study blue (LTC)

Which of the following types of care is covered by Medicare Part A? A) outpatient hospital treatment. B) clinical laboratory services. C) first three pints of blood .D) skilled nursing care.

.D) skilled nursing care.

All are exclusions under the LTC policy except: A) Rest cures. B) Nervous or mental disorders that have no demonstrable organic cause. C) Chemical dependency on prescription drugs. D) Injury arising due to committing a felony.

c)Chemical dependency on prescription drugs.

Which of the following is a factor in the evolution and increasing availability of LTC policies? A) Consumers are increasingly aware that Medicare does not cover long term care. B) Very few people are expected to spend any time in a nursing home. C) Long term care insurance is considered to be very inexpensive. D) Long term care provides prescription drug coverages.

A) Consumers are increasingly aware that Medicare does not cover long term care.

Which of the following is correct concerning an LTC policy? A) Defining a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage. B) Providing coverage for only skilled nursing care instead of lower levels of care. 'C) Cancelling, nonrenewing, or terminating a policy on the grounds of age. D) Establishing a new waiting period when existing coverage is converted or replaced by a new form, except when the insured voluntarily selects an increase in benefits.

A) Defining a preexisting condition as a condition for which advice or treatment was recommended or received within 6 months of the effective date of coverage.

All 12 Medicare supplement or (Medigap) policies are required to be standardized. MSP's are required to have all of the following, EXCEPT A) Have the same premium. B) Have the same core benefits. C) Cover the first 3 pints of blood for Medicare Part A and Part B. D) Part B coinsurance for medical insurance.

A) Have the same premium.

Which of the following best describes the characteristics of Preferred Provider Organizations (PPO's)? A) If service is obtained outside the PPO, benefits are reduced and costs increase. B) PPO's are generally public in nature rather than private. C) Health care providers themselves are barred from forming a PPO due to conflict of interest. D) PPO's operate like an HMO on a prepaid basis.

A) If service is obtained outside the PPO, benefits are reduced and costs increase.

The annual general enrollment period for Medicare Part B begins onA) January 1.B) 1-FebC) 1-MarD) 31-Mar

A) January 1

Which statement regarding Medicare is not true? A) Medicare may be the primary payor to any employer group health plan coverage. B) It is a federal health program for people 65 and older and others of any age, who have received Social Security Disability Benefits for at least 2 years. C) The initial enrollment period lasts 7 months and begins on the 1st day of the 3rd month before one is eligible for Medicare. D) Hospitals and other providers of health care wanting to participate in the Medicare program must be licensed by the state.

A) Medicare may be the primary payor to any employer group health plan coverage.

An insurer offering Medicare Supplements to the senior clients of this state must: A) Offer Core Benefit Plan A if they sell any of the other plans. B) Offer the broader coverage plans only. C) Offer any plan from C to S. D) Offer Core Benefit Plans only.

A) Offer Core Benefit Plan A if they sell any of the other plans.

Which of the following is NOT one of the core benefits included in any Medicare supplement policy? A) Part A deductible for each benefit period. B) Part A co-payments days 61 through 90 of hospitalization. C) Blood deductible for first three pints. D) Part B co-payments on Medicare-approved charges for doctors and medical services.

A) Part A deductible for each benefit period.

A Medicare supplement policy that provides only the basic core benefits is known as:A) Plan AB) Plan FC) Plan G

A) Plan A

Which Long-Term Care definition does not match the coverage? A) Residential Care - health care provided in one's home under a planned program established by his/her attending physician. B) Respite Care - provides relief to the caregiver not the long-term care patient. C) Custodial Care Facility - a licensed facility, operated according to the laws of the state, under the supervision of an R.N. D) Skilled Nursing Facility - a licensed facility, operated in accordance with the laws of the state, providing skilled nursing care under the supervision of a physician.

A) Residential Care - health care provided in one's home under a planned program established by his/her attending physician.

The Initial Enrollment Period for Medicare is 7 months in length. Which of the following is the start and stop dates for this period? A) The 1st day of the 3rd month before eligibility starts and the last day of the 3rd month after the month of eligibility. B) January 1 to July 31, the year of his/her 65th birthday. C) 7 months after his/her 65th birthday. D) Medicare is an automatic enrollment program.

A) The 1st day of the 3rd month before eligibility starts and the last day of the 3rd month after the month of eligibility.

Anna is seeking a Medicare Supplement Policy. An agent has explained that all supplements must contain some of the same items. Which of the following is false? A) The insurer may provide a Buyer's Guide and an Outline of Coverage. B) The policy must contain an Outline of Coverage. C) A question about replacement must appear on the application. D) The policy must contain a 30-day free look provision on the first page.

A) The insurer may provide a Buyer's Guide and an Outline of Coverage. B) The poli

Medicare supplement insurance is designed to A) pay at least some of the health care costs that Medicare will not pay. B) supplement Medicaid. C) provide for a lengthy stay in a Long Term Care skilled nursing facility. D) provide disability income for senior citizens that are currently on Medicare.

A) pay at least some of the health care costs that Medicare will not pay.

A provision in the LTC policy that will cover the cost of replacing the primary care giver for a short period of time is A) respite care. B) hospice care. C) intermediate care. D) custodial care.

A) respite care.

All of the following must be offered or provided on a Long Term Care policy at the time of application, EXCEPT A) Inflation protection. B) 10 day free look period. C) Outline of coverage. D) Shoppers guide.

B) 10 day free look period.

After the deductible has been satisfied, Medicare pays the full cost of up to A) 45 days of inpatient hospital care. B) 60 days of inpatient hospital care. C) 120 days of inpatient hospital care. D) 365 days of inpatient hospital care.

B) 60 days of inpatient hospital care.

A type of Long-Term Care policy written to be renewable, may be convertible, and is more economical than an individual policy, is which of the following? A) A Franchise Policy B) A Group Policy C) A Policy Rider D) An Employer-Employee Policy

B) A Group Policy

The Minimum Benefit Standards under an LTC policy establish all of the following, except: A) An Outline of Coverage must be delivered to an applicant on the initial solicitation and prior to the presentation of the application form. B) Every LTC policy must be issued noncancellable as established on the first page of the policy. C) Every LTC policy must offer optional inflation protection to offset the increased costs of care. D) Every LTC policy must include basic policy requirements in the policy provisions.

B) Every LTC policy must be issued noncancellable as established on the first page of the policy.

Long Term Care Insurance is required to provide a benefit period of no less than A) Six months.B) One year.C) Two years.D) Three years.

B) One year.

Which statement is incorrect concerning Part B of Medicare? A) All Part B recipients pay a monthly premium. B) Part B covers prescription drugs up to $1,500 annually. C) Part B covers blood except for the first 3 pints per benefit period. D) Part B has an annual deductible and requires a copayment.

B) Part B covers prescription drugs up to $1,500 annually.

Medicare Supplement Insurance must meet certain minimum benefit standards in order to be offered to the general public. Those standards include all of the following, except: A) Will not include exclusions for any preexisting conditions if the condition occurred more than 6 months prior to the effective date of coverage. B) The policy may limit coverage to a single disease or affliction. C) If a group policy is replaced, the insurer must offer the same coverage to all of those persons covered by the original group plan. D) The policy must pay both accident and sickness expenses on the same basis.

B) The policy may limit coverage to a single disease or affliction.

In order to be qualified, a long-term care policy must require assistance with how many activities of daily living (ADL's) before benefits may be paid?A) OneB) Two C) Three D) Four

B) Two

The initial enrollment period for Part B of Medicare begins A) on their 65th birthday. B) on the first day of the third month before the month in which the individual attains age 65. C) on the first day of the month in which the individual attains age 65. D) January 1st of the year the individual turns age 65.

B) on the first day of the third month before the month in which the individual attains age 65.

Which of the following is/are true regarding a Medicare Supplement policy? A) All Medicare Supplement plans are designed to reflect and adjust to any changes made to Medicare. B) Changes in a Medicare Supplement plan that are made to mirror Medicare are subject to premium increases. C) Both A and B D) Neither A nor B

C) Both A and B

A Medicare benefit payment may be made to the medical provider: A) If the provider is secondary. B) If the claim is Part B Coverage only. C) If the benefit has been assigned. D) If the claim is Part A Coverage only.

C) If the benefit has been assigned.

Which of the following is not provided under Part A of Medicare?A) Hospice Care B) Home Health Care C) Outpatient Hospital Treatment D) Post-hosp

C) Outpatient Hospital Treatment

Which of the following is incorrect regarding how Medicare works? A) Part B is optional and offered to applicants when they become entitled to Part A. B) Part A is premium free to those who qualify through Social Security or railroad retirement or government employment. C) Part B covers routine physical exams and dialysis for those with kidney failure. D) Part B - outpatient service benefits are determined by consulting a national fee schedule.

C) Part B covers routine physical exams and dialysis for those with kidney failure.

Select the correct statement about long-term care policies. A) All LTC policies are required to have a 10 day examination period. B) LTC policies are only available for individuals age 65 and older. C) Present policies are more likely to pay benefits regardless of the level of care required by the insured. D) Present policies will pay benefits only if the insured has been diagnosed with a cognitive impairment, such as dementia.

C) Present policies are more likely to pay benefits regardless of the level of care required by the insured.

Randy had a preexisting condition for which coverage had been excluded since his Medicare Supplement Policy became effective 4 months ago. If Randy were to replace his Medicare Supplement Policy, what could be said about the preexisting condition under the new policy? A) The exclusion will be waived altogether. B) The exclusion reverts to a 6-month period.' C) The exclusion will be waived to the extent it had already been satisfied under the original policy. D) The exclusion remaining on the old policy will be added to the new policy.

C) The exclusion will be waived to the extent it had already been satisfied under the original policy.

A hospital Board of Directors decides to care for Medicare patients, what must be done to enable these services? A) The hospital must be inspected by the state board of health. B) The hospital must pay certification fees. C) The hospital must obtain a provider's certification and be licensed by the state. D) The hospital must obtain a provider's certification and a state inspection certificate.

C) The hospital must obtain a provider's certification and be licensed by the state.

Nursing or rehabilitative care that is required occasionally and can be performed only by skilled medical practitioners on a doctor's orders is A) allowed care. B) cognitive care. C) intermediate care. D) residential care.

C) intermediate care.

A Medicare Supplement policy may NOT exclude coverage for any preexisting condition that occurred A) 1 month prior to the effective date of coverage. B) 3 months prior to the effective date of coverage. C) 6 months prior to the effective date of coverage. D) 12 months prior to the effective date of coverage.

D) 12 months prior to the effective date of coverage.

Every LTC Policy that provides benefits of homecare or community-based services shall provide all of the following except: A) Adult day care B) Hospice services C) Respite care D) Acute care

D) Acute care

Home Health Care benefits, under a LTC Policy, may not be limited or excluded by A) Limiting benefits to services provided by Medicare-certified providers. B) Requiring a need for care in a nursing home if care is not provided. C) Requiring the existence of an acute condition. D) All of the above

D) All of the above

An insurance company's responsibilities under Medicare are all of the following, except: A) Review Medicare claims. B) Make sure Medicare does not pay all claims when Medicare is the secondary insurer. C) Handle claim processing and payments. D) Caution doctors about excessive fees.

D) Caution doctors about excessive fees.

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

D) Hospital Insurance

Long-Term Care policies may not be written as which of the following? A) Riders/Endorsements to life insurance policies B) Individual policies C) Group policies D) Medical coverage

D) Medical coverage

Medicare Part-D provides prescription drug coverage that requires the insured to pay all of the following, EXCEPT A) A Monthly premium. B) A Co-payment. C) An Annual deductible. D) Medicare Part-A premium.

D) Medicare Part-A premium.

Which of the following is not a Medicare Part A benefit? A) Hospitalizat B) Post hospital skilled nursing facility care C) Hospice care D) Outpatient hospital treatment

D) Outpatient hospital treatment

Which of the following are NOT eligible for Medicare coverage? A) People age 65 and older who are eligible for Social Security B) People age 65 and older not eligible for Social Security, but willing to pay a monthly premium. C) People of any age who have been entitled to disability benefits for 24 months D) People suffering from liver cancer

D) People suffering from liver cancer

All of the following statements are true regarding Long-Term Care policies, except: A) They must provide a free look period of at least 30 days. B) They must have a renewal provision shown on the first page of the policy. C) They must exclude coverage for drug addiction. D) They must require confinement in a hospital as a condition for payment.

D) They must require confinement in a hospital as a condition for payment.

Help in performing ADL's which can be performed by someone without medical skills or training, but must be based on a doctor's orders is A) inpatient care. B) skilled nursing care. C) Medicare. D) custodial or residential care.

D) custodial or residential care.

All of the following are benefits provided under Part A of Medicare EXCEPTA) inpatient hospital care.B) skilled nursing facility care.C) hospice care.D) hospital on staff doctors care.

D) hospital on staff doctors care.

The most important rating factor in a LTC policy is A) applicants face amount of life insurance. B) applicants work history.' C) applicants political affiliation. D) whether or not an individual can perform activities of daily living.

D) whether or not an individual can perform activities of daily living.