A.D Banker - Life Insurance Prep - Chapter 11

In order to be in a Medicare __________ plan, enrollment in both Medicare Parts A and B is required and premium payments for Part B must be continued. B Health C Life D Medi-Cal

A Advantage In order to be in a Medicare Advantage plan enrollment in both Medicare Parts A and B is required and premium payments for Part B must be continued.

A sale of a new ____________ plan to a Medicare Advantage enrollee will result in automatic disenrollment from Medicare Advantage. A Medicare Supplement B Hospital indemnity C Long-term care D Medical expense

A Medicare Supplement A sale of a new Medicare Supplement plan to a Medicare Advantage enrollee will result in automatic disenrollment from Medicare Advantage.

Medicare Advantage plans are offered by ___________ that contract with Medicare to provide both Part A and Part B benefits and typically prescription drugs. A Private insurance companies B State governments C Hospitals D Physician groups

A Private insurance companies Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide both Part A and Part B benefits and typically prescription drugs.

For Medi-Cal beneficiaries there may be a __________ requirement, which requires the beneficiary to spend a certain amount of monthly income toward health care expenses before Medi-Cal begins to cover those expenses. A Share of cost B Spend down C Funding D Payment

A Share of cost For Medi-Cal beneficiaries there may be a 'Share of Cost' requirement, which requires the beneficiary to spend a certain amount of monthly income toward health care expenses before Medi-Cal begins to cover those expenses.

A comprehensive Long-Term Care policy will provide benefits in each of the following settings, EXCEPT: A Therapeutic care in a an acute care hospital B The home of the insured C Intermediate care nursing facility D Hospice care in a family member's home

A Therapeutic care in a an acute care hospital Long-term care does not pay the expenses connected with an acute care hospitalization.

An insured is hospitalized for at least 3 days. How long will Medicare pay for confinement in a skilled nursing facility? A Up to 100 days B Up to 365 days C Up to 30 days D Up to 90 days

A Up to 100 days Medicare Part A will provide coverage for up to 100 days of post-hospital skilled nursing care. Only the first 20 days are covered at 100% of the actual cost.

Which of the following is not a core benefit in a Medicare Supplement policy? A Up to 365 days of long-term care expenses after three days of hospitalization B Up to 365 days of hospital charges after Medicare benefits run out C Coinsurance amounts payable under Part B D The first 3 pints of blood administered in a calendar year

A Up to 365 days of long-term care expenses after three days of hospitalization Basic (or Core) Benefits in Medicare Supplement insurance do not include coverage for LTC expenses

How long is the free look period for a Medicare Supplement policy? A 20 days B 30 days C 10 days D 15 days

B 30 days A Medicare Supplement policy must contain a 30-day free look provision on the first page in bold print.

Under Medicare Part B, if a claim is denied or the beneficiary disagrees with a decision on the amount Medicare will pay on a claim, the beneficiary has the right to _____ the decision if the amount in question exceeds $99.99. A Arbitrate B Appeal C Explain D Reject

B Appeal Under Medicare Part B, if a claim is denied or the beneficiary disagrees with a decision on the amount Medicare will pay on a claim, the beneficiary has the right to appeal the decision if the amount in question exceeds $99.99.

What is the purpose of a respite care benefit in a Long-Term Care policy? A Provides care for a person who is terminally ill B Gives a primary care giver a break C Covers the cost of insurance when a person is disabled D Covers care in an adult day care facility

B Gives a primary care giver a break Respite care benefits provide the individual primarily responsible for the care of a disabled person in a home care setting with a break from their duties. It will pay for a substitute caregiver or for the disabled person to be placed in an institutional setting for a short period of time.

Part A of Medicare is known as: A Medicare + Choice B Hospital Insurance C Medical Insurance D Outpatient Insurance

B Hospital Insurance Part A of Medicare is formally known as Hospital Insurance. Part B is formally known as Medical Insurance.

The goal of the Long-term care Partnership program is to encourage the purchase of long-term care policies that subsequently will ease the financial burden on: A Nursing homes B Medicaid C Hospitals D Medicare

B Medicaid The goal of the Long-term care Partnership program is to encourage the purchase of long-term care policies that subsequently will ease the financial burden on Medicaid.

Which of the following statements is not true: A Lifetime reserve days under Medicare Part A are not renewable B Medicare Part A pays for outpatient hospital expenses such as Emergency Room C Medicare Part A is premium-free for most persons covered by Social Security D Medicare Part A does not pay for the first three units of blood needed in a year

B Medicare Part A pays for outpatient hospital expenses such as Emergency Room Medicare Part A only pays inpatient hospital expenses and, under certain circumstances, will also pay for skilled nursing care, home health care, and hospice care.

A Medicare beneficiary enrolled in a Medicare Advantage plan may have any of these other insurance plans, EXCEPT: A Life insurance with cash value in excess of $1,500 B Medicare supplement C Long-term care D Disability income

B Medicare supplement A person enrolled in a Medicare Advantage plan cannot also have a Medicare Supplement plan.

Which of the following is not provided under Part A of Medicare? A Home Health Care B Outpatient Medical Treatment C Post-hospital Skilled Nursing Facility Care D Hospice Care

B Outpatient Medical Treatment Part A of Medicare is Hospital Insurance, mainly providing inpatient coverage. Part B of Medicare is Medical Insurance, under which outpatient services are covered.

Any premium rate adjustments and increases for a Medicare Supplement insurance policy must be provided to the insured in writing by the insurer at least _____ days prior to the effective date of the change. A 15 B 20 C 30 D 10

C 30 Any premium rate adjustments and increases for a Medicare Supplement insurance must be provided to the insured in writing by the insurer at least 30 days prior to the effective date of the change.

Which reference to Medicaid is true? A Requires beneficiaries to pay an out-of-pocket premium B Private insurance purchased by persons over age 65 to supplement Medicare C Administered by the state using federal guidelines; funded federally and by states for poor persons of all ages; for poor persons 65+, disabled, or blind, may qualify for nursing home benefits D Provides a death benefit to surviving family members

C Administered by the state using federal guidelines; funded federally and by states for poor persons of all ages; for poor persons 65+, disabled, or blind, may qualify for nursing home benefits Medicaid is a state medical benefit program for persons whose incomes and resources are insufficient to pay for health care, regardless of age.

How does Medicaid differ from Medicare? A Medicaid is only for persons over age 21 and under age 65 B Medicaid is optional coverage for Medicare beneficiaries C Medicaid is a federal-state partnership providing health care benefits for low income persons D Medicaid is health insurance for persons who do not have access to group health insurance

C Medicaid is a federal-state partnership providing health care benefits for low income persons Medicaid is a federal-state partnership that provides health care to persons whose incomes are under 138% (percentage dependent on Medicaid expansion) of the Federal Poverty Level.

As long as the premium is paid, a Medigap policy is __________ renewable. A Conditionally B Partially C Optionally D Guaranteed

D Guaranteed As long as the premium is paid, a Medigap policy is guaranteed renewable.

A 67-year-old individual works for a large company and plans on working until at least age 70. The individual signed up for Medicare at age 65 and the employer has a group health insurance plan. If a loss occurs, how will the claim be handled? A Medicare will cover it all B Medicare will be the primary payor while her group health plan will be the secondary payor C The employer group health plan will cover it all D Her group health plan will be the primary payor while Medicare will be the secondary payor

D Her group health plan will be the primary payor while Medicare will be the secondary payor Since the individual is currently employed by a company with more than 20 employees, over 65, and the company has a health insurance plan, the primary payor will be the company health insurance plan. Medicare will take on the secondary payor role.

Medicare Part B covers all of the following, except: A Preventive care B Home health care C Mental health care D Long-term care (private or custodial nursing care) in any setting

D Long-term care (private or custodial nursing care) in any setting Medicare Part B covers medical expenses, preventative care, laboratory services, home health care, mental health care, and outpatient hospital (emergency room/urgent care) treatment, but not long-term care.

What advantage do persons have when applying for a Medicare Supplement insurance plan at the same time they are first eligible for Medicare? A They will be accepted at preferred rates even if declared substandard by underwriting B They will be issued noncancellable policies C They will be subject to preexisting condition waiting periods, higher premiums and exclusions D They cannot be declined for the insurance

D They cannot be declined for the insurance An applicant may not be declined for insurance when applying for a Medicare Supplement insurance policy within the first 6 months after enrolling in Medicare Part B for the first time.