible expenses, and coverage under Medicare Parts An and B for the first 3 pints of blood. Although Plan A does not provide coverage for the Medicare Part A deductible, other Medicare Supplement policies (Plans B through J) cover this deductible.

According to the National Association of Insurance Commissioners' standardized model Medicare supplement policy insurers must offer coverage for all fo the following ore benefits EXCEPT

THE MEDICARE PART A DEDUCTIBLE All Medicare supplement policies must provide certain core benefits, including coverage for Medicare Part A- eligible hospital expenses not covered by Medicare form the 61st day through the 90th day in any Medicare benefit period, the coinsurance amount of Medicare Part B - eligible expenses, and coverage under Medicare Parts A and B for the first 3 pints of blood. Although Plan A does not provide coverage for Medicare Part A deductible, other Medicare supplement policies (Plans B through J) cover this deductible.

Which of the following statements regarding Medicare supplement insurance is INCORRECT?

THE NUMBER OF STANDARD MEDIGAP PLANS CHANGES EVERY YEAR Medicare supplement insurance (Medigap) is standardized by the National Association of Insurance Commissioners (NAIC). There are 10 standard plans which offer different combinations fo benefits and premiums.

In addition to the Buyer's Guide, what must be delivered to an applicant or insured either with or before the delivery of a life insurance policy?

THE OUTLINE OF COVERAGE The outline of coverage must be delivered with the policy or before the policy is delivered, whether by a producer or a direct response insurer.

Which of the following statements regarding the lifetime reserve of hospital coverage for Medicare patients is CORRECT?

THE RESERVE DOES NTO RENEW WITH A BENEFIT PERIOD The lifetime reserve is an additional 60 days of coverage on top of the 90-day benefit period Medicare provides for hospitalization. A patient who is hospitalized for longer than 90 days can tap into the 60-day reserve. This reserve is a onetime benefit; it is not replenished with a new benefit period. Tapping into the reserve will require a higher co-payment from the patient. If a patient is hospitalized beyond the 60th lifetime reserve day, thus exhausting the reserve, she will be responsible for all hospital charges.