CH16 GOV HEALTH INS PLAN
For how many days of skilled nursing facility care will Medicare pay benefits?
100 [full for the first 20 days, 21-100, daily copay]
in order to collect SS disability benefits, the claimant must be able to demonstrate that the disability will last at least
12 months
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?
20 in a skilled nursing facility. [21-100 days are daily copay]
what is a penalty tax for nonqualified distributions from a health savings account?
20% [an HSA holder who uses the money for a nonhealth expenfiture pay tax on it, plus 20%]
which of the following must the patient pay under medicare part b
20% of covered charges above the deductible
an insured has medicare part d coverage, upon reaching the initial benefit limit, what % of the prescription drug cost is the insured responsible for paying
25%
under the NY disa benefit law, no employee may be entitled to bene for more than how many weeks after 52 consecutive calendar weeks or during any one period of disa
26 weeks
elimination period for SS disa bene?
5 months [benefits begin at the beginning of the 6th month and are not retroactive to the beginning of the disability]
under the NY disa bene law, the weekly benefit that the disabled employee is entitled to receive is
50% of weekly wage [<=$170]
to attain currently insured status under SS, a worker must have earned at least how many credits during the last 13 quarters
6 credits
the minimum number of credits required for partially insured status for SS disa bene is
6 credits during the last 13-quarter period
how long is an open enrollment period for medicare supplement policies
6 month [guarantees the applicants the right to buy medigap once they first sign up for medicare part b]
At what age may an individual make withdrawals from an HSA for nonhealth purposes without being penalized?
65
under the NY disa bene law, for an employed individual, disa bene will be payable after a waiting period of
7 days [if weekly avg wage is <20$, the bene is such avg weekly wage]
which of the following individuals is eligible for a health savings account
Allison is insured by a high deductible health plan HDHP
all of the following are covered by part a of medicare EXCEPT -home health services -physician's and surgeon's services -inpatient hospital services -post hospital nursing care
B [covered PART B]
all of the following are requirements of eligibility for SS disa income benefits EXCEPT -fully insured status -wating period of 5mon -being age 65 -inability to perform any gainful work
C
all of the following statements about medicare part b are correct EXCEPT -covers services and supplies not covered by part a -it is financed by monthly premium -it is financed by tax reve -it is a compulsory program
D [Part B is elective]
which of the following is NOT true regarding workers compensation -bene are not regulated by fed -bene vary from state to state -bene are regulated by the state gov -bene are offered by the insurer
D [no, regulated by state gov]
all of the following statements about medicare part b are correct EXCEPT -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
D [part b is ELECTIVE]
which of the following statements is CORRECT concerning the relationship between medicare and hMOS
HMOS may pay for services not covered by medicare
what are the 2 types of flexible spending accounts
Health care accounts [for out of pocket expense] and dependent care accounts [help to pay for dependent expense for spouse to work]
The annual contribution limit of a Dependent Care Flexible Spending Account is set by
IRS
which is NOT covered by medicare
LTC [有hospice, respite, hospital in PLAN A]
all of the following individuals may qualify for medicare health ins bene EXCEPT
a retired person age 50
which is not correct for worker compensation
a worker receives benefits only if the work related injury was not his'her fault [regardless fault or negligence]
what is the amount of a physician or supplier bills for a particular service or supply
actual charge
who is not included in the definition of an employee under the NY disa bene law -a domestic or personal worker in a private home who is employed for less than 40 hours per week by any one employer -a licensed minister -an executive officer of a corp who owns all the outstanding stocks, and holds all the offices of the corp
all of the above
assuming that all of the following people are covered by a high deductible health plan and are not claimed as dependents on anyone's tax returns, which would not be eligible for a health savings account?
amanda is 67 and is covered by a basic medical exp policy [MUST NOT BE covered by other health ins except for specific injury]
All of the following qualify for Medicare Part A EXCEPT
anyone who is willing to pay a premium
which of the following is NOT an enrollment period for medicare part a applicants
automatic enrollment [3 types for part A: initial, general, special]
which NY program specifically provides health insurance for children under the age of 19 whose families meet income guidelines
child health plus
other than for a qualified life event, when can a change be made in benefits for a flexible spending account FSA
during the open enrollment period [unless the circumstances are deemed a qualified life event]
all of the following are advantages of HMO or PPO for a medicare recipient EXCEPT
elective cosmetic procedures are covered
what is the difference between medicare approved amount for a service or supply and the actual charge
excess charge
which of the following is an eligibility requirement for all social security disability income benefits
have attained fully insured status
which is eligible requirement for all social security disability income benefits?
have attained fully insured status [although SS offers many benefits, such as retirement, survivors and medicare, only those who have attained fully insured status are eligible for disability income benefits. contributing to SS for 40 quarters (10 years) attains fully insured status]
which NY program was instituted to make insurance available to employees whose employers do not provide group health insurance and small employers
healthy NY
health savings accounts are designed to
help individuals save for qualified health expenses [save for qualified out of pocket such as deductible expense from a high deductible health plan]
the amount of SS disa bene is based upon the worker's primary insurance amount PIA, which is calculated from their avg indexed monthly earning over which years? which years of income may be deleted from calculation
highest 35, lowest 5 [will continue for 3 months when a person returns to work making more than $850 per month. this is an incentive to get ppl get back to work]
all of the following would fall under the definition of durable medical equipment EXCEPT
hospital blankets [use in the home]
Medicaid provides all of the following benefits EXCEPT
income assistance for work-related injury [有眼镜但是没有跟工作有关的]
who is eligible for health savings account?
insured by high deductible health plan HDHP
which of the following is NOT true concerning medicaid
it consists of 3 parts, a hospitalization, b doctor's services, c disability income [THESE ARE MEDICARE]
which is not true regarding flexible spending account?
it does not have limits on contribution [FSA cafeteria plan, are annual maximum and use-or-lose rule]
how is the amount of SS disability benefits calculated?
it is based upon the worker's primary ins amount PIA, which is calculated from their avg indexed monthly earnings over their highest 35 years [lowest 5 years]
Concerning Medicare Part B, which statement is INCORRECT?
it is fully funded by SS taxes FICA [A is, B by fed]
which of the following is INCORRECT concerning medicaid -it is solely a fed administered program -it provides medical assistance to low-income ppl who cannot otherwise provide for themselves -it pays for hospital care, outpatient care, and lab and xray -the fed gov provides 56% for every $ spent
it is solely a fed administered program [STATE & FED]
which about part b is correct
it pays for physician services, diagnostic tests, and physical therapy [also pay 80% out of patient cost after a deductible has been met]
under workers compensation, which of the following bene are NOT included?
legal benefits [INCLUDE medical, rehabilitation, income, and death benefits]
which program expands individual public assistance programs for people with insufficient income and resources?
medicaid ["need" tested program administered by the states to provide assistance to persons who are not able to provide for themselves]
all of the following statements concerning medicaid are correct EXCEPT
medicaid is a state funded program that provides health care to persons over 65, only [designed health care to poor ppl at all age]
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
medicare [part A is FICA, B by prem and payroll taxes. C allows ppl to receive all of their health care services through available provider organ, D prescription drug coverage]
which is NOT correct regarding medicare?
medicare c must provided through HMO [NOT MUST, HMO+ PPO]
medicare advantages is also know as
medicare part c [A: hospital insurance protection B: medical insurance protection]
The primary eligibility requirement for Medicaid benefits is based upon
need
if one takes SS retirement benefits at age 62, what needs to be done at age 65 qualify for medicare
nothing [automatically for A and B]
what is the official name for SS program
old age survivors disability insurance OASDI
Medicare Part A services do not include which of the following?
outpatient hospital treatment [PART B covers]
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 a
to sign up for a medicare prescription drug plan, individuals must first be enrolled in
part a
which of the following statements is INCORRECT concerning medicare part b coverage -participants under part b are responsible for an annual deductible -part b will pay 80% of covered exp, subject to medicare's standards for resonable charges -it is a voluntary program designed to provide supplementary medical ins 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 [those who desire part b coverage must enroll and pay a monthly premium]
which of the following is NOT covered under part b of a medicare policy
routine dental care [ACCIDENT ONLY]
workers compensation benefits are regulated by which entity?
state gov
workers compensation benefits are regulated by which entity
state government
your client wants to know what the tax implications are for contributions to a health savings account. you should advise her that the contributions are
tax deductible [contributions to HSAs by individuals are deductible, even if the taxpayer does not itemize]
hospice care is intended for 临终关怀
terminally ill [if the care is provided by a medicare-certified hospice]
How do employer contributions to a Health Savings Account affect the insured's taxes?
the employer contributions are not included in the individual insured's taxable income
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 first been hospitalized for 3 consecutive days [part a covers the cost of care in a skilled nursing facility as long as the patient was first hospitalized for 3 consecutive days, and the services are medically necessary and only up to amounts deemed]
An HSA holder who is 65 years old decides to use the money in the account for non-health expense. WHich of the following is true?
there will be a tax [<65: tax and penalty >65: oNLY tax]
An insured makes regular contributions to his Health Savings Account. How are those contributions treated in regards to taxation?
they are tax deductible [an indi covered by a high deductible health plan can make a tax-deductible contribution to an HSA and use it pay for out of pocket medical exp]
which is a type of covered employment under NY disability benefit law?
trade organization employment
which is a type of covered employment under the NY disability benefit law?
trade organization employment [service performed for the state and service subject to the fed railroad and unem ins act are excluded from employment coverage under this law]
social security was created to provide all of the following benefits EXCEPT
unemployment income [INCLUDE financial loss due to old age, disability, death, income during retirement ]
SS was created to provide all of the following benefits EXCEPT
unemployment income [old age, disability, death, income during retirement]
which are not eligible under SS
welfare benefits [SS is a entitlement program, not a welfare p]
child health plus provides health insurance for children
whose fam meet income guidelines [<19years, and meet guidelines]
workers compensation insurance covers a worker's medical expenses resulting from work related sickness or injuries and covers loss of income from
work-related disabilities [all states have workers compensation laws, which were enacted to provide mandatory bene for employee's work related injuries, illnesses, or death]
an employee is injured in a construction accident, rendering him unable to work for a year. which of the following plans would provide him with medical expense coverage and income assistance
workers compensation [provides medical, income, death ,and rehabilitation benefits in the event of work-related injury]
