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Medicare Supplement and Long Term Care NC Study Set Exam Q & A, Exams of Study of Commodities

A study set or exam preparation material related to medicare supplement and long-term care insurance in north carolina. It covers a wide range of topics, including the differences between medicare and medicaid, the requirements for skilled nursing facility coverage, the rules around returning medicare supplement policies, the commission structure for agents selling medigap insurance, the coverage details of medicare part a and part b, the cost-sharing responsibilities of medicare beneficiaries, the eligibility criteria for medicare home health services, the classification of diagnosis-related groups under the prospective payment system, the characteristics of private fee-for-service plans, the coverage of long-term care policies, and various other medicare-related concepts. A comprehensive study resource for individuals preparing for an exam or assessment on these topics.

Typology: Exams

2023/2024

Available from 09/14/2024

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Medicare Supplement and Long Term Care NC
Study Set Exam Q & A
what facility is long term care NOT provided in - Answer - Hospital
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? - Answer - Yes, she must begin receiving her prescription Drug
coverage through Part D
To quality for skilled nursing care a patient must - Answer - have a qualifying hospital
stay of at least 3 consecutive days
if a insured returns a Medicare supplement policy too the insurer with in 30 days of
policy delivery without providing a reason, how much of policy premium with be
refunded? - Answer - 100%
An individual long term care insurance policy holder has the right to return the policy for
a full refund of premium with in 30 days of the policy - Answer - delivery to the insured
If an agent receives 1000 in commissions upon the first renewal of a medigap policy
what is the maximin compensation that the agent may receive on the fourth renewal -
Answer - 1000 dollars
claim for Medicare part a services are filed by - Answer - the provider with the Medicare
intermediary
An agent sells medigap insurance in north Carolina, her renewal commission is 10% the
most that the agent can receive in first year commission is? - Answer - 20 percent
What Medicare part WILL allow an assignment payment method? - Answer - Part B
If a patient is admitted to a hospital for special care, inpatient dialyze treatments are
covered under what? - Answer - Medicare Part A
How many lifetime reserve days does Medicare part a have? - Answer - 60 days
Medicare pays the first 20 days of skilled nursing facility care. For days 21 through 100,
Medicare pays what? - Answer - 235 per day
A man is considered homebound and is eligible for Medicare Home Health services. He
has Medicare Part A and Medicare Part B. Medicare will pay for covered home health
visits. The patient's share of the cost is what percent? - Answer - 20%
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Medicare Supplement and Long Term Care NC

Study Set Exam Q & A

what facility is long term care NOT provided in - Answer - Hospital 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? - Answer - Yes, she must begin receiving her prescription Drug coverage through Part D To quality for skilled nursing care a patient must - Answer - have a qualifying hospital stay of at least 3 consecutive days if a insured returns a Medicare supplement policy too the insurer with in 30 days of policy delivery without providing a reason, how much of policy premium with be refunded? - Answer - 100% An individual long term care insurance policy holder has the right to return the policy for a full refund of premium with in 30 days of the policy - Answer - delivery to the insured If an agent receives 1000 in commissions upon the first renewal of a medigap policy what is the maximin compensation that the agent may receive on the fourth renewal - Answer - 1000 dollars claim for Medicare part a services are filed by - Answer - the provider with the Medicare intermediary An agent sells medigap insurance in north Carolina, her renewal commission is 10% the most that the agent can receive in first year commission is? - Answer - 20 percent What Medicare part WILL allow an assignment payment method? - Answer - Part B If a patient is admitted to a hospital for special care, inpatient dialyze treatments are covered under what? - Answer - Medicare Part A How many lifetime reserve days does Medicare part a have? - Answer - 60 days Medicare pays the first 20 days of skilled nursing facility care. For days 21 through 100, Medicare pays what? - Answer - 235 per day A man is considered homebound and is eligible for Medicare Home Health services. He has Medicare Part A and Medicare Part B. Medicare will pay for covered home health visits. The patient's share of the cost is what percent? - Answer - 20%

How many days of care in a skilled nursing facility does Medicare Part A cover? - Answer - 100 days As compared to Part A deductible, the coinsurance amount for days 61 - 90 is how much of the deductible? - Answer - 1/ An individual insured under a Medicare plan moves, but his current plan's service area does not include his new home. He has not chosen a new plan during this Special Enrollment Period. What will happen? - Answer - He will automatically be enrolled in Original Medicare. What is not a diagnosis-related groups according to the classification by the Prospective Payment System (PPS)? - Answer - Prescription drug payment. An enrollee has a Medigap policy that is noncancellable. What does that Mean? - Answer - The company cannot change anything about the policy, including the premium. If a person is a member of a private Fee-For-Service plan, where can he or she receive emergency medical care? - Answer - Anywhere in the U.S. What benefit option is nonrenewable? - Answer - Lifetime reserve days When would Medicare make a conditional payment to a beneficiary? - Answer - When the primary plan does not pay promptly What Home Health Care? - Answer - Primarily skilled care. What is the relationship between Medicare and HMOs? - Answer - HMOs may pay for services not covered by Medicare. A woman has Medicare Part B. She goes to the chiropractor to receive manual manipulation for subluxation of the spine. Will Medicare pay? - Answer - Yes, this is a covered service. A Medicare hospital patient has a hospital stay of 160 consecutive days. For how many days will Medicare participate in the cost of the hospital stay? - Answer - 150 days Reasons to purchase a long-term care policy include what? - Answer - To make sure the insured can choose the type of care they get. What will The Medicare Hospice Care benefit will not pay for? - Answer - Care In An emergency room Which of the following best describes the term "community spouse"? - Answer - The spouse of an institutionalized individual who remains at home

As defined by long-term care policies as an activity of daily living, the term toileting includes which of the following? - Answer - Performing personal hygiene An individual purchases a Medicare supplement policy in March and decides to replace it with another in May. His history of coronary artery disease is considered to be a pre- existing condition. Which of the following is true? The rules of replacement dictate that pre-existing conditions must be waived in the renewal policy; therefore, the individual can be covered for sickness relating to coronary artery disease upon the policy's effective date. or The pre-existing condition waiting period that he served on the old policy will be transferred to the new policy, the new one picking up where the old one left off. - Answer - The pre-existing condition waiting period that he served on the old policy will be transferred to the new policy, the new one picking up where the old one left off. If a Medicare insured does not have a Medigap policy and has a hospital stay that lasts 70 days, what will he pay? - Answer - The yearly deductible, plus a daily rate for the number of days above 60 A Medical Supplement policy must cover pre-existing conditions after it has been in effect for what time period? - Answer - 6 months Immunosuppressive drugs are what? - Answer - Needed for life First-dollar coverage applies to - Answer - Home health care. Medicare Supplement business was transferred from one issuer to another. What is this action called? - Answer - Discontinuance A man is considered homebound and is eligible for Medicare Home Health services. He has Medicare Part A and Medicare Part B. Medicare will pay for covered home health visits. The patient's share of the cost is what? - Answer - 0% Medicare will pay all costs of care in a skilled nursing facility for the first - Answer - 20 days The minimum age to purchase long-term care insurance is - Answer - 18 what diagnostic does medicare part a not cover? - Answer - Hearing test. A man was hospitalized for a broken leg and received 10 days of Medicare-approved care. He met all qualifications for Medicare coverage for a skilled nursing facility (SNF),

including the 3-day qualifying hospital stay. His Medicare coverage ended when he stopped needing skilled care. He chose to go home rather than pay for custodial care. After 10 days, his doctor decided he needed more skilled care, so the insured was readmitted to the SNF. Will Medicare cover this SNF stay? - Answer - Yes A long-term care policy may EXCLUDE coverage for - Answer - Pre-existing conditions. An insured has Medicare Supplement Plan A. How much will the insured have to pay for a 60-day stay hospital care? - Answer - 1484 In accordance with the Affordable Care Act, what percentage of premiums must an insurer return to an insured in the form of benefits? - Answer - 80% When comparing the private fee-for-service plan to the original Medicare plan, what is not true - Answer - Both plans require the patient to have a Medigap policy. The benefit period for the Medicare Part B deductible is - Answer - 1 year In regards to enrollment for Medicare Part B, a person age 65 who is covered under a group health plan is entitled to - Answer - Special enrollment. An example of skilled care is - Answer - Changing sterile dressings.