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North Carolina Medicare Supplement and
Long-Term Care | 100% Correct Answers |
Verified | Latest 2024 Version
An individual who is not eligible for premium-free Medicare Part A coverage may apply for coverage during which of the following enrollment periods? A. All of the above B. Initial enrollment period C. General enrollment period D. Special enrollment period - ✔✔A. All of the above Medicare makes what payment for services in which another payer may be responsible: A. Conditional payment B. Interim payment C. Transitional payment D. Temporary payment - ✔✔A. Conditional payment Insurers must offer inflation protection in which of the following policies? A. Medicare Part C B. Medigap C. Long-Term Care D. Medicaid - ✔✔C. Long-Term Care What program safeguards against unnecessary and inappropriate medical care rendered to Medicaid recipients?
A. Medicaid review program B. Utilization renew program C. Quality improvement organization D. Utilization review program - ✔✔D. Utilization review program Which of the following is not a requirement for long-term care plans? A. The individual must be unable to perform at least two ADLs B. Inflation protection must be provided C. Policies must accrue cash value D. Coveraged cannot reimburse insureds for medical expenses or services covered by Medicare. - ✔✔C. Policies must accrue cash value. Which entity handles claims from hospitals, skilled nursing facilities, home health agencies and hospices? A. Carrier B. Intermediary C. Quality Improvement Organization D. Utilization Review Committee - ✔✔B. Intermediary What is the term for private organizations that administer Medicare Part B benefits? A. Carriers B. Medical Providers C. Intermediaries D. Peer review organizations - ✔✔A. Carriers All of the following are requirements for long-term care and medigap policy except:
If an individual enrolls in medicare before their birthday month and their birthday is NOT the first day of the month, when does coverage begin? - ✔✔The first day of their birthday month B's long-term care insurance policy has a 30-calendar day elimination period. He became eligible for long-term care benefits and started receiving care on May 1. At what point will his policy begin paying benefits? A. After Bill has received 30 days of weekday care B. After Bill has received 30 days of care C. 30 days after the policy is issued D. 30 days after the triggering event - ✔✔D. 30 days after the triggering event What are the benefit triggers of tax-qualified long-term care insurance policies? - ✔✔Physical impairment or severe cognitive impairment Hospital coverage is provided by: A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D - ✔✔A. Medicare Part A What is a system of classifying hospital patients on the basis of diagnosis consisting of distinct groupings? A. Patient diagnostic system B. Distinct grouping assignment C. Patient classification basis D. Diagnosis-related group - ✔✔D. Diagnosis-related group
What two types of long-term care insurance policies resulted from the Health Insurance Portability and Accountability Act? - ✔✔Tax qualified and non-tax qualified Medicare Part B covers which of the following expenses? A. Hospital care B. Physicians' services C. Hospice care D. Skilled nursing home care - ✔✔B. Physicians' services Medicare pays the remaining 80% of covered Medicare Part B charges after: A. Premiums are paid B. The annual deductible is met C. The $1,000 deductible is met D. The blood deductible is met - ✔✔B. The annual deductible is met Medicare Part A covers which of the following services? A. Medications B. Hospital room and board C. Physicians services D. Surgical services - ✔✔B. Hospital room and board Which of the following services in NOT excluded under Medicare Part B? A. Custodial care B. Skilled nursing care C. Diagnostic tests
A. Receive unlimited benefits tax free B. Receive limited benefits tax free C. Receive a partial return of premium if no claim is filed within ten years D. Receive a partial return of premium if no claim is filed within three years - ✔✔B. Receive limited benefits tax free J received the following home health services: housekeeping, shopping, custodial care and physical therapy. Which of these services will be covered by Medicare Part A? A. Housekeeping B. Shopping C. Custodial Care D. Physical therapy - ✔✔D. Physical therapy When can individuals change from Original Medicare to Part C Medicare coverage? - ✔✔During open enrollment. The open enrollment period is Oct. 15th to Dec. 7th, with coverage beginning on Jan. 1st. Which of the following is covered by Medicare Part C: A. Skilled nursing facility care B. Doctors' services C. Occupational therapy D. Managed care plans - ✔✔D. Managed care plans An agent's commission for the sale of a medicare supplement policy in the first year following its effective date cannot exceed what percentage of the commission paid for servicing the policy in the second year? - ✔✔ 200
After being released from a week's stay in the hospital, Jim's doctor orders him into a into a skilled nursing facility for wound care. How long will Medicare Part A cover 100% of the approved charges in the facility? - ✔✔20 days Longer elimination periods reduce the __________ - ✔✔Premium amount S is enrolled in a group health plan that is scheduled to terminate on March 1st. When can he enroll in Medicare Part B without having to pay the 10 percent premium surcharge? - ✔✔During the eight month period following the month his group coverage ends. G is applying for Medicare supplement Plan C. At what point must the insurer give her an outline of coverage? - ✔✔At the time of application Long-term coverage differs from Medigap in what way? - ✔✔Long-term care coverage provides custodial care How much is the penalty for delaying in Medicare Part A or Part B beyond the initial enrollment period? - ✔✔10% Who regionally manages policy and payment related to reimbursement and payment for medicare? - ✔✔Medicare Administrative Contractors Medicare Part B supplement insurance is: - ✔✔Voluntary Individual long-term care policies are generally available to individuals between the ages of - ✔✔40 and 85 Medicare Parts A and B have gaps in their coverage where subscribers must pay for their coverage. What do these gaps include? - ✔✔The Part A deductible and daily co-payments for hospitalization and nursing home care and the part B deductible, which requires 20% coinsurance or copayments Prescription drug coverage is covered by: - ✔✔Medicare Part D
C. Intermittent skilled care D. Durable medical equipment and supplies - ✔✔B. Full-time skilled care To be eligible for medicare someone must have been a permanent legal residents for at least how many consecutive years? A. 1 B. 5 C. 7 D. 10 - ✔✔B. 5 Medicare makes what payment for services in which another player may be responsible? A. Transitional payment B. Conditional payment C. Temporary payment D. Interim payment - ✔✔B. Conditional payment What benefits are not covered by a medicare special needs plan? A. Part A coverages B. Parts A & B deductibles + coinsurance amounts C. Part B Coverages D. Prescription drug coverage under Part D - ✔✔B. Parts A & B deductibles + coinsurance amounts Who regionally manages policy and payment related to reimbursement for medicare? A. Medicare fiduciaries B. Medicare coverage intermediaries
C. Local coverage determinators D. Medicare Administrative contractors - ✔✔D. Medicare Administrative contractors When can individuals add a Medicare Part D plan if they did not select one when enrolling in Medicare Parts A & B? A. General enrollment period B. Initial enrollment period C. Open enrollment period D. Special enrollment period - ✔✔A. General enrollment period When can individuals change from original medicare to medicare part C coverage? A. General enrollment period B. Open enrollment period C. Initial enrollment period D. Speech enrollment period - ✔✔B. Open enrollment period Which type of medicare supplement policy provides that as long as the insured pays the premiums, the insurer cannot modify premium, coverage or any provisions of the policy: A. Noncancelable B. Guaranteed renewable C. Conditionally renewable D. Renewable at insurer's option - ✔✔A. Noncancelable A person who is not eligible for premium-free medicare Part A coverage must pay: A. A monthly premium of $115.
C. Four months D. Seven months - ✔✔D. Seven months Which of the following medical services is not covered by Medicare Part B? A. Preventive care B. Private duty nursing C. Physicians fees D. Outpatient care - ✔✔B. Private duty nursing How can a long-term policy be written? A. Both stand-alone policy & rider B. Stand-alone policy only C. None of the above D. Rider only - ✔✔A. Both stand-alone policy & rider A person who is not eligible for premium-free medicare Part A coverage must pay: A. A monthly premium of $115. B. A monthly premium of $ C. A monthly premium of $ D. A monthly premium of $141.50 - ✔✔B. A monthly premium of $ Which type of medicare supplement policy provides that as long as the insured pays the premiums the insurer cannot modify the premium, coverage or any provisions of the policy: A. Noncancelable B. Guaranteed renewable
C. Conditionally renewable D. Renewable at insurer's option - ✔✔A. Noncancelable Who regionally manages policy and payment related to reimbursement for medicare? A. Medicare fiduciaries B. Medicare coverage intermediaries C. Local coverage determinators D. Medicare administrative contractors - ✔✔D. Medicare administrative contractors To be eligible for medicare someone must have been a permanent legal residents for at least how many consecutive years? A. 1 B. 5 C. 7 D. 10 - ✔✔B. 5 Which of the following services would not be covered by Medicare Part A? A. Home health aide services B. Full-time skilled care C. Intermittent skilled care D. Durable medical equipment & supplies - ✔✔B. Full-time skilled care For Medicare Part A, Coinsurance must be paid ________ of a hospital stay: A. For days 91 through 150 B. For days 61 through 90
