Chapter 8 life insurance test

If Medicare beneficiaries don't enroll in Medicare Part D when they are first eligible, what type of penalty must they pay each month they delay enrollment? A) 1% B) 2% C) 3% D) 4%

1%

If someone misses the window for Medicare during the General enrollment period( annual enrollment), the cost of Medicare part B goes up how much for each full 12 month period the individual could have had Medicare Part B?

10% penalty

For how many days of skilled nursing facility care will Medicare pay benefits?

100 ( treatment in a skilled nursing facility is covered in full for the first 20 days. from the 21st to the 100th day, the patient must pay the daily co-payment. there are no medicare benefits provided for treatment in a skilled nursing facility beyond 100 days)

Under medicare Part A, the first 60 days in a hospital are A) 25% covered B) 50% covered C) 75% covered D) 100% covered?

100% covered

If a person is disabled at the age of 27 and meets social security's definition of total disability, how many work credits must he/she have earned to receive benefits?

12 credits

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 days ( following hospitalization for at least 3 days, if medically necessary, Medicare pays for all covered services for the first 20 days in a skilled nursing facility. Days 21 through 100 require a daily co-payment)

Following an injury, a policy-owner covered under Medicare Parts A&B was treated by her physician on an outpatient basis. how much of her doctors bill will she be required to pay out-of-pocket?

20% of covered charges above the deductible

Which of the following must the patient pay under Medicare Part B?

20% of covered charges above the deductible ( As established by Medicare, the patient must pay 20% of covered charges above the deductible)

Once the person meets the stringent requirements for disability benefits, how long is the waiting period under Social Security before any benefits will be paid?

5 months (Must wait 5 months before benefits will be paid. Actual benefit payments start with the sixth month of disability)

How long is an open enrollment period for Medicare supplement policies?

6 months ( an open enrollment period is a 6-month period that guarantees applicants the right to buy Medigap once they first sign up for medicare Part B)

How long does the initial enrollment period for medicare part B last?

7 months ( begins 3 months before their 65 birthday and ends 3 months after their birthday month)

All of the following individuals may qualify for Medicare health insurance benefits EXCEPT A) A healthy person age 65 B) A person age 45 who has a permanent kidney failure C) A person under age 65 who is receiving social security disability benefits D) A retired person age 50

A retired person age 50 ( Under current federal laws, any of the described persons could qualify for Medicare, except individuals under age 65 who have no special circumstances)

What is the amount a physician or supplier bills for a particular service or supply?

Actual charge (Actual charge is the amount a physician or supplier bills for a particular service or supply)

in which medicare supplemental policies are the core benefits found?

All plans ( Benefits in Plan A are considered to be core benefits and must be included in other types. Therefore all types contain the core benefits offered by plan A)

In reference to the standard Medicare supplement benefits plans, what does the term standard mean?

All providers will have the same coverage options and conditions for each plan ( In reference to the standard Medicare supplement benefits plans, the term "standard" implies that all providers will have the same coverage options and conditions for each plan)

What is another term for the general enrollment period for Medicare part B?

Annual enrollment period ( General enrollment period, also known as annual enrollment period, runs from January 1st through March 31st of each year)

When does the " donut-hole" under Medicare Part D reset?

Annually

All of the following qualify for Medicare Part A EXCEPT A) Anyone that qualifies through social security B) Anyone who is at the end stage of renal disease C) Anyone who is over 65, not covered by social security, and is willing to pay premium. D) Anyone who is willing to pay a premium

Anyone who is willing to pay a premium ( For medicare Part A, a person must be age 65 or otherwise to qualify)

Which of the following is NOT an enrollment period for medicare Part A applicants? A) Initial enrollment B) Special enrollment C) General enrollment D) Automatic enrollment

Automatic enrollment ( there are 3 types of enrollment periods for Part A medicare: initial enrollment period, general enrollment period, and special enrollment period)

Core benefits are also known as

Basic benefits

Medicare supplement plan A provides only the ____ benefits

Core

Which of the following is NOT covered by Medicare? A) doctor bills B) Cosmetic surgery C) Outpatient expenses D) Surgery

Cosmetic surgery

Social security disability definition includes all the following EXCEPT A) The inability to engage in any gainful work B) Disability resulting from a medically determinable mental impairment C) A physical impairment expected to result in death D) Disability expect to last a least 6 months

Disability expect to last a least 6 months ( It must result in death or last a continuous period of 12 months)

An insured has Medicare Part D coverage. He has reached his initial benefit limit and must now pay 50% of his prescription drug costs. What is the term for this gap in coverage?

Donut hole ( Once the initial benefit limit is reached, a gap called a "donut hole" occurs, in which the beneficiary is responsible for a portion of prescription drug coverage

All of the following are advantages of an HMO and PPO for a Medicare recipient EXCEPT A) There are no claims forms required B) Elective cosmetic procedures are covered C) Prescriptions might be covered, unlike Medicare D) Health care costs can be budgeted

Elective cosmetic procedures are covered ( No claims forms required, most medical problems are covered for a set fee, HMO and PPO may pay services not usually covered by Medicare or Medicare supplement policies, such as prescriptions, eye exams, hearing aids, or dental care)

What is the difference between the medicare approved amount for a service or supple and the actual charge?

Excess charge (excess charge is the difference between medicare approved amount for a service or supply and the actual charge)

How many pints of blood will paid by Medicare supplement core benefits?

First 3 ( since Medicare will NOT pay the first 3 pints of blood, a Medicare supplement plan will cover that)

Which of the following is an eligibility requirement for social security disability income benefits?

Fully insured status

You did not enroll in Medicare Part B when you first became eligible. Which of the following would allow you another opportunity to enroll?

General enrollment period ( the individuals who did not sign up for Medicare part B when they were first eligible, may sign up during the general( or annual) enrollment period

A Medicare supplement plan MUST have at least which of the following renewal provisions?

Guaranteed renewable ( Medicare supplements must be at least guaranteed renewable)

Which of the following statements is correct?

HMOs may pay for services not covered by Medicare ( no claims forms are required, most medical problems are covered for a set fee)

An insured becomes disabled at age 22 and can no longer work. She meets the definition of total disability under Social Security. What other requirement must the insured have met to receive Social Security disability benefits?

Have accumulated 6 working credits in the past 3 years ( a maximum of 4 work credits can be earned in a year. the amount of credits varies by age. Persons disabled before the age of 24 can qualify for social security benefits with only 6 work credits earned in 3 years prior to the start of the disability)

Which of the following statements is NOT true concerning Medicaid A) it is a state program B) it is funded by state and federal taxes C) It is intended to provide medical assistance for certain categories of people who are needy D) It consists of 3 parts: Part A: Hospitalization, Part B: doctor's services, Part C: Disability income

It consists of 3 parts: Part A: Hospitalization, Part B: doctor's services, Part C: Disability income ( Medicaid is a state program funded by state and federal taxes that provide medical care for the needy. Part A-C are part of Medicare

All of the following statements about Medicare Part B are correct EXCEPT A) It is financed by tax revenue B) It is a compulsory program C) It covers services and supplies not covered by Part A D) It is financed by monthly premium

It is a compulsory program ( Part B is elective. individuals become eligible for Part B at the same time they become eligible for Part A, however Part B that monthly premium be paid.)

Concerning Medicare Part B, which statement is INCORRECT? A) It is known as medical insurance B) It offers limited prescription drug coverage C) It provides partial coverage for medical expenses not covered by Part A D) It is fulled funded by social security taxes (FICA)

It is fulled funded by social security taxes (FICA) ( Part B is funded by monthly premiums and from the general revenues of a federal government)

Which of the following statements concerning Medicare Part B is correct?

It pays for physician services, diagnostic tests and physical therapy ( For those who have purchased the coverage, Part B pays 80% of outpatient medical cost after a deductible has been met)

Which type of care is NOT covered by Medicare? A) Hospice B) Respite C) Hospital D) Long-term care

Long-term care

Which of the following programs expands individual public assistance programs for people with insufficient income and resources?

Medicaid ( Medicaid is a "needs" tested program administered by the states to provide assistance to person who are not able to provide for themselves)

Which of the following programs is made up of 4 parts, where the first part is paid for by FICA, and the second is financed by premiums and payroll taxes?

Medicare

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 ( medicare has 4 parts: A,B,C,D)

Which of the following statements is NOT correct? A) Medicare Part A provides hospital care B) Medicare Part B provides physician services C) Medicare Advantages must be provided through HMOs D) Medicare advantage may include prescription drug coverage at no cost

Medicare Advantages must be provided through HMOs

Which of the following statements pertaining to Medicare part A is correct?

Medicare Part A is automatically provided when an individual qualifies for social security benefits at age 65 ( Workers who have paid FICA taxes automatically qualify for Medicare Part A at age 65. Workers who qualify for part A also qualify for Part B, however it requires that a monthly premium be withheld from social security benefits)

Medicare Advantage is also known as?

Medicare Part C ( Formally known as Medicare-choice)

Doug decided to retire at age 62. when he applied for social security retirement benefits, he discovered

Medicare coverage was not available until the month of his birthday ( those who qualify for Medicare through social security are not eligible until age 65, unless they are totally disabled or suffer from kidney failure)

Medicare supplement plans are referred to as?

Medigap ( issued by private insurance companies that are designed to full some of the gaps in Medicare- due to deductibles, co-payment requirements, and benefit periods)

the primary eligibility requirements for Medicaid benefits is based upon?

Need ( Medicaid is a program operated by the state, with some federal funding, to provide medical care for those in need)

If one takes Social Security retirement benefits at age 62, what needs to be done at age 65 to qualify for Medicare?

Nothing ( Nothing needs to be done in this case. Medicare part A and B will automatically be effective the month you turn 65)

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?

Offer the supplement policy on a guaranteed issue basis ( Once a person becomes eligible for Medicare supplement plans, and during the open enrollment , coverage MUST be offered on guaranteed issue basis)

What is a another name for social security benefits?

Old age, survivors, and disability insurance

medicare part A services do NOT include which of the following? A) Hospice care B) Outpatient hospital treatment C) Post hospital skilled nursing facility care D) Hospitalization

Outpatient hospital treatment ( Outpatient treatment is covered under Part B)

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

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 ( Medicare Part A pays for these services, subject to co-payments and limitations on the number of care)

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 ( Medicare Part A pays for these services, subject to copayments and limitations on the number of days of care)

Which of the following statements is INCORRECT concerning Medicare Part B coverage? A) It is a voluntary program designed to provide supplementary medical insurance to cover physician services, medical services and supplies not covered under Part A B) Part B coverage is provided free of charge when an individual turns 65 C) Participants under Part B are responsible for an annual deductible D) Part B will pay 80% of covered expenses, subject to Medicare's standards for reasonable charges

Part B coverage is provided free of charge when an individual turns 65 ( Those who desire Part B coverage must enroll and pay a monthly premium)

Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?

Parts A and B of Medicare

Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?

Parts A and B of medicare

All of the following are covered by Part A of medicare EXCEPT A) In-patient hospital services B) Post-hospital nursing care C) Home health services D) Physician's and surgeon's services

Physician's and surgeon's services ( Physician's and surgeon's cervices are covered under Medicare Part B)

Which of the following must be present in all Medicare supplement plans

Plan A ( the benefits in Plan A are considered to be core benefits and must be included in the other types)

Medicare Part D provides

Prescription drug benefit

What does PIA stand for?

Primary Insurance Amount

Which of the following is NOT covered under Part B of Medicare policy? A) Home health care B) Lab services C) Physician expenses D) Routine dental care

Routine dental care ( Medicare Part B covers dental expenses resulting from an accident only)

Which of the following is NOT covered under Part B of a medicare policy? A) Home health care B) Lab services C) Physician expenses D) Routine dental care

Routine dental care (Medicare Part B covers dental expenses resulting from an accident only)

Which benefit is based on the persons Person's primary insurance amount (PIA)?

Social security disability benefit ( The amount of the social security disability benefit will be based on the person's primary insurance amount (PIA). the PIA is based on the persons average indexed earnings on which social security taxes have been paid)

What is available to individuals who are eligible for Medicare Part B based on their age, but who waited to enroll because they had a group health plan through their own, or spouses employer?

Special enrollment period ( SEP)

Which of the following is NOT covered under Plan A in Medigap insurance? A) Approved hospital costs for 365 days after the Medicare benefits end B) The 20% Part B coinsurance amounts for Medicare approved services C) The first 3 pints of blood each year D) The Medicare Part A deductible

The Medicare Part A deductible ( all of the above are parts of the basic benefits, except for the Medicare Part A deductible, which is a benefit offered through nine other plans)

For an individual who is eligible for Medicare at age 65, and who is still employed and covered under the employer's plan, which of the following is true?

The employer plan is the primary coverage, and medicare is the secondary coverage

Which statement regarding qualifications for social security disability benefits is NOT true? A) the individual must have proper insured status B) The individual must be at least 65 years old C) The individual must satisfy the waiting period D) The individual must meet the definition of a disability

The individual must be at least 65 years old

In which of the following situations would Social security Disability benefits NOT cease? A) The individual's son gets a part time job to help support the family B) The individual reaches 65 C) the individual dies D) The individual has undergone therapy and is no longer disabled

The individual's son gets a part time job to help support the family ( Benefits cease when an individual reaches age 65, dies or is no longer disabled. If a person has been receiving social security disability benefits at the time he or she turns age 65, the disability benefits cease and are replaced with Social security retirement benefits. At death, family benefits will continue as survivor benefits. Benefits will continue for an adjustment period of 3 months if an individual no longer satisfies the definition of disability)

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

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 inured must have first been hospitalized for 3 consecutive days

If someone is in the hospital with Medicare Part A for more than 90 days, who is responsible for paying all costs?

The person insured under Medicare Part A

Which of the following is correct about medicare?

The program is divided into 4 parts (A-D)

Hospice care is intended for?

The terminally ill

all of the following statements about medicare supplement insurance policies are correct EXCEPT A) They supplement Medicare benefits B) They are issued by private insurers C) They cover the cost of extended nursing home care D) They cover Medicare deductibles and co-payments

They cover the cost of extended nursing home care (Medicare supplement policies [medigap] do not cover the cost of extended nursing home care. Medigap plans are designed to fill the gap in coverage attributable to medicare's deductibles, co-payment requirements and benefit periods. these plans are issued by private companies)

Which of the following statements is CORRECT about social security?

To be eligible, one must meet certain requirements ( A person must have been employed in a job that is covered under social security, or the spouse of a deceased covered coworker)

Which of the following is NOT a factor in determining qualifications for social security disability benefits? A) Worker's age B) Number of work credits earned C) Worker's occupation D) Workers PIA

Worker's occupation ( A worker's specific occupation is not a factor in determining benefits, so as long as the worker has earned the required amount of work credits)

Once a "donut-hole" is reached under Medicare Part D, What is the beneficiary responsible for paying?

a percentage of prescription drug costs

Which of the following persons is NOT eligible for Medicare? A) a person who has been entitled to social security benefits for the last 6 months B) a person age 70 C) a person who has turned age 65 and continues to work D) a person who has a permanent kidney failure

a person who has been entitled to social security benefits for the last 6 months ( a person must have been entitled to social security benefits for 2 years to qualify for medicare)

What is Part C - Medicare advantage?

allows people to receive all their health care services through available providers

Under medicare Part A, after 60 days in a hospital, days 61-90 would be covered with a

copayment

All of the following would fall under the definitions of durable medical equipment EXCEPT A) oxygen equipment B) wheel chairs C) hospital bed D) hospital blankets

hospital blankets

What is the purpose of Medicare Part A?

hospital insurance, inpatient care in a nursing home, home health care, and hospice

Under Medicare Part D, what is catastrophic coverage

it occurs when the beneficiary's spending during the gap reaches the limit of gap coverage. catastrophic coverage will cover 95% of prescription drug costs.

How is Part A of Medicare financed?

its financed through a portion of the payroll tax (FICA)

How is Part B of Medicare financed?

its financed through monthly premiums paid by the insureds and from general revenues of the federal government

What is the purpose of Medicare part B?

medical insurance

What is Part C of medicare called?

medicare advantage

What is Part D of medicare for?

prescription drugs