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NC Medicare Supplement Questions and Answers, Exams of Andragogy

University of Connecticut (UConn) - StamfordAndragogy

A comprehensive overview of medicare, including details on medicare parts a, b, c, and d, as well as information on medicare savings programs, medicare advantage plans, and medicare supplement (medigap) policies. It covers topics such as funding sources, beneficiary responsibilities, coverage details, and the differences between various plan types. The document aims to answer common questions about medicare and related insurance options, making it a valuable resource for individuals seeking to understand their medicare benefits and options.

Typology: Exams

2023/2024

Available from 09/14/2024

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NC Medicare supplement questions and answers
100% Verified Solutions
Medicare - Answer - A federal program of health insurance for persons 65 years of age
and older
Medicare is run by - Answer - Centers for Medicare and Medicaid services of the
department of health and human services
Medicare parts A & B are - Answer - Referred to as original Medicare
Medicare Part A(Inpatient) is funded - Answer - By the hospital insurance portion of the
FICA payroll tax collected from workers and employers. Also by the premiums paid by
individuals who aren't automatically covered by medicare but wish to purchase it.
This also pays for Medicare part A - Answer - Taxes paid on Social Security benefits
Medicare part B is funded - Answer - Partially by general tax revenues and partially by
premiums paid to the federal government by Medicare part B beneficiaries
Part B beneficiary must - Answer - Must pay a premium for coverage on like Part a
Most part B beneficiaries pay - Answer - The standard part B premium which may be
adjusted each year for inflation
What is the threshold Part B beneficiaries have to a seed for a higher premium? -
Answer - $85,000 for single people and $170,000 for married couples filing jointly
Medicare Savings Program - Answer - A state run programs some low income
individuals may qualify for that assist with paying the cost of Medicare coverage
Qualified Medicare beneficiary(QMB) program - Answer - A program for those whose
monthly income is no more than the federal poverty level plus $20. Helps pay the part B
premium and may also help pay a beneficiary's part a premium , Deductibles,
coinsurance, and copayments
Specified low-income Medicare beneficiary (SLMB) - Answer - To qualify, a persons
Monthly be income is no more than 120% of the federal poverty level plus $20. This
program only pays for the part B premium no other Medicare costs
qualifying individual (QI) - Answer - To qualify a persons monthly income is no more
than 135% of the federal Poverty level Plus $20. This program helps pay for only the
part B premium
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NC Medicare supplement questions and answers

100% Verified Solutions

Medicare - Answer - A federal program of health insurance for persons 65 years of age and older Medicare is run by - Answer - Centers for Medicare and Medicaid services of the department of health and human services Medicare parts A & B are - Answer - Referred to as original Medicare Medicare Part A(Inpatient) is funded - Answer - By the hospital insurance portion of the FICA payroll tax collected from workers and employers. Also by the premiums paid by individuals who aren't automatically covered by medicare but wish to purchase it. This also pays for Medicare part A - Answer - Taxes paid on Social Security benefits Medicare part B is funded - Answer - Partially by general tax revenues and partially by premiums paid to the federal government by Medicare part B beneficiaries Part B beneficiary must - Answer - Must pay a premium for coverage on like Part a Most part B beneficiaries pay - Answer - The standard part B premium which may be adjusted each year for inflation What is the threshold Part B beneficiaries have to a seed for a higher premium? - Answer - $85,000 for single people and $170,000 for married couples filing jointly Medicare Savings Program - Answer - A state run programs some low income individuals may qualify for that assist with paying the cost of Medicare coverage Qualified Medicare beneficiary(QMB) program - Answer - A program for those whose monthly income is no more than the federal poverty level plus $20. Helps pay the part B premium and may also help pay a beneficiary's part a premium , Deductibles, coinsurance, and copayments Specified low-income Medicare beneficiary (SLMB) - Answer - To qualify, a persons Monthly be income is no more than 120% of the federal poverty level plus $20. This program only pays for the part B premium no other Medicare costs qualifying individual (QI) - Answer - To qualify a persons monthly income is no more than 135% of the federal Poverty level Plus $20. This program helps pay for only the part B premium

Medicare part C is referred to as - Answer - Medicare advantage Medicare Advantage is - Answer - A combination of part a and part B coverage plus additional benefits not covered by original Medicare such as hearing or vision care Medicare part D is funded - Answer - Partially by general tax revenues and partially by premiums paid by part the beneficiaries... Like part B Medicare part B premiums are - Answer - Pay to the provider of the part D plan rather than the federal government unlike part B To be eligible to enroll in Medicare individuals must be - Answer - Age 65 or older, social security disability beneficiaries (Generally after two years) Are suffering from end- stage renal disease Enrollment in Medicare part a and B is automatic for - Answer - People who are already receiving Social Security benefits For people covered by Social Security - Answer - Part A is premium free but part B is not. Individuals automatically enroll in part B have the option to drop it if they don't want to pay the premium The late enrollment penalty for part B plans is - Answer - And additional charge of 10% of the part B premium for every 12 months that has passed since their eligibility for Medicare. initial enrollment period (IEP) - Answer - For Medicare is a seven month. That includes the month someone's birthday occurs and the three months on either side general enrollment period (GEP) - Answer - The designated enrollment period from January 1 through March 31 each year for those who missed their initial enrollment. The coverage does not become effective until July 1 special enrollment period (SEP) - Answer - A currently employed individual who is still insured under a group health plan when he or she reaches age 65 can either enroll into Medicare while still covered by his or her group health plan, or defer Medicare enrollment until he or she retires. Once employer group health coverage has ended, a retiree enters a Special Enrollment Period (SEP) in which he or she has 8 months to enroll into Parts A and B without being charged late Part A and Part B enrollment penalties. open enrollment period - Answer - The time period from October 15 until December 7 one can make changes to their Medicare coverage.

  • change from original Medicare to a Medicare advantage plan, or Vice versa
  • switch from one Medicare advantage plan to another
  • Obtain, change or drop their Medicare part D

Where do participating providers submit their claims? - Answer - Directly to Medicare because there is also a convenience benefit to using providers that except assignment When providers do not except assignment, Medicare beneficiaries - Answer - Can still obtain services From non-participating providers Non-participating providers can charge - Answer - More than the Medicare approved amount and Medicare beneficiaries are responsible for paying the difference in addition to their deductibles and coinsurance Non-participating providers are Prohibited from Charging - Answer - And excess of 15% of the Medicare approved charge known as a limiting charge Medicare beneficiaries who use non-participating providers may also have to - Answer - File their own claims with Medicare and/or Pay the entire amount of a providers bill at the time of service and wait to be reimbursed by Medicare for any Medicare covered charges Types of insurance that are primary to Medicare(subrogation) - Answer - Workers compensation, no-fault insurance, liability insurance and black lung benefits The three other types of coverage Medicare part A(hospital insurance)provides - Answer - - skilled nursing facility care

  • Home health care
  • Hospice care On the Medicare part A, the benefit period - Answer - Begins on the first day a beneficiary is admitted to the hospital and ends on the 60th day after the beneficiary has been discharged For the first 60 days of each benefit period, Medicare pays - Answer - The entire cost of covered services, minus the amount of the part a deductible. This is an inexhaustible benefit. For the next 30 days of each benefit period(31 through 90) Medicare pays - Answer - Most of the cost and the beneficiary pays a daily copayment... which is referred to as the daily coinsurance amount. This is an inexhaustible benefit For the next 60 days of each benefit period (91 through 150) Medicare coverage is - Answer - Provided in the form of lifetime reserve days. For his lifetime reserve days Medicare still pays most of the costs, but the beneficiary is responsible for a coinsurance amount. Lifetime reserve days are an exhaustible benefit Covered expenses under Medicare part A include - Answer - - A semi private room
  • Meals
  • General nursing
  • miscellaneous hospital services and supplies (Prescription drugs administered in the hospital, x-rays, laboratory test, operating in recovery room charges, rehabilitative services) Exclusions under Medicare part A include - Answer - - Long-term or custodial care
  • homemaker services
  • private nursing
  • cosmetic surgery unless medically necessary
  • experimental or alternative medicines or procedures
  • Routine dental care or dentures
  • Eye exams related to prescribing eyeglasses
  • hearing aids and exams for fitting them Skilled Nursing Facility (SNF) - Answer - Is one that provides round the clock medical and rehabilitative care Provided by license nurses and other medically trained professionals based on writer orders by a physician A skilled nursing facility does not include - Answer - Intermittent or part time medical care Personal non-medical care such as long-term care or custodial care To qualify for a skilled nursing facility - Answer - A physician must certify that the Medicare beneficiary requires skilled care on a daily basis For skilled nursing facility care Medicare pays for - Answer - The entire cost of covered services for The first 20 days For the next 80 days (21-100) Of skilled nursing facility Medicare pays - Answer - Most of the cost and the beneficiary is responsible for a daily coinsurance amount The deductible that applies to the skilled nursing facility care of benefit - Answer - None. However the beneficiary will be responsible for the Deductible on the inpatient hospital stay that must proceed admission to the skilled nursing facility The Medicare beneficiary is responsible for 100% of the cost of care in a skilled nursing facility - Answer - After 100 days Skilled nursing facility care services covered by Medicare include - Answer - - Semi private room
  • Meals
  • nursing care
  • rehabilitative services
  • medications administered in the facility
  • miscellaneous medical supplies

coinsurance cost are the same as a regular inpatient hospital stay. The inpatient psychiatric facility must be a participating provider though Regarding the Medicare part a blood deductible - Answer - The blood required by a beneficiary to receive treatment is paid for except the first 3 pints Medicare part B (medical insurance) - Answer - Provide coverage for medical care receives in other settings: Doctors office, outpatient clinic or laboratory, or a hospital emergency room or outpatient department Before Medicare begins paying for part B services - Answer - Medicare beneficiaries must satisfy the part B deductible which applies on an annual basis from January to December For Medicare part B, beneficiaries are generally responsible for paying - Answer - 20% on part B coverage services while Medicare pays the other 80% of the Medicare approved charge Medicare Part C (Medicare Advantage) - Answer - managed care health plans under the Medicare program Beneficiaries that use a Medicare advantage plan must continue to - Answer - Pay for their part B premium (and part a premium if they did not receive that coverage premium free). Medicare Advantage Plans - Answer - Commonly called Plan C, these plans provide Medicare benefits to eligible people, but they differ in that they are administered by private providers rather than by the government. Common supplemental benefits include vision, hearing, dental, general checkups, and health and wellness programs. Medicare advantage plans are able to control cost - Answer - By maintaining their own provider network To enroll in a Medicare advantage beneficiaries must - Answer - Reside in the plans service area. Beneficiaries may not belong to more than one Medicare advantage plan at a time Health Maintenance Organization (HMO) plans - Answer - A Medicare advantage plan that has a network of providers that beneficiaries must use exclusively, except for emergencies. Some HMO plans offer - Answer - Point of service (POS) plans that allow beneficiaries to obtain out of network services, but they must pay higher copayment for coinsurance than in network care

Preferred Provider Organization (PPO) - Answer - Allows beneficiaries to go to Obtain services from any provider, but they will pay lower coinsurance or co-pay payments if they use providers in the PPO network Private fee for service (PFFS) - Answer - Allows beneficiaries to go to any provider as long as they except the plans payment terms. The plan determines how much it will pay providers and how much beneficiaries must pay for care Special needs plans (SNP) - Answer - Provide specialized care for specific groups of people such as beneficiaries who: Are eligible for both Medicare and Medicaid, live in a nursing home, or suffer from certain chronic medical conditions The two most common types of Medicare advantage plans are - Answer - HMOs and PPOs Health maintenance organization(HMO) plans include: - Answer - - prescription drug coverage

  • beneficiary must choose a primary care physician
  • referral is required to see a specialist in most cases
  • No coverage for out of network here, except for POS plans where it is covered at an additional cost Preferred Provider Organization (PPO) Plans include - Answer - Prescription drug coverage is usually included Beneficiary doesn't have to choose a primary care physician Referral is not required to see a specialist in most cases Out of network care is covered, but usually at an additional cost Medicare part D - Answer - A voluntary prescription drug program Under which certain low income individuals may receive part D premium, deductible, and copayment subsidies The last of prescription drugs covered by Medicare part D is referred to as - Answer - Formulary Under part D anyone entitled to or enrolled in part a and or B - Answer - Can enroll in Medicare part D Beneficiaries who have only part a or part B but wont Medicare part D - Answer - Can only obtain it through a standalone plan, since beneficiaries cannot join a Medicare advantage plan unless they have both part a and part B Medicare advantage prescription plans are not available to - Answer - Beneficiaries who have original Medicare