Medicare and Long-Term Care Insurance
An insured's long-term care policy is scheduled to pay a fixed amount of coverage of $120 per day. The long-term care facility only charged $100 per day. How much will the insurance company pay? - 20% of the total cost - $120 a day - $100 a day - 80% of the total cost
$120 a day
According to OBRA, what is the minimum number of employees required to constitute a large group? - 15 - 20 - 50 - 100
100
For how many days of skilled nursing facility care will Medicare pay benefits? - 30 - 60 - 90 - 100
100
Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay full benefits in this facility for how many days? - 3 - 20 - 100 - 80
20
Long-term care policies' outlines of coverage should include graphics comparing benefit levels over at least - 10 years - 30 years - 5 years - 20 years
20 years
Following an injury, a policyowner covered under Medicare Parts A & B was treated by her physician on an outpatient basis. How much of her doctor's bill will she be required to pay out-of-pocket? - 80% of covered charged above the deductible - all reasonable charges above the deductible according to Medicare standards - a per office visit deductible - 20% of covered charges above the deductible
20% of covered charges above the deductible
Which of the following must the patient pay under Medicare Part B? - 80% of covered charges above the deductible - all reasonable charges above the deductible according to Medicare standards - a per benefit deductible - 20% of covered charges above the deductible
20% of covered charges above the deductible
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying? - 15% - 16% - 23% - 25%
25%
The Medicare supplement renewal commissions paid in the third year must be as high as the commission of which year? - 1st - 2nd - 3rd - 4th
2nd
If a new individual long-term care policyholder is not satisfied with a new policy, within how many days can the insured return the policy for a full premium refund? - 30 - 7 - 10 - 90
30
A person buys an individual long-term care policy and is not satisfied with the provisions. Within how many days will the insured be able to return the policy for a full premium refund? - 10 days - 15 days - 20 days - 30 days
30 days
What is the duration of the free-look period for Medicare supplement policies? - 10 days - 15 days - 30 days - 60 days
30 days
Employer health plans must provide primary coverage for individuals with end-stage renal disease before Medicare becomes primary for how many months? - 12 months - 24 months - 30 months - 36 months
30 months
How long is an open enrollment period for Medicare supplement policies? - 6 months - 1 year - 30 days - 90 days
6 months
Long-term care insurance policies must cover which of the following? - Alzheimer's disease - all mental disorders - treatment of alcoholism - injuries caused by an act of war
Alzheimer's disease
Long-term care policies MUST cover - treatment payable by Medicare - alcoholism - a pre-existing condition - Alzheimer's disease
Alzheimer's disease
Which of the following statements is CORRECT concerning the relationship between Medicare and HMOs? - HMOs do not pay for services covered by Medicare - Medicare advantage is Medicare provided by an approved HMO only - all HMOs and PPOs charge premiums beyond what is paid by Medicare - HMOs may pay for services not covered by Medicare
HMOs may pay for services not covered by Medicare
Which of the following programs expands individual public assistance programs for people with insufficient income and resources? - unemployment compensation - Medicaid - Medicare - social security
Medicaid
Which of the following statements is NOT correct regarding Medicare? - medicare advantage may include prescription drug coverage at no cost - medicare part a provides hospital care - medicare part b provides physician services - medicare advantage must be provided through HMOs
Medicare Advantage must be provided through HMOs
Medicare Advantage is also known as - Medicare Part A - Medicare Part B - Medicare Part C - Medicare Part D
Medicare Part C
A long-term care insurance shopper's guide must be provided in the format developed by which of the following? - medical information bureau - NAIC - office of insurance regulation - director
NAIC
All of the following individuals may qualify for Medicare health insurance benefits EXCEPT - a person age 45 who has a permanent kidney failure - a person under age 65 who is receiving social security disability benefits - a retired person age 50 - a health person age 65
a retired person age 50
What is the amount a physician or supplier bills for a particular service or supply? - actual charge - assignment - coinsurance - approved amount
actual charge
Which of the following is NOT covered under a long-term care policy? - adult day care - hospice care - home health care - acute care in a hospital
acute care in a hospital
Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis? - home health care - adult day care - residential care - assisted living
adult day care
The Omnibus Budget Reconcilliation Act of 1990 (OBRA) requires that large group health plans must provide primary coverage for disabled individuals under - age 65 who are retired - age 59 1/2 who are retired - age 65 who are not retired - age 59 1/2 who are not retired
age 65 who are not retired
A 63-year old man is planning to be employed until age 68. When will he be eligible for Medicare? - age 69 1/2 if no longer employed - age 65, regardless of his employment status - as soon as he retires at age 68 - age 70, if still employed
age 65, regardless of his employment status
In which Medicare supplemental policies are the core benefits found? - plans a-d only - all plans - plans a and b only - plan a only
all plans
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? - coverage options and conditions comply with the law, but will vary from provider to provider - all plans must include basic benefits A-N - coverage options and conditions are developed for average individuals - all providers will have the same coverage options and conditions for each plan
all providers will have the same coverage options and conditions for each plan
All of the following qualify for Medicare part A EXCEPT - anyone who is over 65, not covered by Social Security, and is willing to pay premium - anyone who is willing to pay a premium - anyone that qualifies through social security - anyone who is at the end stage of renal disease
anyone who is willing to pay a premium
A formulary must include how many drugs in each treatment category? - at least one - at least 2 - at least 3 - any number of drugs
at least 2
When must an insurance company present an outline of coverage to an applicant for Medicare supplement? - within 30 days of policy delivery - only upon the applicant's request - at the time of application - when the policy is delivered
at the time of application
Occasional visits by which of the following medical professionals will NOT be covered under LTC's home health care? - community-based organization professionals - attending physician - registered nurses - licensed practical nurses
attending physician
Which of the following is NOT an enrollment period for Medicare Part A applicants? - general enrollment - automatic enrollment - initial enrollment - special enrollment
automatic enrollment
Which of the following is NOT required to be stated in the outline of coverage provided with a long-term care policy? - the right to return the policy - basic information about the insurance company - basic information about supplementary policies - the policy number
basic information about supplementary policies
A man is still employed at age 65 and is now eligible for Medicare. He wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him? - medicare only - both group health and Medicare - continuation of group health only - reapplication for group health
both group health and medicare
Who must sign the notice regarding replacement? - applicant only - agent only - both the applicant and agent - both the agent and the insurer
both the applicant and agent
Who can provide skilled nursing care? - spouse - family member - community volunteer - doctor
doctor
All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT - elective cosmetic procedures are covered - prescriptions might be covered, unlike Medicare - health care costs can be budgeted - there are no claims forms required
elective cosmetic procedures are covered
OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage? - end-stage heart failure - end-stage renal failure - black lung - leukemia
end-stage renal failure
An insured has a long-term care policy. How often can she expect her insurer to notify her of the right to change the person she has designated to receive notice of any unintentional lapse? - only at the policy issue - every 6 months - once a year - every 2 years
every 2 years
What is the difference between the Medicare approved amount for a service or supply and the actual charge? - actual charge - limiting charge - coinsurance - excess charge
excess charge
How many pints of blood will be paid for by Medicare Supplement core benefits? - everything after first 3 - 1 pint - first 3 - none; Medicare pays for it all
first 3
What term refers to a listing of approved drugs covered by a Medicare prescription drug plan? - formulary - tiers - authorized listing - supplemental benefits
formulary
Which provision allows a person to return a Medicare supplement policy within 30 days for a full premium refund? - trial period - refund of premium - free look - policy review
free look
Most LTC plans have which of the following features? - open enrollment - guaranteed renewability - no elimination period - variable premiums
guaranteed renewability
Which of the following types of LTC is NOT provided in an institutional setting? - home health care - custodial care - skilled nursing care - intermediate care
home health care
All of the following would fall under the definition of Durable Medical Equipment except - wheel chairs - hospital bed - hospital blankets - oxygen equipment
hospital blankets
In which of the following locations would skilled care most likely by provided? - in an outpatient setting - at a physician's office - in an institutional setting - at the patient's home
in an institutional setting
Medicaid provides all of the following benefits EXCEPT - eyeglasses - family planning services - income assistance for work-related injury - home health care services
income assistance for work-related injury
In long-term care (LTC) policies, as the benefit period lengthens, the premium - LTC premiums are not based on benefit periods - decreases - increases - remains unchanged
increases
Regarding long-term care coverage, as the elimination period gets shorter, the premium - remains constant - premiums are not based on elimination periods - decreases - increases
increases
Which of the following statements pertaining to Medicare Part A is correct? - individuals entitled to Social Security disability are not eligible for coverage under medicare part a - individuals who have ALS automatically qualify for Medicare part a, regardless of age - individuals who have the end stage renal disease do not qualify for medicare part a - for the first 90 days of hospitalization, medicare part a pays 100% of all covered services, except for the initial deductible
individuals who have ALS automatically qualify for Medicare part a
Which of the following entities must approve all Medicare supplement advertisements? - consumer protection agency - insurance commissioner or director - NAIC - federal association of insurers
insurance commissioner or director
Which of the following statements is NOT true concerning Medicaid? - it consists of 3 parts: part A: hospitalization, part B: doctor's services, part C: disability income - it is a state program - it is funded by state and federal taxes - it is intended to provide medical assistance for certain categories of people who are needy
it consists of 3 parts: part A: hospitalization, part B: doctor's services, part C: disability income
All of the following statements about Medicare Part B are correct EXCEPT - it is a compulsory program - it covers services and supplies not covered by part a - it is financed by monthly premium - it is financed by tax revenues
it is a compulsory program
Concerning Medicare Part B, which statement is INCORRECT? - it provides partial coverage for medical expenses not fully covered by part a - it is fully funded by social security taxes (FICA) - it is known as medical insurance - it offers limited prescription drug coverage
it is fully funded by social security taxes (FICA)
Which of the following is INCORRECT concerning Medicaid? - it provides medical assistance to low-income people who cannot other provide for themselves - it pays for hospital care, outpatient care, and laboratory and X-ray services - the federal government provides about 56 cents for every Medicaid dollar spent - it is solely a federally administered program
it is solely a federally administered program
Which of the following statements concerning Medicare Part B is correct? - it pays on a first dollar basis - it pays 100% of Medicare's standards for reasonable charges - it pays for physician services, diagnostic tests, and physical therapy - it is provided automatically to anyone who qualifies for part A
it pays for physician services, diagnostic tests, and physical therapy
Which type of care is NOT covered by Medicare? - hospital - long-term care - hospice - respite
long-term care
All of the following statements concerning Medicaid are correct EXCEPT - individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care - persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits - Medicaid is a state funded program that provides health care to persons over age 65, only - individual states design and administer the Medicaid program under broad guidelines established by the federal government
medicaid is a state funded program that provides health care to persons over age 65, only
Which of the following programs is made up of 4 parts, where the first part is paid for by FICA, and the second part is financed by premiums and payroll taxes? - blue shield - medicaid - medicare - blue cross
medicare
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? - medicare part a - medicare supplement - medicare advantage - medicare SELECT
medicare SELECT
Which type of Medicare policy requires insureds to use specific healthcare providers and hospitals (network providers), EXCEPT in emergency situations? - medicare part a - preferred - medicare SELECT - medicare advantage
medicare SELECT
To sign up for a Medicare prescription drug plan, individuals must first be enrolled in - medicare parts b and c - medicare parts a and c - medicare part d - medicare part a
medicare part a
The primary eligibility requirement for Medicaid benefits is based upon - number of dependents - need - whether the claimant is insurable on the private market - age
need
Which renewal provision(s) must be included in a long-term care policy issued to an individual? - renewable and convertible - cancellable and conditionally renewable - renewable at the option of the insurer - noncancellable and guaranteed renewable
noncancellable and guaranteed renewable
If one takes social security retirement benefits at age 62, what needs to be done at age 65 to qualify for Medicare? - nothing - apply for coverage through the state - appear for a physical at the social security office - apply at a local social security office
nothing
Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the - buyer's guide - certificate of coverage - notice regarding replacement - policy application
notice regarding replacement
In long-term care insurance, what type of care is provided with intermediate care? - daily care, but not nursing care - intensive care - occasional nursing or rehabilitative care - nonmedical daily care
occasional nursing or rehabilitative care
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do? - send the applicant to a doctor for a physical. nothing can happen until they get the results - offer the supplement policy on a guaranteed issue basis - exclude pre-existing conditions from coverage under the supplement policies - look at the applicant's medical history to decide what premium to charge
offer the supplement policy on a guaranteed issue basis
Medicare part a services do NOT include which of the following? - post hospital skilled nursing facility care - hospitalization - hospice care - outpatient hospital treatment
outpatient hospital treatment
The part of Medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care, is known as - part c - part d - part a - part b
part a
Which of the following statement is INCORRECT concerning Medicare Part B coverage? - participants under part b are responsible for an annual deductible - part b will pay 80% of covered expenses, subject to Medicare's standards for reasonable charges - it is a voluntary program designed to provide supplementary medical insurance to cover physician services, medical services and supplies not covered under Part a - part b coverage is provided free of charge when an individual turns age 65
part b coverage is provided free of charge when an individual turns age 65
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? - all four parts of Medicare - any private insurance policy - only part a of medicare - parts a and b of medicare
parts a and b of medicare
All of the following are coverage by Part A of Medicare EXCEPT - physician's and surgeon's services - in-patient hospital services - post-hospital nursing care - home health services
physician's and surgeon's services
Which of the following must be present in all Medicare supplement plans? - plan A - foreign travel provisions - outpatient drugs - plan C coinsurance
plan A
Medicare part d provides - hospital insurance - medical insurance - private fee-for-service plans - prescription drug benefit
prescription drug benefit
Which of the following is NOT among the goals of a Medicare supplement application? - advising applicants regarding the availability of counseling services - presuming the applicant is eligible for Medicaid, based on the nature of the policy - determining whether or not an applicant has an existing Medicare supplement policy - determining whether or not the policy will replace another accident and health policy
presuming the applicant is eligible for Medicaid, based on the nature of the policy
In the care of producer solicitation, at what point must a long-term care Shopper's Guide must be presented to the applicant? - at the time of policy delivery - prior to the time of application - at the time of application - between the completion of the application and the delivery of the policy
prior to the time of application
A medicare SELECT policy does all of the following EXCEPT - make full and fair disclosure in writing of the provisions, restrictions, and limitation of the Medicare SELECT policy to each applicant - provide payment for full coverage under the policy for covered services not available through network providers - provide for continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program - prohibit payment for regularly covered services if provided by non-network providers
prohibit payment for regularly covered services if provides by non-network providers
What type of care is Respite care? - institutional care - 24-hour care - relief for a major care giver - daily medical care, given by medical personnel
relief for a major care giver
When an employee is still employed upon reaching age 65 and eligible for Medicare, which of the following is the employee's option? - wait until the next birthday to enroll - remain on the group health insurance plan and defer eligibility for Medicare until retirement - enroll in Medicare, while the company must provide additional retirement benefits - enroll in Medicare when eligible; otherwise, Medicare benefits will be forfeited
remain on the group health insurance plan and defer eligibility for Medicare until retirement
Which of the following is NOT covered under Part B of a Medicare policy? - routine dental care - home health care - lab services - physician expenses
routine dental care
All of the following long-term care coverages would allow an insured to receive care at home EXCEPT - home health care - skilled care - custodial care in insured's house - respite care
skilled care
Regarding long-term care policies, which of the following would NOT be included in activities of daily living? - sleeping - bathing - dressing - eating
sleeping
Which of the following is NOT an activity of daily living (ADL)? - talking - eating - dressing - bathing
talking
What is necessary in order to be eligible to receive benefits from a long-term care policy? - the insured must have been receiving disability benefits for 6 months - age is the only requirement; upon reaching age 65, LTC benefits are available - the insured must be unable to perform some activities of daily living - the insured must meet certain economic standards
the insured must be unable to perform some activities of daily living
In order for an insured under Medicare Part A to receive benefits for care in a skilled nursing facility, which of the following conditions must be met? - the insured must have been hospitalized for 3 consecutive days - the insured must have a Medicare supplement insurance policy - there is no benefit provided under medicare part a for skilled nursing care - the insured must cover daily copayments
the insured must have first been hospitalized for 3 consecutive days
Regarding the return of premium option of LTC policies, what happens to the premium if the policy lapses? - the premium will only be returned if the insured dies - the insurer will return all of the premiums paid - the insurer will return a percentage of the premiums paid - the insurer will not return any premiums in the case the policy is allowed to lapse
the insurer will return a percentage of the premiums paid
When an applicant applies for Medicare supplement insurance, whose responsibility is it to confirm whether the applicant has an accident or sickness insurance policy in force? - the soliciting agent's - the insurer's - the applicant's - a primary care physician's
the insurer's
Which of the following is NOT covered under Plan A in Medigap insurance? - the first three pints of blood each year - the medicare part a deductible - approved hospital costs for 365 additional days after Medicare benefits end - the 20% part B coinsurance amounts for Medicare approved services
the medicare part a deductible
An individual purchased a Medicare supplement policy in March and decided to replace it 2 months later. His history of coronary artery disease is considered a pre-existing condition. Which of the following is true? - the pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off - coronary artery disease coverage will be permanently excluded from the new policy - in replacement, pre-existing conditions must be waived, so sickness relating to coronary artery disease will be covered upon the policy's effective date - because this is a new policy, the pre-existing condition waiting period starts over
the pre-existing condition waiting period fulfilled in the old policy will be transferred to the new policy, the new one picking up where the old one left off
Which of the following is correct about Medicare? - the program is divided into four parts (a-d) - part b is available to the insured at no cost - it is a federal program for welfare recipients - the program provides complete medical care at no cost
the program is divided into four parts (a-d)
Hospice care is intended for - the caregiver - the terminally ill - people in need of acute care - home health visits from a participating home health agency
the terminally ill
Which of the following is true regarding optional benefits with long-term care policies? - they are offered at no additional cost to the insured - they are included in all policies - they are available for an additional premium - only standard benefits are available with LTC policies
they are available for an additional premium
Regarding Medicare SELECT policies, what are restricted network provisions? - they determine premium rates - they help avoid adverse selection - they condition the payment of benefits - they determine who can be insured
they condition the payment of benefits
All of the following statements about Medicare supplement insurance policies are correct EXCEPT - they cover the cost of extended nursing home care - they cover Medicare deductibles and copayments - they supplement Medicare benefits - they are issued by private insurers
they cover the cost of extended nursing home care
What do long-term care policies offer to policyholders to account for inflation? - they automatically increase premiums to account for inflation - they pay a dividend that increases every 7 years - they offer the option of purchasing coverage that raises benefit levels accordingly - they do not account for inflation
they offer the option of purchasing coverage that raises benefit levels accordingly
An insurer offers a policy very similar to Medicare. An agent tells an applicant that the policy is Medicare, since the policies are similar anyway. Which of the following is true? - this is illegal only if the policy is bought by the applicant - this practice is illegal - this is a legal practice - this is legal as long as the applicant understands all the benefits
this practice is illegal
