LTC ExamFX
An insured enrolled in Medicare Part B last year. This year he has a yearly wellness exam on February 25. How much will the insured have to pay?
$0 because Medicare will cover all cost
A patient who has medicare part B goes to a doctor for treatment on January 1 and then again on July 15. What is the total deductible the insured will have to pay?
$233
A 45-year-old woman has Medicare Part A. She is admitted to the hospital for a 4-day stay and pays the total inpatient hospital deductible. Upon release from the hospital, she enters a Medicare certified skilled nursing facility for a 30-day stay. Her care in the skilled nursing facility is a continuation of the kind of treatment she received in the hospital. How much does she have to pay?
$3,501
A man is covered under medicare part A. He has a 10-day stay in the medicare certifeid skilled nursing facility. The cost per day is $400. How much will this insured have to pay?
$4000
A man with medicare part A coverage enters the hospital for 70 days of continuous stay. How much will he have to pay?
$5,446
The benefit period for the Medicare Part B deductible is
1 year.
A producer has replaced one Medigap policy with another. Both plans have the same benefits. The producer's first year commission is 20%. Her renewal commission is 10%. Both plans are with the same insurer. The producer's first year commission on the new policy is
10%
How many consecutive months of coverage must LTC insurance provide in this state?
12 months
Medicare will pay all costs of care in a SNF for the first
20 days
An insured has paqrt D coverage. upon reaching the approved limit, what % of the drug cost is the insured responsible for paying?
25%
When does the initial enrollment period for Medicare part B begin?
3 months before the month in which the enrolee turns age 65
During a hospital stay, a patient had to receive 5 pints of blood. A month later, in the same calendar year, he received 2 more pints of blood at the doctor's office. How many pints of blood will the patient have to pay for that year?
3 pints
According to a pre-existing provision in Medicare supplement policies, an insurer CANNOT deny a claim for issues incurred more than how many months from the effective date of coverage?
6 months
If an insured appeals a service on the Medicare Summary Notice (MSN) and sends a request to the Medicare Administrative Contractor, within how many will the MAC generally send the decision to the insured?
60 days
Under Medicare Part A, a new benefit period starts if an insured has not received any inpatient hospital care for many consecutive days?
60 days
According to the NC asset rules for medicaid insured, the look-back period for assets transferred to an individual is
60 months
In NC, the expected loss ratio for individual LTC insurance is at least
60%
For personal long term care, premiums are deductible to the extent they exceed what max percentage?
7.5%
A patient has part A and part B and is homebound with a wheelchair. What percent of the wheelchair will be paid by medicare?
80% of teh MC approved amount after teh patient has met the medicare part B deductible
A patient has medicare part B. She is receiving outpatient OT from a hospital upon the recommendation of her daughter. Medicare will pay
80% of the medicare approved amount after the annual deductible.
All of the following statements are true about HMOs EXCEPT
A Medicare HMO is not a Medicare Advantage Plan.
Prior to obtaining coverage through part D, individuals must have which of the following?
A or B
Which of the following persons is not eligible for medicare?
A person who is age 50 and has cancer.
the LTC insurance outline includes all of the following except
Advertising material
To be eligible for a medicare supplement policy a person must be
Age 65 and have A and B
A Private Fee-For-Service Plan must cover
All of the services covered under Medicare Part A and Medicare Part B.
When must the nonforfeiture benefit begin in long-term care policies?
At the end of the third year after the policy issue date
An outline of coverage for a medicare supplement policy must be delivered to the applicatn
At the time of the policy application
Most people are enrolled in Medicare Part A
Automatically.
In order to participate in medicare a person must?
Be a US Citizen or a permanent legal resident.
According to the NC LTC insurance regulations, services that include the performance of tasks incidental to activities of daily living that do not required services of a homemaker
Chore services
Which of the following will NOT be covered as an inpatient hospital care expense under medicare part A?
Clipper socks
A deficiency in a person's short or long-term memory, orientation as to person, place, and time, deductive or abstract reasoning, or judgement as it relates to safety awareness is
Cognitive impairment
A 72 year old woman works full time. She has a lot of health policies. What does she use first?
Company plan
Medigap Plan A includes
Core benefits only.
Skilled care includes all of the following except
Custodial care
Which of the following is EXCLUDED from coverage under Medicare Part B?
Custodial care received in the home.
If an insured did not take part B in the initial enrollment period, the insured may be able to enroll
During the GEP
Which of the following best describes Medicaid?
Eligibility standards are established by each state within national guidelines.
Which of the following statements is true regarding LTC insurance?
Every policy must offer nonforfeiture benefits to the applicant.
Part A deductible must be paid
For each benefit period.
A 65 year old man joined a private FFS plan. He is worried that his next visit won't be covered. What should he do?
Get a written notice.
Which of the following LTC policy classifications allows rates to be revised by the insurer on a class basis?
Guaranteed renewable
Medicare covers a part of the cost for all of these diagnostic tests EXCEPT
Hearing test.
Supportive services provided by qualified para-professionals
Homemaker services
Which of the following regarding lifetime reserve days under medicare part A is true?
Insureds do not have to use lifetime if they notify the hospital and pay all costs out of pocket.
A patient is considered homebound if the patient
Is normally unable to leave home
All of the following statements are true of a stand-alone prescription drug plan EXCEPT
It covers prescription drugs and basic medical expenses.
Which of the following is true regarding a suitability personal worksheet?
It must be submitted with an application
Following the General Enrollment period for Medicare Part B, coverage begins
July 1.
Any contract of insurance offering institutional and noninstitutionalized support to restore deteriorating health and to maintain functional independence is
LTC
In a long-term care policy, which of the following terms can only be used when the insurer does not have the right to change the premium?
Level premium
Hospice benefits are available for a beneficiary who has met all these except?
Longer than 6 months to live.
A 66-year-old man works for a small company with 15 employees. He has a group health plan with the company and Medicare Part A and Medicare Part B. Who is the primary payer?
Medicare
An insured who has Medigap Policy Plan B is covered for
Medicare Part A deductible and basic benefits.
Medicare Advantage includes all of the following plans EXCEPT
Medigap policies.
Which of the following may not be defined to include conditions other than neurosis, psychoneurosis, psychopathy, or psychosis?
Mental or nervous disorder
Immunosupressive drugs are
Needed for life
Doctors and hospitals who join a Medicare HMO are called the plan's
Network.
An NC resident has long term care. According to the policy, the company can never raise premiums. What is this?
Noncancellable and guaranteed renewable
Persons who plan to enroll in part b during the special enrollment period should
Not enroll in medicare part B during the initial enrollment period
An insured has a long-term care insurance policy that he purchased at the age of 55. When the insured reaches age 66, the company may
Not increase his premium because of age.
What will Medicare Part B pay for a patient's tooth extraction?
Nothing
A patient who has end stage renal disease enrolled in medicare on July 1 and started receiving dialysis treatments at the same time. Dialysis treatment will begin
October 1
An insured has end stage renal disease and has started dialysis treatment. If he enrolls in medicare, when will coverage begin?
On the 4th month of dialysis treatments
A medicare patient was hospitalized, then discharged, then admitted again. How many deductibles did they pay?
One
The traditional pay-per-visit arrangement available nationwide is known as
Original Medicare Plan.
Which of the following health conditions will be covered by a LTC policy?
Parkinson's disease
A patient covered by Medigap Plan A enters the hospital for a 61-day stay. Which of the following benefits is covered by his Medigap policy?
Part A copayment
If a premium rate on the insured's long-term care policy was increased, the insured may exercise all of the following options EXCEPT
Pay the increased premium but require the increase in coverage from the insurer.
Prior to enrolling in a Medigap policy, an insured was covered by a group health plan for 6 months. Which of the following is true regarded coverage for pre-existing conditions under the new Medigap policy?
Pre-existing conditions will be covered immediately.
A woman purchased a Medigap policy on December 6. The policy was issued on December 20. The policy was mailed by the company to the agent on January 1. The agent did not deliver the policy to the applicant until March 1. The applicant, then, chose to return the policy on March 28. The insurance company has to
Refund all premiums collected.
Which of the following can be defined as the services provided by a substitute provider?
Respite care
Regarding cost containment in medical plans, review process and effectiveness
Retrospective
When a Medicare beneficiary chooses hospice care to be provided in a nursing home, Medicare will NOT pay for which of the following?
Room and board
SNC is primarily
Round the clock
Long term care policies exclude
Service in the armed services
Regarding LTC policies, which of the following would NOT be included in activities of daily living?
Sleeping
A new retiree has received his Medicare card and is eligible for Medicare. The Medicare program is administered by
The Center for Medicare and Medicaid Services.
All advertising for the sale of Medigap insurance in this state has to have the approval of which of the following?
The Commissioner of Insurance
To receive medicare benefits, a 65 year old individual must apply with
The Social Security Administration
When a medicare supplement policy is guaranteed renewable, that means
The company must automatically renew the policy as long as the premium is paid.
A 41-year old insured has ALS just became eligible for SSDB. When should the insured be eligible for medicare?
The first month the insured receives disability benefits from SS
If a Medicare Supplement policy is based on the insured's issue age, what happens to the premium as the insured ages?
The premium remains the same.
The premium in an insurance policy is based on the insured's attained age. Which is true?
The premium will increase every year
All of the following are features of medicare part D except
They are offered without premium
Which of the following is true about the benefit periods in Medicare Part A?
With each new benefit period, most of Part A hospital benefits are renewed.
A man is planning to retire after age 65. Until then, he will have his employer's health plan. When should he enroll in Medicare Part B?
Within 8 months of the day he is no longer employed or when coverage under the group plan ends
An insured receives health care through both Medicare and Medicaid. She currently has prescription drug coverage through Medicaid. Does the insured need to enroll in Medicare Part D?
Yes, she must begin receiving her prescription drug coverage through Part D.
Medicare pays the first 20 days of SNF care. For days 21 through 100, medicare pays
all but $194.50 per day
Medicare Part B will cover services received from a doctor performed
anywhere
Every insurer providing LTC must issue a shopper's guide
before sale
Long term care is care provided in all of the following facilities except
hospital
Regarding long term care coverage, as the elimination period gets shorter, the premium
increases
LTC insurance
may not be right for everyone
What is another name for medicare supplement
medigap
Insurers are prohibited from selling medicare supplement policies to individual enrolled under medicare
part C
Under WMB program, Medicare pays
premiums, deductibles, and coinsurance
Medicare is administrated by
the state government
Medicare may pay for ambulance transportation
to the nearest medical facility