Final Missed Medicare Questions

Which of the following is covered by all Medicare supplement policy's? Medical care while in a foreign country Long-term care First 3 pints of blood Vision care

First 3 pints of blood

Most long-term care insurance policies have benefit limits defined in terms of the dollar amount that will be paid for any one covered service or services. What are common benefit limits? Specified annual amounts, such as $5000, $10,000, or $20,000 Flat daily amounts, such as $50, $100, or $200 Flat monthly amounts, such as $400,$700, or $1000 Sliding scale amounts from $100-$500

Flat daily amounts, such as $50, $100, or $200

Mrs. S receives home health care under Medicare Part A. Which of the following services would not be covered? Durable medical equipment and supplies Intermittent skilled care Home health aide services Full time skilled care

Full time skilled care

When can individuals sign up for Medicare Part B coverage that did not sign up upon initial eligibility? Special enrollment period Late enrollment period General enrollment period Open enrollment period

General enrollment period

All of the following can deduct the full cost of the qualified long-term care insurance premiums, subject to the age-based limits, except Group participants whose premiums are paid by the employer Fran, the president and CEO of beautiful baskets, LLC Members of a tax consulting partnership business Marianne, whose business is form as a sole proprietorship

Group participants whose premiums are paid by the employer

Long-term care policies must be at least Optionally renewable Guaranteed renewable Cancelable Conditionally renewable

Guaranteed renewable

Medicare supplement policy states that the company can cancel or decline renewal only if he fails to pay premiums or made a material misrepresentation in the application. Which type of renewability provision does his policy have? Guaranteed renewable Non-cancelable Renewable at insurers option Conditionally renewable

Guaranteed renewable

Which of the following plans is used to offer Medicare Part C coverage, and is intended for individuals who are insured under Medicare and Medicaid? POS HMO PSO SNP

HMO

A Medicare Medical Savings Account is comprised of which of the following? A special type of Medicare Advantage plan only High deductible Medicare plan and a savings account Medicare savings account only Managed care Medicare plan and a savings account

High deductible Medicare plan and a savings account

Which provision in a long-term care policy guarantees that is the insured stops paying premiums after a specified. Here she will at least receive some of the benefits from the policy? Non forfeiture Guaranteed issue Waiver of premium Premium refund

Non forfeiture

Which type of Medicare supplement policy provides that as long as the insured pays the premiums, the insurer cannot modify the premium, coverage, or any provisions of the policy? Guaranteed renewable Conditionally renewable Non-cancelable Renewable at insurers option

Non-cancelable

Under which of the following types of plans does cognitive impairment not require substantial assistance from another person to qualify as a benefit trigger? Tax qualified LTC plans Both tax qualified and non tax qualified LTC plans Neither tax qualified nor non-tax qualified LTC plans Non-tax qualified LTC plans

Non-tax qualified LTC plans

You are an agent in a state that allows the marketing of Medicare select plans. This means that you, through your insurance company, can do which of the following? Sell certain supplement plans at different rates After the policy through a network of providers Sell Medicare plans Offer discounts on Medicare coverage

Offer the policy through a network of providers

When is open enrollment for Medicare supplement policy's? Open enrollment for Medigap policy span a six-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare part B Open enrollment for Medigap policy span a five-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare part B Open enrollment for Medigap policy span a three-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare part B Open enrollment for Medigap policy span a eight-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare part B

Open enrollment for Medigap policy span a six-month period beginning on the first day of the month in which the individual is age 65 or above and enrolls in Medicare part B

When can individuals add a Medicare Part D plan if they did not select one when enrolling in Medicare Parts A and B? Open enrollment period Special enrollment period General enrollment period Initial enrollment period

Open enrollment period

When can individuals change from Original Medicare to Medicare Part C coverage? General enrollment period Open enrollment period Initial enrollment period Special enrollment period

Open enrollment period Open enrollment period applies to Part C. Period is from October 15- December 7, with coverage beginning Jan. 1

Which of these statements is INCORRECT regarding a Preferred Provider Organization (PPO)? Prices are negotiated in advanced for PPO providers PPO's normally have more providers to chose from as compared to an HMO In network PPO providers offer members better coverage of incurred expenses PPO's are NOT a type of managed care systems

PPO's are NOT a type of managed care systems

Which Medicare Part C plan is managed by one or more medical providers? HMO SNP POS PSO

PSO

In 2006, federal legislation expanded Medicare to include which of the following? Part D Part F Part C An updated Medigap program

Part D

M suffers from congestive heart failure and is enrolled in a Medicare Special Needs plan. Which benefit will not be provided by her plan? Parts A and B deductibles and coinsurance amounts Part A coverage Prescription drug coverage under Part D Part B coverage

Parts A and B deductibles and coinsurance amounts

Mr. J is covered under Medicare Advantage, which includes a private fee for service PFFS plan. What does PFFS provide for? Rehabilitative services Prescription drug and durable equipment charges Ambulance services Payment of traditional Medicare services, plus certain additional services

Payment of traditional Medicare services, plus certain additional services

Long-term care policies can limit or exclude coverage for all of the following, except Alcohol addiction Pre-existing conditions or diseases Family history of heart condition Intentionally self inflicted injury

Family history of heart condition

For the first 30 months an individual with ESRD and has group health coverage through an employer or union and Medicare coverage, Medicare is Secondary Primary Solely Responsible Shared Equally

Secondary

If an individual has no fault group health coverage through an employer or union and Medicare coverage, Medicare is Solely responsible Primary Secondary Shared Equally

Secondary

The outline of coverage for long-term care policies is also referred to as Policy summary Plan summary All of the above Shoppers guide

Shoppers guide

Insurance has two options for inflation protection in a long-term care policy. Which option increases the original benefit on a simple interest bases, usually by 5% per year? Simple inflation protection Compound inflation protection Complex inflation protection Routine inflation protection

Simple inflation protection

If an individual has coverage under an employer group health plan and wants to enroll in Medicare, he or she qualifies for what type or enrollment? Late enrollment Open enrollment Special enrollment General enrollment

Special enrollment

Which of the following is not an option for eligible individuals to enroll in Medicare Part D? Initial enrollment period for Medicare Special enrollment period October 15th through December 7th each year Annual enrollment period for Medicare Part D

Special enrollment period Individuals have 2 options for enrolling in a Medicare Part D plan: during the initial enrollment period for Medicare; or during the annual enrollment period for Medicare Part D: October 15th through December 7th each year. Coverage begins on January 1st of the following year

Which program is not offered through a state Medicare savings program? Qualified Medicare beneficiary program QMB Qualify disabled working individual program Qualified individual program Special-needs awareness program

Special needs awareness program

If an applicant assets are above the allowable limits for Medicaid, the applicant must nearly exhaust them to be eligible. What is this process of exhausting assets called? Asset depletion Diminution of assets Paying out Spending down

Spending down

Congress amended the law regarding Medicaid spend down rules to eliminate what problem? Spousal abuse Spousal impoverishment Spousal abandonment Spousal participation

Spousal impoverishment

Which of the following pays monthly income for food, shelter and clothing needs to individuals with limited incomes, or disabled or blind, or are age 65 and older? Supplemental security income benefits Medigap Social Security Medicare

Supplemental security income benefits

What to types of long-term care insurance policies resulted from the health insurance portability and accountability act? Hospital triggered and a DL triggered Contributory and non-contributory Binding and nonbinding Tax qualified and non-tax qualified

Tax qualified and non-tax qualified

F is comparing the Medicare supplement that he offers with one that his customer, J, owns from a competitor. F leads Jay to believe that his current policy will not pay out as stated in the contract and suggest that day by his F's supplement. Which of the following unfair practices is F engaging in? High-pressure tactics Twisting Coercion Intimidation

Twisting Twisting is making miss leading statements or fraudulent comparisons of insurance policies or insurers to induce a person to lapse, forfeit, surrender, terminate, or two otherwise compromise an insurance policy to buy another policy from another insurer

Which of the following best describes the Medicare Part D "coverage gap?" After the $405 deductible has been met, the coverage gap begins When the individual pays 44% of all generic prescription drug costs When catastrophic coverage begins, the individual only pays a 6% copayment for each prescription drug When Medicare Part D pays all prescription drug costs

When the individual pays 44% of all generic prescription drug costs

B have a long-term care insurance policy with a return of premium option where option returns a part of the premium fee paid for the LTC coverage to be a state or to a named beneficiary when B dies. What is the amount of the premium returned based on? Whether B elects to receive limited benefits tax-free How well insurers sell both qualified and nonqualified LTC insurance policies How well or for how long B maintained his ability to perform daily activities without assistance Whether B used the policies benefits and if so, to what extent

Whether B elects to receive limited benefits tax-free

When a person applies for Medicaid, the limit and the types of income and assets counted vary depending on which of the following? Whether the applicant has a spouse who requires support Whether the applicant is at least 65 years of age Whether the applicant has relatives who require support Whether the applicant has extraordinary need and require extraordinary support

Whether the applicant has a spouse who requires support

J received the following home health care services: housekeeping, shopping, custodial care, and physical therapy. Which of these services will be covered by Medicare Part A? custodial care shopping housekeeping physical therapy

physical therapy

G owns a Medicare Advantage policy and requires emergency care while visiting her daughter, but there are no network providers nearby. What should G do? travel home where she can see a network provider forego treatment see a non-network provider get approval from Medicare before seeing a non-network provider

see a non-network provider

The special needs plan (SNP) under Medicare Advantage provides for all of the following, EXCEPT those who are severely disabled those with acute onset conditions those who are Medicare and Medicaid eligible those who are institutionalized

those with acute onset conditions

A person who is not eligible for premium free Medicare Part A coverage must pay A monthly premium of $422 A monthly premium of $283 A monthly premium of $141.50 A monthly premium of $115.40

A monthly premium of $422

An individual who is not eligible for premium free Medicare Part A coverage may apply for coverage during which of the following enrollment periods? All of the above Initial enrollment period General enrollment period Special enrollment period

All of the above

Medicare Part C may be offered as a/an: All of the above PPO Private fee for service HMO

All of the above

Medicare Part D has: Deductibles All of the above Copayments Monthly premiums

All of the above

When can an individual enroll into, drop, or change Medicare Part C plans? October 15th through December 7th All of the above During the general enrollment period During the initial enrollment period

All of the above

How is Medicare Part A primarily funded? FICA payroll taxes Premium payments None of the above Through donations

FICA payroll taxes

E is 67 years old and incurred the following medical expenses for the year: $100 for an eye exam, $300 for a dental exam, $3,000 for a hearing aid. What amount of E's expenses is covered by Medicare Part A? $3,000 $0 $400 $3,400

$0 Part A does not cover eye exams, dental exams, or hearing aids

What is the deductible for each Medicare Part A benefit period? $1,340 $450 $141.50 $283

$1,340

What is the Medicare Part B annual deductible? $283 $1,100 $450 $183

$183

Depending on the types of services required and rendered, what is the annual cost of long-term care? $10,000-$50,000 $20,000-$50,000 $40,000-$100,000 $30,000-$60,000

$40,000-$100,000

How much is the maximum deductible that must be paid before Medicare Part D begins to cover the cost of prescription drugs? $4,550 $405 $450 $162

$405

Which of the following correctly states the Medicare Part D late enrollment penalty? 50% penalty calculation 1% penalty calculation 10% penalty calculation 30% penalty calculation

1% penalty calculation

Medicare has how many enrollment periods? There is no limit 2 3 1

3 Initial, General, special

All of the following are true regarding coverage of hospice care under Medicare, EXCEPT Drugs and occupational therapy are covered Counseling services are covered Nursing care is covered A deductible is required before coverage begins

A deductible is required before coverage begins

How much is the penalty for delaying enrollment in Medicare Part A or B beyond the initial eligibility period? 10% 50% 20% 1%

10%

Those who buy tax qualified long-term care insurance policies can deduct their premium payments by the amount that their unreimbursed medical expenses including LTC premiums exceed what percent of your adjusted gross income? 6% 10% 7.5% 5%

10%

Medicare Part B will not pay skilled nursing home care after 80 days 100 days 50 days 10 days

100 days

What is the maximum number of days of skilled nursing facility care for which Medicare will pay benefits? 100 days 75 days 30 days 60 days

100 days

Nursing home care benefits under Medicare Part A last for how long? 60 days 90 days 100 days 20 days

100 days After the first 20 days of care, the patient must pay a coinsurance amount. Beyond 100 days, no medicare benefits are available for care in a skilled nursing facility

What percent of clinical laboratory services, such as blood tests and urinalysis, will Medicare Part B pay? 20% 100% 80% 50%

100%

M Is considered a qualified Medicare beneficiary in North Carolina, which means that Medicare aid will pay for all of the following except Part b copayments Part B premium 100% of the part D prescription drug costs Deductibles for part a and B

100% of the part D prescription drug costs

A long-term care insurance policy is designed to provide coverage for at least how many months? 24 18 12 36

12

Brian is insured under Medicare Part A and enters the hospital for surgery. Assuming he has not yet tapped into his lifetime reserve, what is the maximum number of days that Medicare will pay for his hospital bills? 120 days 150 days 90 days 60 days

150 days

How many days of care in a specialty psychiatric hospital will Medicare Part A cover during a person's lifetime? 100 210 190 120

190

How many days of skilled nursing facility care are fully covered under Medicare Part A? 90 60 150 20

20

If a policyholder becomes eligible for Medicaid, a Medicare supplement policy must suspend benefits and premiums at the policyholders request for up to how many months? 36 6 24 12

24

Disabled individuals are eligible to begin receiving Medicare Part A benefits after a waiting period of ___ months. Benefits will begin in the ___ month of disability 12; 13th 24; 25th 5; 6th 18; 19th

24; 25th

What is the blood deductible? Medicare does not have a blood deductible 3 pints under both Medicare Part A and B 3 pints biannually 3 pints annually under Medicare Part A or Part B

3 pints annually under Medicare Part A or Part B

How long is the conversion. For group long-term care policies? 90 days 31 days 60 days 180 days

31 days

Individual long-term care policies are generally available to applicants between the ages of 40 and 65 40 and 85 65 and 85 30 and 59 1/2

40 and 85

A Medicare supplement policy cannot define a pre-existing condition more restrictively then a condition for which medical advice was given or treatment recommended by or received from a medical doctor within how many months before the effective date of coverage? 3 12: 24 6

6

What is the allotted number of lifetime reserve days under Medicare Part A? 150 60 10 20

60 Everyone has 60 lifetime reserves after 90 days of inpatient care

J, a Medicare recipient, is required to remain in the hospital beyond 90 days. The expenses of this hospitalization can be covered by which of the following? 45 day lifetime reserve 30 day reserve that can be replenished Unlimited lifetime reserve 60 day lifetime reserve

60 day lifetime reserve

How long is the initial enrollment period under Medicare? 3 months 4 weeks 7 months 1 month

7 months

Premiums for Medicare part B and Medicare supplement insurance are tax-deductible if, when added to other medical expenses, they exceed how much of a persons adjusted gross income? 10% 2% 5% 7.5%

7.5%

For how many days in a benefit period does Medicare pay for hospitalization? 30 days 60 days 90 days 180 days

90 days

A contract designed primarily to admit reimbursement under Medicare for Hospital, medical or surgical expenses is An alternative healthcare plan A Medicare supplement plan A separate coverages plan And assisted living plan

A Medicare supplement plan

Which of the following best illustrates what makes a states long-term care partnership policy different from other long-term care policies? A partnership is established between the insurer and the insured A partnership policyholder tax favored status The insured that offer partnership policies are more reliable and have better customer service Partnership policies are endorsed by senior advocacy groups

A partnership policyholder tax favored status

To be eligible for PACE, and individual must be Age 50 or above and require nursing home care Age 40 or above and disabled Age 60 or above live in a PACE service area, and require home health care Age 55 or above, live in a PACE service area, and state certified as requiring nursing home care

Age 55 or above, live in a PACE service area, and state certified as requiring nursing home care

All of the following are waves long-term care coverage may be offered, except AD&D rider Individual plan Group plan Life insurance rider

AD&D rider

Long-term care insurance plans differ in which of the following ways? According to whether they require prior hospitalization as a benefit trigger According to whether the LTC insurance policies offer one or two categories of care According to the level of care offered and the services provided According to a persons physical or mental condition and ability to function independently

According to the level of care offered and the services provided

Premiums for Medicare Part B are based on: An individual's eligibility for premium free Medicare Part A coverage Medicare Part A deductibles An individual's annual earnings Annually indexed rates

An individual's annual earnings

How often must insurers in North Carolina file their Medicare supplement policy rates and reading schedules with the commissioner? Every two years Every five years Every five years Annually

Annually

Which statement about the Medicare supplement program is NOT correct? All Medicare supplement policies must be issued as guaranteed renewable. Once issued, a policy cannot be cancelled because of the insured's health Plan A provides the basic core benefits All companies selling Medicare supplement policies must sell Plan A As Medicare adjusts its deductibles and co payments, Medicare supplement policies can align their benefits to match the adjustments, but that is not required

As Medicare adjusts its deductibles and co payments, Medicare supplement policies can align their benefits to match the adjustments, but that is not required

B just enrolled in a Medicare Advantage plan, while his brother is covered by Original Medicare. Which of the following statements is correct? B must pay monthly premiums, while T does not pay a premium B will receive his health care from a Medicare sanctioned managed care HMO or PPO, while T can select his own provider Both B and T will receive prescription drug coverage B and T will receive almost identical benefits under their plans

B will receive his health care from a Medicare sanctioned managed care HMO or PPO, while T can select his own provider

Jay's long-term care policy contains a waiver of premium provision, which means that she can start paying premiums when she Begins receiving long-term care benefits under her policy Spends down or assets to $2000 or less Becomes eligible for Medicare eight Is ill

Begins receiving long-term care benefits under her policy

A person eligible for Medicare Part A or Part B who missed the initial enrollment period can signup during an annual enrollment period, which occurs when? One year after IEP Between Jan. 1 and Mar. 31 each year 60 days after the end of IEP 6 months after the IEP

Between Jan. 1 and Mar. 31 each year

Which of the following is a Medicare supplement core benefit? Medicare part B deductible Foreign travel Blood deductible Medicare part A deductible

Blood deductible

How can a long-term care policy be written? Both stand-alone policy and rider None of the above Writer only Stand alone policy only

Both stand-alone policy and rider

What is the term for private organizations that administer Medicare Part B benefits? Intermediaries Medical providers Carriers Peer Review Organizations

Carriers

Eligibility for Medicaid is determined by state requirements. Which of the following is not one of those requirements? Asset limitations Citizenship limitations Income limitations Disability or age

Citizenship limitations

Medicare makes what payment for services in which another payer may be responsible? Conditional Payment Temporary Payment Transitional Payment Interim Payment

Conditional Payment

The core supplementary policy (plan a) developed by NAIC as a standard Medicare supplement policy includes all of the following, except Coverage for the part a Medicare copayments for approved hospital charges Coverage for the part a Medicare deductible Coverage for the first 3 pints of blood or packed cells each year Coverage for the 20% part B: insurance amounts for Medicare approved services

Coverage for the part a Medicare deductible

What must the recipient pay after the Medicare Part A deductible is paid? Hospital coinsurance or co-payment for the 31st to the 60th day Daily hospital coinsurance or co-payment for the 61st to the 90th day Hospital coinsurance or co=payment for the 61st to the 120th day Hospital coinsurance or co-payment for the 31st to the 90th day

Daily hospital coinsurance or co-payment for the 61st to the 90th day

Which of the following medical services is not excluded under Medicare Part B? Routine Physical Exams Diagnostic Tests Custodial Care Skilled Nursing Care

Diagnostic Tests

S, age 67, is covered by a group health plan that is scheduled to terminate on March 1.S can enroll in Medicare Part B without having to pay the 10% premium surcharge if he enrolls when? During the first general enrollment period after his group coverage ends During the six month period following the month his group coverage ends During the eight month period following the month his group coverage ends During a special enrollment period beginning six months after his group coverage ends

During the eight month period following the month his group coverage ends

Which of the following statements regarding Medicare Part C coverage is true? Each Medicare Part C plan is different, so premiums vary as a result Coverage for Medicare Part D, if included in Medicare Part C, is always included in the premium Medicare Part C plans never offer prescription drug coverage Medicare Part C plans never have annual deductibles

Each Medicare Part C plan is different, so premiums vary as a result

Which entity handles claims for Part A from hospitals, skilled nursing facilities, home health agencies, and hospices? Carrier Utilization Review Committee Quality Improvement Organization Intermediary

Intermediary

Which statement about the supplementary medical insurance plan, Part B, of Medicare is correct? It pays for all of a subscriber's long term care and nursing home needs It is optionally available to anyone covered under Medicare Part A It is mandatory for individuals covered by Medicare Part A It requires the payment of a one time premium before coverage will begin

It is optionally available to anyone covered under Medicare Part A

When is the general enrollment period for Medicare? January 1st through March 31st The six month period spanning three months prior to reaching age 65 to three months after reaching age 65 March 15th through November 15th November 15th through December 31st

January 1st through March 31st

What Medicare supplement pot plants provide for payments to limit a person's annual out-of-pocket medical costs related to coinsurance, co-pays, and deductibles? M and N C and D I and J K and L

K and L

All of the following are LTC non-forfeiture benefits, except Life annuity Cash value Extended term insurance Reduced paid up

Life annuity

Medicare Part A hospital insurance covers, within certain limits, all of the following expenses, EXCEPT Long term care Home health care costs Hospice Costs Inpatient hospital cost

Long term care Within certain limits, Medicare Part A covers skilled nursing facility costs, but no long term care costs

Insurers must offer inflation protection in which of the following policies? Long-term care Medicaid Medigap Medicare part C

Long-term care

If a person may require more than 90 days of care what should he or she probably have? Medicaid Medicare part B Long-term care insurance Medicare part a

Long-term care insurance

Long-term care insurance differs from Medigap in which of the following ways? Long-term care insurance provides custodial care Long-term care insurance must provide a 30 day free look. Long-term care insurance may impose a six month pre-existing condition exclusion Long-term care insurance must be guaranteed renewable

Long-term care insurance provides custodial care

What serves as the primary point of contact for provider enrollment and Medicare coverage? AQOs LCDs QIOs MACs

MACs

All of the following are available to Medicare beneficiaries through the Medicare Advantage Program, EXCEPT PSOs HMOs Medicaid PPOs

Medicaid

Individuals enrolled in ______ are automatically covered by Medicare Part D Medicaid Medicare Part A and B Medicare Part C Tricare

Medicaid

Which of the following statements best describes the Medicaid benefit program? Medicaid provide a range of health services for beneficiaries in all states, but services vary from county to county Medicaid provide a range of health services for beneficiaries, but services vary from state to state Medicaid provides the same range of health care services for beneficiaries in all states Medicaid provide a range of health care services for beneficiaries, but service is vary from city to city

Medicaid provide a range of health services for beneficiaries, but services vary from state to state

Which of the following accurately describes differences between tax qualified and non-tax qualified long term care insurance plans? Medical necessity cannot be a benefit trigger under tax qualified LTC plans Non-tax qualified LTC plans require an inability to perform two out of six activities of daily living ADLs Cognitive impairment must be severe under non-tax qualified plans Medical necessity cannot be a benefit trigger with non-tax qualified LTC plans

Medical necessity cannot be a benefit trigger under tax qualified LTC plans

Who acts as the fiscal intermediary for Medicare? Medicare Fiduciaries Medicare Coverage intermediaries Local Coverage Determinators Medicare Administrative Contractors

Medicare Administration Contractor

Who regionally manages policy and payment related to reimbursement for Medicare? Medicare Fiduciaries Local Coverage Determinators Medical coverage intermediaries Medicare Administrative Contractors

Medicare Administrative Contractors

All of the following statements about the way Medicare Parts A and B are funded are true, EXCEPT: Medicare Part B is funded by FICA payroll taxes Medicare Part B is funded in part by participants' contributions Medicare Part B is funded in part from general revenues Medicare Part A is funded by FICA payroll taxes

Medicare Part B is funded by FICA payroll taxes Part B is financed in part by participants' contributions and in part by tax revenues because participation is voluntary

Medicare Part C is a combination of parts? Medicare Parts A and D Medicare Parts C and D Medicare Parts A and B Medicare Parts A, B and D

Medicare Parts A, B and D

Medicare made a conditional payment to cover J's medical expenses after he was injured by a third party in a car accident. What happens if the third party's insurance company reimburses his care? Medicare can recover the conditional Payment only if it files a lien against J's Medicare benefits Medicare can recover the conditional Payment Medicare cannot recover from J Medicare can recover the conditional Payment only from the insurance company

Medicare can recover the conditional Payment

How would you explain the meaning of "Medicare Approved" to a client? Medicare must approve the medical service in advance Medicare must approve the health care provider in advance Medicare must approve the patient in advance Medicare must approve the primary payor in advance

Medicare must approve the health care provider in advance

Is enrolled in Medicare parts ANB and is now eligible for his state Medicaid program. He incurred $500 and doctors fees this month. How will this expense be paid? Medicaid and Medicare must share the cost of the doctors fees Medicaid must pay benefits first Medicare must pay benefits first Neither Medicaid or Medicare must pay for the doctors fees

Medicare must pay benefits first

All of the following statements about Medicare part a home healthcare are correct, except No prior hospitalization is required for these services to be covered No maximum number of home health care visits applies. Medicare part a pays 100% of the approved amount for the services Medicare part a pays 80% of The approved amount for durable medical equipment, such as wheelchairs Medicare part A pays 50% of the approved amount for disposable medical supplies, such as bandages

Medicare part A pays 50% of the approved amount for disposable medical supplies, such as bandages

All of the following are a Medicare supplement additional benefits, except Preventive care Skilled nursing facility care part a coinsurance for days 21 through 100 Medicare part B excess charges Medicare part B 20% coinsurance

Medicare part B 20% coinsurance

Which of the following is a Medicare supplement additional benefit? Blood deductible Medicare part A copayments for approved hospital charges for the 60 lifetime reserve days Medicare part A copayments for approved hospital charges during the 61st through 90th day of hospitalization Medicare part B deductible

Medicare part B deductible

What program receive funds from Medicaid to assist individuals in paying Medicare premiums? Medicare Medicaid Medicare savings program Medicare supplement policy's

Medicare savings program

M wants to purchase a Medicare supplement policy that includes prescription drug coverage. As his advisor, you inform him that If you choose is a policy with prescription drug coverage, the policy will be significantly more expensive He should purchase a high deductible plan to offset the increased cost of prescription drug coverage Medicare supplement plans can only offer a limited prescription drug benefit Medicare supplement plans can no longer contain prescription drug coverage

Medicare supplement plans can no longer contain prescription drug coverage

As Medicare adjusts it's deductibles and copayments, what must Medicare supplement policies do, and what can they not do? Medicare supplement policies must keep their benefits the same for 18 months, but they may selectively increase or decrease benefits after the end of that period Medicare supplement policy's must align their benefits to match the adjustments, and they cannot drop people for health reasons Medicare supplement policies do not have to align their benefits to match the adjustments. They cannot drop coverage from an existing insurance for health reasons Medicare supplement policies must increase their benefits by the same or greater amount, and they may drop certain people for health reasons

Medicare supplement policy's must align their benefits to match the adjustments, and they cannot drop people for health reasons

Which of the following BEST describes how a Preffered Provider Organization (PPO) is less restrictive than a Health Maintenance Organization (HMO)? Typically not subject to deductibles More benefits available Not regulated by the federal government More physicians to choose from

More physicians to choose from

Medicare supplement plans are provided by private insurance companies, but federal law ensures that people who meet the minimum requirements can qualify for coverage. What are those requirements? People must be at least 60 years old and in good health. They must apply for a Medicare supplement policy at the same time they enrolled in Medicare part A People must be at least 65 years old, regardless of their health condition, and must apply for Medicare supplement Policy within six months of enrolling in Medicare part B People must only be at least 65 years old to apply for Medicare supplement policy People must be at least 65 years old, regardless of their health condition, and must apply for a Medicare supplement policy while in rolling in part B

People must be at least 65 years old, regardless of their health condition, and must apply for Medicare supplement Policy within six months of enrolling in Medicare part B

Your client wants to purchase a Medicare supplement policy with a high deductible option and low premium payments. Which plan would you recommend among the following options? Plan K or L Plan N Plan D Plan F

Plan K or L

Medicare supplement plan a provides the copayment for hospitalization from day 61 through day 90. Which of the other Medicare supplement plans also provide this coverage? Plans A through N Plan A and B only Plans A and C only Plans C and D only

Plans A through N

Which of the following statements about Medicare supplement plans K and L is correct? Plans K & L represent a higher level of benefits Plans K & L can offer a high deductible options, which further decrease premium payments Plans K & L premiums are much higher than those associated with other plans Plans K & L both pay 80% of Medicare coinsurance, co-pays, and deductibles after the insured annual out-of-pocket limit is reached

Plans K & L can offer a high deductible options, which further decrease premium payments

For Medicare supplement plans K & L, which of the following statements is true? Plans K and L pay 80% of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached Plans K and L pay 50% of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached Plans K and L pay 100% of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached Plans K and L pay 70% of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached

Plans K and L pay 100% of Medicare coinsurance, co-pays, and deductibles after the insured's annual out-of-pocket limit is reached

All of the following are true regarding Medicare Part C premiums and deductibles, EXCEPT Premiums for Medicare Part D may be charged separately if prescription coverage is included in the plan Premiums vary from plan to plan Some Medicare Part C plans charge an annual deductible Premiums are separate for Medicare Parts A and B

Premiums are separate for Medicare Parts A and B

Medicare supplement policies cover all of the following, except 20% part B copayment Prescription drugs Medicare part a deductible An allowance for blood

Prescription drugs

Which of the following medical services is not covered by Medicare Part B? Private duty nursing Preventive Care Physician's fees Outpatient care

Private Duty Nursing

What is a method of reimbursement in which Medicare payment is made based on predetermined, fixed amount? Standard Payment System (SPS) Prospective Payment System (PPS) Predetermined Payment System (PPS) Assigned Payment System (APS)

Prospective Payment System (PPS)

Medicare Part A and B have gaps in their coverage, where Medicare subscribers must pay the costs. What do these gaps include? Benefits for doctor's services, but not for inpatient and outpatient medical and surgical services, under Part B The qualifications that participants must be at least 65 years old and must apply for coverage within six months of enrolling in Medicare Part B Coverage for inpatient hospital costs, but not for skilled nursing facility costs, under Part A The Part A deductible and daily co-payments for hospitalization and nursing home care, and the Part B deductible and its required 20 percent coinsurance or co payments

The Part A deductible and daily co payments for hospitalization and nursing home care, and the Part B deductible and its required 20 percent coinsurance or co payments

Medicare pays the remaining 80% of covered Medicare Part B charges after: The blood deductible is met The annual deductible is met The $1,000 deductible is met Premiums are paid

The annual deductible is met

If an individual enrolls in Medicare before their birthday month and their birthday is NOT the first day of the month, when does coverage begin? The first day of the month after their birthday The first day of the next quarter year after their birthday The first day of the month prior to their birthday The first day of their birthday month

The first day of their birthday month

For the skilled nursing coverage to be covered under Medicare part A, all of the following must apply, except Admission to the facility must occur within 30 days of hospital discharge Care at the facility must be related to the care at the hospital The patient must have supplementary health insurance Care at the facility must be related to the care at the hospital

The patient must have supplementary health insurance

All of the following are required to qualify for Medicare's nursing facility benefit, EXCEPT The patient must spend at least three days in a hospital within past 30 days The patient must meet state income limits The patient must enter a Medicare certified skilled nursing facility The patient's physician must certify that skilled care is required

The patient must meet state income limits

Eligible people who apply for Social Security retirement benefits at age 65 are automatically enrolled in Medicare Part A. What happens if a person does not apply for Social Security retirement benefits at age 65 but still wants Medicare? The person is still automatically enrolled in Medicare Part A The person can only apply for Medicare Part B The person must enroll for Medicare Part A The person is automatically dropped from Medicare rolls

The person must enroll for Medicare Part A

You have a Medicare select client who wants to choose her own doctor. The doctor is not part of the provider network. What can you tell her to expect? She may pay slightly higher copayment Under Medicare, she can choose her provider The plan will not cover the services She can choose her own doctor if she makes a copayment

The plan will not cover the services

M, 72, thinks she may be spending a significant amount of money on medical expenses. She considers transferring her assets to her son so that she will be poor enough to qualify for Medicaid. Her son cautions her about Medicaid's look back rules. How old these rules pertain to her? They will reflect the amount of Medicaid benefits paid on M's behalf during the first six months of Medicaid eligibility These rules allow Medicaid to look back on transfers of assets made during the 60 months before applying for Medicaid Look back Rules look at the income, if any, that M earned during the 36 months before she applied for Medicaid They will reflect the amount of benefits Medicare pays for care that Marilyn receives if she is in a skilled nursing home facility

These rules allow Medicaid to look back on transfers of assets made during the 60 months before applying for Medicaid

All of the following statements about the purpose of Medicare supplement policies are correct, except Medicare supplement policies were designed mainly to supplement reimbursements under Medicare Medicare supplement policies are also known as Medigap policy's They were designed to make funds available to pay medical services providers They help pay for the hospital, medical, or surgical costs of persons eligible for Medicare

They were designed to make funds available to pay medical services providers

In general, long-term care insurance policies issued can limit or exclude coverage with respect to which of the following? Treatment for a specific type of illness Treatment for a specific medical condition Treatment for conditions covered by Medicaid Treatment for injuries resulting from a specific type of accident

Treatment for conditions covered by Medicaid

E is enrolled in a Medicare Part D plan but would like to change plans and obtain better coverage. At what point during the year can he switch to a different Part D plan? each year from January 1 until March 1 at any time between November 15 and December 31, Medicare's annual election period between June 1 and September, Medicare's special election period

between November 15 and December 31, Medicare's annual election period

All of the following must be met for a person to receive Medicare Part D benefits, EXCEPT must have Medicare Parts A and B must have Medicare Parts C must enroll in a Medicare Part D plan in their service area If there are no Medicare Part D plans in their service area, a federal standard plan will be provided

must have Medicare Parts C

P, age 80, just learned that he is eligible for Medicare's home health care benefits, which means that he can receive full time housekeeping services part time housekeeping services occupational therapy services in his house custodial care

occupational therapy services in his house