Medicare is an insurance program. Medical bills are paid from trust funds which those covered have paid into. It serves people over 65 primarily, whatever their income; and serves younger disabled people and dialysis patients. Patients pay part of costs
through deductibles for hospital and other costs. Small monthly premiums are required for non-hospital coverage. Medicare is a federal program. It is basically the same everywhere in the United States and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government. For more information regarding Medicare and its components, please go to http://www.medicare.gov. Medicaid is an assistance program. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments within federal guidelines. To see if you qualify for your state's Medicaid (or Children's Health Insurance) program, see: https://www.healthcare.gov/medicaid-chip/eligibility/ For more information on Medicaid, please go to http://www.medicaid.gov Content created by Digital Communications Division (DCD) Which of the following is NOT covered under Part B of a Medicare policy? A. Lab services B. Physician expenses C. Routine dental care D. Home health care C. Routine dental care *Medicare Part B covers dental expense resulting from accident only. Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? A. Parts A and B of Medicare B. All four parts of Medicare C. Any private insurance policy D. Only Part A of Medicare A. Parts A and B of Medicare * To buy a Medigap policy, the applicant must generally have both Medicare Part A and Part B. Medicaid provides all of the following benefits EXCEPT A. Family planning services B. Income assistance for work-related injury C. Home health care services D. Eyeglasses B. Income assistance for work-related injury *Medicaid covers a variety of medical costs, from eyeglasses to hospitalization. Which of the following is INCORRECT concerning Medicaid? A. It provides medical assistance to low-income people who cannot otherwise provide for themselves B. It pays for hospital care, outpatient care, and laboratory and X-ray services C. The federal government provides about 56 cents for every Medicaid dollar spent D. It is solely a federally administered program D. It is solely a federally administered program *Medicaid is assistance program for persons with Insufficient income and/or resources to pay for health care. States administer the program that is financed by federal and state funds. Hospice care is intended for A. The caregiver B. The terminally ill C. People in need of acute care D. Home health visits from a participating home health agency. B. The terminally ill *Under certain conditions, hospital insurance can help pay for hospice for terminally ill insured, if the care is provided by a medicare-certified hospice. All of the following statements about Medicare Part B are correct EXCEPT A. It is a compulsory program B. It covers services and supplies not covered by Part A C. It is financed by monthly premium D. It is financed by tax revenues A. 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 requires that a monthly premium be paid. Which type of care is NOT covered by Medicare? A. Hospital B. Long-term care C. Hospice D. Respite B. Long-term care *Hospice care, which includes respite care, and hospital care are included in Medicare Part A. Which of the following must be present in all Medicare supplement plans? A. Plan A B. Foreign travel provisions C. Outpatient drugs D. Plan C coinsurance A. Plan A *In order to standardize the coverage provided under Medicare supplement policies, the NAIC has developed standard Medicare Supplement benefit plans which are identified with the letters A through N. The benefits in Plan A are considered to be core benefits and must be included in the other types. 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? A. Send the applicant to a doctor for a physical. Nothing can happen until they get the results B. Offer the supplement policy on a guaranteed issue basis C. Exclude pre-existing conditions from coverage under the supplement policies D. Look at the applicants medical history to decide what premium to charge. B. Offer the supplement policy on a guaranteed issue basis *Once a person become eligible for Medicare supplement plans, and during the open enrollment period, coverage must be offered on a guaranteed issue basis. Which of the following is NOT an enrollment period for Medicare Part A applicants? A. Automatic enrollment B. Initial enrollment C. Special enrollment D. General enrollment A. Automatic enrollment *There are 3 types of enrollment periods for Medicare Part A: initial enrollment period, general enrollment period, and special enrollment period. All of the following statements about Medicare supplement insurance policies are correct EXCEPT A. They cover the cost of extended nursing home care B. They cover Medicare deductibles and copayments C. They supplement Medicare benefits D. They are issued by private insurers A. They cover the cost of extended nursing home care *Medicare supplement policies (Medigap) do no cover the cost of extended nursing home care. Medigap plans are designed to fill the gap in coverage attributable to Medicare's deductibles, copayment requirements, and benefits periods. These plans are issued by private insurance companies. How long is an open enrollment period for Medicare supplement policies? A. 6 months B. 1 year C. 30 days D. 90 days A. 6 months *An open enrollment period is a 6-month period that guarantees the applicants the right to buy Medigap once they first sign up for Medicare Part B. Which of the following is NOT a factor in determining qualifications for Social Security disability benefits? A. Worker's occupation B. Worker's PIA C. Worker's age D. Number of work credits earned A. Workers occupation *A worker's specific occupation is not a factor in determining benefits, so long as the worker has earned the required amount of work credits. Social Security disability definition includes all of the following EXCEPT A. Disability resulting from a medically determinable mental impairment B. A physical impairment expected to result in death C. Disability expected to last for at least 6 months D. The inability to engage in any gainful work C. Disability expected to last for at least 6 months *For the purposes of obtaining benefits, the Social Security Act defines disability as inability to engage in any gainful employment due to a medically determinable physical or mental impairment that is expected to result in death or last for a continuous period of 12 months. Which of the following is NOT covered under Plan A in Medigap insurance? A. The first three pints of blood each year B. The Medicare Part A deductible C. Approve hospital costs for 365 additional days after Medicare benefits end D. The 20% Part B coinsurance amounts for Medicare approved services B. The Medicare Part A deductible *Medicare supplement Plan A provides the core, or basic, benefits established by law. All of the above are part of the basic benefits, except for Part A deductible, which is a benefits offered through nine other plans. If a person is disabled at age 27 and meets Social Security's definition of total disability, how many work credits must he/she have earned to receive benefits? A. 20 credits B. 6 credits C. 40 credits D. 12 credits D. 12 credits *Persons disabled between ages 24 and 31 can qualify for benefits if they have credit for having worked half of the time between age 21 and the start of the disability. For example, if Joe becomes disabled at age 27, he would need 12 credits (or 3 years' worth) out of the prior 6 years (between ages 21 and 27) If one takes Social Security retirement benefits at age 62, what needs to be done at age 65 to qualify for Medicare? A. Nothing B. Apply for coverage through the state C. Appear for a physical at the Social Security office D. Apply at a local Social Security office A. Nothing *Nothing needs to be done in this case. Medicare Part A and B will automatically be effective the month you turn 65. All of the following are covered by Part A of Medicare EXCEPT A. Home health services B. Physician's and surgeon's services C. In-patient hospital services D. Post-hospital nursing care B. Physician's and surgeon's services *Physicians's and surgeon's services are covered under part B. All of the following statements concerning Medicaid are correct EXCEPT A. Individual states design and administer the Medicaid program under broad guidelines established by the federal government B. Individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care C. Persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits D. Medicaid is a state funded program that provides health care to persons over age 65, only. D. Medicaid is a state funded program that provides health care for persons over age 65, only. *Medicaid is a government funded (both state and federal) program designed to provide health care to poor people of all ages. Following hospitalization because of an accident, Bill was confined in a skilled nursing facility. Medicare will pay benefits in this facility for how many days? A. 3 B. 20 C. 100 D. 80 B. 20 *Following hospitalization for at least 3 days, if medically necessary, Medicare pays for all covered services during the first 20 days in a skilled nursing facility. Days 21 through 100 require daily copayment. An insured 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? A. Have reached the age of 25 B. Have accumulated 6 work credits in the past 3 years C. Have accumulated 20 work credits in the past 10 years D. Have accumulated 40 work credits B. Have accumulated 6 work credits in the past 3 years. *To qualify for disability benefits under Social Security, the disabled person must have earned a certain amount of work credits. A maximum of 4 work credits can be earned each year. The amount of credits required varies by age. Persons disabled before the age of 24 can qualify for Social Security benefits with only 6 work credits earned in the 3 years prior to the start of the disability. All of the following qualify for Medicare Part A EXCEPT A. Anyone who is at the end state of renal disease B. Anyone who is over 65, not covered by Social Security, and is willing to pay premium C. Anyone who is willing to pay premium D. Anyone who qualifies through Social Security C. Anyone who is willing to pay premium *For Medicare Part A, a person must be age 65 or otherwise qualify. All of the following are advantages of an HMO or PPO for a Medicare recipient EXCEPT A. Prescriptions might be covered, unlike Medicare. B. Health care costs can not be budgeted C. There are no claims forms required D. Elective cosmetic procedures are covered D. Elective cosmetic procedures are covered * The advantages of an HMO or PPO for a Medicare recipient may be that there are no claims forms required, almost any medical problem is covered for a set fee so health care costs can be budgeted, and the HMO or PPO may pay for services not usually covered by Medicare or Medicare supplement policies, such as prescriptions, eye exams, hearing aids, or dental care. Which of the following statements is NOT true concerning Medicaid? A. It is funded by state and federal taxes B. It is intended to provide medical assistance for certain categories of people who are needy C. It consists of 3 parts: Part A: Hospitalization, Part B: doctor's services, Part C: disability income D. It is a state program C. 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. Parts A-C are part of Medicare. What is another name for Social Security benefits? A. Disability and long-term care insurance B. Survivor benefits C. Old Age, Survivors, and Disability Insurance D. Medicare Benefits C. Old Age, Survivors, and Disability Insurance *Social Security benefits are also known as Old Age, Survivors, and Disability Insurance (OASDI) What type of Medicare policy requires insured to use specific healthcare provider and hospitals (network providers), EXCEPT in emergency situations? A.Medicare Part A B. Preferred C. Medicare SELECT D. Medicare Advantage C. Medicare SELECT *Medicare SELECT policies require insured to use specific healthcare providers and hospitals, except in emergency situations. In return, the insured pays lower premium amounts. A Medicare SELECT policy does all of the following EXCEPT A. Provide payment for full coverage under the policy for covered services not available through network providers. B. Provide continuation of coverage in the event that Medicare SELECT policies are discontinued due to the failure of the Medicare SELECT program C. Prohibit payment for regularly covered services if provided by non-network providers D. Make full and fair disclosure in writing of the provisions, restrictions, and limitations of the Medicare SELECT policy to each applicant C. Prohibit payment for regularly covered services if provided by non-network providers *A Medicare SELECT policy issued in this state must not restrict payment for covered services provided by non-network providers if the services are for symptoms requiring emergency care and is not reasonable to obtain such services through a network provider. To sign up for Medicare prescription drug plan, individuals must first be enrolled in A. Medicare Parts A and C B. Medicare Part D C. Medicare Part A D. Medicare Parts B and C C. Medicare Part A *To receive Medicare prescription drug benefits, beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Medicare part A or in Parts A and B. How many pints of blood will be paid for by Medicare Supplement core benefits? A. First 3 B. None; Medicare pays for it all C. Everything after first 3 D. 1 pint A. First 3 *Medicare supplemental policies cover costs of deductibles and coinsurance for Parts A and B. Since Medicare will not pay the first 3 pints of blood, a Medicare Supplement plan will cover that. This is considered to be a core benefit. Medicare Part A services do NOT include which of the following? A. Outpatient Hospital treatment B. Post-hospital skilled nursing facility care C. Hospitalization D. Hospice Care A. Outpatient Hospital treatment *Outpatient treatment is covered in Part B. Regarding Medicare SELECT policies, what are restricted network provisions? A. They determine who can be insured B. They determine premium rates C. They help avoid adverse selection D. They condition the payment of benefits D. They condition the payment of benefits *A Medicare SELECT policy is a Medicare supplement policy that contains restricted network provisions - provisions that condition the payment of benefits, in whole or in part, on the use of network providers. A 63 year-old man is planning to be employed until age 68. When will he be eligible for Medicare? A. Age 69 1/2 if no longer employed B. Age 65, regardless of his employment status C. As soon as he retires at age 68 D. Age 70, if still employed B. Age 65, regardless of his employment status *The individual will still be eligible for Medicare at age 65, but if he is still insured under his employer's group health plan, the group plan will be his primary coverage and Medicare will be secondary coverage. Which of the following is NOT covered under Plan A in Medigap insurance? A. The first three pints of blood each year B. The Medicare Part A deductible C. Approved hospital cost for 365 additional days after Medicare Benefits end D. The 20% Part B coinsurance amounts for Medicare approved services B. The Medicare Part A deductible *Medicare supplement Part A provides the core, or basic, benefits established by law. All of the above are part of the basic benefits, except for Medicare Part A deductible, which is a benefit offered through nine other plans. Medicare Part D provides A. Private fee-for-service plans B. Prescription drug benefit C. Hospital insurance D. Medical insurance B. Prescription drug benefit Which of the following statements is not correct? A. Medicare Part B provides physician services B. Medicare advantage must be provided through HMOs C. Medicare Advantage may include prescription drug coverage at no cost D. Medicare Part A provides hospital care B. Medicare Advantage must be provided through HMOs. *Medicare Part A provides hospital care; Medicare Part B provides doctor's and physician's services, and Medicare Advantage (previously Medicare + Choice) offers expanded benefits for a free through private health insurance programs such as HMOs and PPOs. A Medicare supplement plan must have at least which of the following? A. Nonrenewable B. Noncancellable C. Guaranteed Renewable D. Conditionally renewable C. Guaranteed renewable *Medicare supplements must be at least guaranteed renewable. Medicare Part D provides A. Medical Insurance B. Private fee-for-service plans C. Prescription Drug Benefit D. Hospital Insurance C. Prescription Drug Benefit *The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) was passed in November 2003. This act implemented a plan to add a Part D - Prescription Drug Benefit to the standard Medicare Coverages. 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? A. Bridge B. Blackout Period C. Latency Period D. Donut Hole D. 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 costs. Which of the following programs expands individual public assistance programs for people with insufficient income and resources? A. Medicare B. Social Security C. Unemployment compensation D. Medicaid D.
Medicaid*Medicaid is a "needs" tested program administered by the states to provide assistance for persons who are not able to provide for themselves. Once the person meets the stringent requirements for disability under Social Security, how long is the waiting period before any benefits will be paid? A. 5 Months B. 12 Months C. Benefits will be paid immediately D. 90 days A. 5 months *Under Social Security disability benefits, a person will have to wait 5 months before any benefits will be paid. Actual benefit payments start with the sixth month of disability. How many days of skilled nursing facility care will Medicare pay benefits? A. 90 B. 100 C. 30 D. 60 B. 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 copayment. There are no medicare benefits provided for treatment in a skilled nursing facility beyond 100 days. Medicaid provides all of the following benefits EXCEPT A. Eyeglasses B. Family Planning services C. Income assistance for work related injury D. Home Health care services C. Income assistance for work-related injury *Medicaid covers a variety of medical costs, from eyeglasses to hospitalization Which of the following statements concerning Medicare Part B is correct? A. It pays 100% of Medicare's standards for reasonable charges B. It pays for physician services, diagnostic tests, and physical therapy C. It is provided automatically to anyone who qualifies for Part A D. It pays on a first dollar basis B. It pays for physician services, diagnostic tests, and physical therapy *For those who have purchased the coverage, Part B pays 80% of out-patient medical cost after a deductible has been met. Part B covers physician and outpatient hospital services, and other medical and health services, such as diagnostic tests, and physical therapy. Which statement regarding qualifications for Social Security disability benefits is NOT true? A. The individual must meet the definition of disability B. The individual must have proper insured status C. The individual must be at least 65 years old D. The individual must satisfy the waiting period C. The individual must be at least 65 years old *It is difficult to receive Social Security disability benefits. Prospective recipients must have a particular insured status and satisfy a waiting period. Recipients must also meet a strict definition of total disability, making qualifying for benefits difficult. Which of the following statements is CORRECT about Social Security? A. It is very easy to qualify for disability benefits B. It is designed for people over 59 1/2 C. To be eligible, one must meet certain requirements D. It is more than income received while employed C. 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 worker. Which of the following definitions would make it easier to qualify for total disability benefits? A. The more liberal "own occupation" B. The more strict "any occupation" C. The more liberal "any occupation" D. The more strict "own occupation" A. The more liberal "own occupation" *Total disability is defined differently under some disability income policies. The more liberal "own occupation" definition of disability makes it easier to qualify for benefits. In reference to the standard Medicare Supplement benefit plans, what does the term standard mean? A. All plans must include basic benefits A-N B. Coverage options and conditions are developed for average individuals C. All providers will have the same coverage options and conditions for each plan D. Coverage options and conditions comply with the law, but will vary from provider to provider C. All providers will have the same coverage options and conditions for each plan *In reference to the standard Medicare Supplement benefit plans, the term "standard" implies that all providers will have the same coverage options and conditions for each plan. All of the following are true of the Key Person Disability income policy EXCEPT A. Benefits are considered taxable income to the business B. Premiums are not deductible to the business C. It is typically written to protect the company in the event a key employee becomes disabled and is unable to work D. The income may be used to find a replacement for the key employee A. Benefits are considered taxable income to the business *Key person disability benefits are not considered taxable income to the business. Which of the following premium modes would result in the highest annual cost for an insurance company? A. Monthly B. Quarterly C. Semi-annual D. Annual A. Monthly *If the policyowner choose to pay the premium more frequently than annually, there will be an additional charge (loading) because the company will not have the premium to invest for a full year, and the company will have additional expenses in billing the premium. A woman's health insurance policy dictates which doctors she is allowed to see. Her health providers share an assumed risk for their patients and encouraged preventive care. What best describes the health system that the woman is using? A. Managed care B. Comprehensive health C. Major medical D. Group health A. Managed care *There are 5 distinguishing features of managed care: controlled access to providers, comprehensive case management, risk sharing, preventative care, and high-quality care. Disability income policies can provide coverage for a loss of income when returning to work only part-time after recovering from total disability. What is the benefit that is based on the insured's loss of earnings after recovery from a disability? A. Income replacement B. Residual disability C. Recurrent Disability D. Partial disability B. Residual disability *A residual disability will pay an amount to make up the difference between what the insured would have earned before the loss. When a disabled dependent child reaches the age limit for coverage, how long does the policyowner have to provide proof of dependency in order for the dependent to remain covered under the policy? A. 15 days B. 31 days C. 60 days D. 10 days B. 31 days *Every policy providing coverage for a dependent child until a specified age will not terminate that coverage if the child is dependent upon the insured and is incapable of self-support because of physical or mental handicaps. Proof of the dependency is required within 31 days of the child attaining the maximum age. Under the ACA, which classification applied to health plans based on the amount of covered costs? A. Risk classification B. Metal level classification C. Guaranteed and nonguaranteed D. Grandfathered and nongrandfathered B. Metal level classification *Plans other than self-insured plans will be classified into four levels determined by how much of one's expected health care costs are covered. The four plans are bronze, silver, gold, and platinum. This is called metal level classification. According to the PPACA metal levels classification, if a health plan is expected to cover 90% of the cost of an average population, and the participants would cover the remaining 10%, what type of plan is that? A. Silver B. Gold C. Platinum D. Bronze C. Platinum *Bronze level benefit plans pay 60% of expected health care costs; silver level plans pay 70%; gold level plans pay 80%, and platinum level plays pay90%.
Which of the following statements regarding the Change of Beneficiaries Provision is false? A. The policyowner cannot change beneficiaries if he/she has chosen to have an irrevocable beneficiary, unless the policyowner has the permission of the irrevocable beneficiary. B. All policies that allow a death benefit must at least provide the option of a change of beneficiary provision C. The policyowner has the right to change beneficiaries in any case D. A policyowner can change beneficiaries without the consent of the former revocable beneficiary. C. The policyowner has the right to change beneficiaries in any case *The policyowner has the right to change beneficiaries unless he/she has chosen to have an irrevocable beneficiary. Otherwise, the policyowner can legally change beneficiaries, without the consent of the former beneficiary. Which of the following statements is correct concerning taxation of long-term care insurance? A. Benefits may be taxable as ordinary income B. Premiums may be taxable as income C. Premiums are not deductible in any case D. Excessive benefits may be taxable D. Excessive benefits may be taxable *Regardless of whether or not the insured can deduct individual long-term care premiums, the benefits are received income tax-free by the individual. Excessive benefits as determined by statute are taxable as ordinary income. Under which of the following employer-provided plans are the benefits taxable to an employee in proportion to the amount of premium paid by the employer? A. Dental expense B. Basic Medical Expense C. Disability Income D. Major Medical C. Disability Income *The part of the benefit that is provided by the employer's contribution is income taxable to the employee. An insured is covered under 2 group health plans - under his own and his spouse's. He had suffered a loss of $2,000. After the insured paid the total of $500 in deductible and coinsurance, the primary insurer covered $1,500 of medical expenses. What amount, if any, would be paid by the secondary insurer? A. $0 B. $500 C. $1,000 D. $2,000 B. $500 *Once the primary insurer has paid the full available benefit, the secondary insurer will cover the first company will not pay, such as deductibles and coinsurance. The insured will, then, be reimbursed for out-of-pocket costs. The sole proprietor of a business makes a total salary of $50,000 a year. This year, his medical expenses have reached a total of $75,000. What amount may the sole proprietor deduct in regards to his medical expenses? A. $10,000 B. $25,000 C. $50,000 D. $75,000 C. $50,000 *The proprietors of a business may deduct the cost of a medical expense plan because they are considered to be self-employed individuals instead of employees. The deduction cannot legally exceed the taxpayer's earned income for the year even if the cost of the medical expense plan exceeds this amount (in this scenario, $50,000) Premium payments for personally-owned disability income policies are A. Eligible for tax credits B. Tax deductible C. Tax deductible to the extent that they exceed 10% of the adjusted gross income of those itemizing deductions D. Not tax deductible D. Not tax deductible *Premiums for personally-owned individual disability income policies are not deductible Which of the following is not correct? A. Medicare Part B provides physician services B. Medicare Advantage must be provided through HMOs C. Medicare Advantage may include prescription drug coverage at no cost D. Medicare Part A provides hospital care B. Medicare advantage must be provided through HMOs *Medicare Part A provides hospital care; Medicare Part B provides doctors and physician services, and Medicare Advantage (previously Medicare+Choice) offers expanded benefits for a fee through private health insurance programs such as HMOs and PPOs.
Concerning Medicare Part B, which statement is INCORRECT? A. It is fully funded by Social Security taxes (FICA) B. It is known as medical insurance C. It offers limited prescription drug coverage D. It provides partial coverage for medical expenses not fully covered by Part A. A. It is fully funded by Social Security (FICA) *Part B is funded by monthly premiums and from the general revenues of the federal government. The primary eligibility requirement for Medicaid benefits is based upon A. Whether the claimant is insurable on the private market B. Age C. Number of dependents D. Need D. Need *Medicaid is a program operated by the state, with some federal funding, to provide medical care for those in need. Which type of Medicare policy requires insureds to use specific health care providers and hospitals (network providers), EXCEPT in emergency situations A. Medicare Advantage B. Medicare Part A C. Preferred D. Medicare SELECT D. Medicare SELECT *Medicare SELECT policies require insured to use specific healthcare providers and hospitals, except in emergency situations. In return, the insured pays lower premium amounts. Which of the following must the patient pay under Medicare Part B? A. A per benefit deductible B. 20% of covered charges above the deductible C. 80% of covered charges above the deductible D. All reasonable charges above the deductible according to Medicare Standards B. 20% of covered charges above the deductible *As established by Medicare, the patient must pay 20% of covered charges above the deductible Which of the following statements is NOT correct? A. Medicare Part B provides physician services B. Medicare Advantage must be provided through HMOs C. Medicare advantage may include prescription drug coverage at no cost D. Medicare Part A provides hospital care B. Medicare Advantage must be provided through HMOs. *Medicare Part A provides hospital care; Medicare Part B provides doctors and physician services, and Medicare Advantage (previously Medicare+Choice) offers expanded benefits for a fee through private health insurance programs such as HMOs and PPOs. 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? A. The insured must have Medicare supplement insurance policy B. There is no benefit provided under Medicare Part A for skilled nursing care C. The insured must cover daily copayments D. The insured must have first been hospitalized for 3 consecutive days D. The insured must have been hospitalized for 3 consecutive days *Part A covers the cost of care in a skilled nursing facility as long as the patient was first hospitalized for 3 consecutive days, and the services are medically necessary and only up to amounts deemed. 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? A. Exclude pre-existing conditions from coverage under the supplement policies B. Look at the applicant's medical history to decide what premium to charge C. Send the applicant to a doctor for a physical. Nothing can happen until they get the results D. Offer the supplement policy on a guaranteed issue basis D. Off the supplement policy on a guaranteed issue basis *Once a person become eligible for Medicare Supplement plans, and during the open enrollment period, coverage must be offered on a guaranteed issue basis. Which of the following is NOT covered under Plan A in Medigap insurance? A. The first three pints of blood each year B. The Medicare Part A deductible C. Approved hospital costs for 365 additional days after Medicare benefits end D. The 20% Part B coinsurance amounts for Medicare approved services B. Medicare Part A deductible *Medicare Supplement Plan A provides the core, or basic, benefits established by law. All of the above are part of the basic benefits, except for the Medicare Part A deductible, which is a benefit offered through nine other plans. All of the following individuals may qualify for Medicare health insurance benefits EXCEPT A. A person age 45 who has permanent kidney failure B. A person under age 65 who is receiving Social Security disability benefits C. A retired person age 50 D. A healthy person age 65 C. A retired person age 50 *Under the current federal laws, any of the described person could qualify for Medicare, except for individuals under 65 who have no special circumstances. An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? A. Medicare Advantage B. Medicare SELECT C. Medicare Part A D. Medicare Supplement B. Medicare SELECT *Medicare SELECT policies require insured to use specific healthcare providers and hospitals, except in emergency situations. In return, the insured pays lower premium amounts. A Medicare supplement plan must have at least which of the following renewal provisions? A. Nonrenewable B. Noncancellable C. Guaranteed renewable D. Conditionally renewable C. Guaranteed renewable *Medicare supplements must be at least guaranteed renewable. In which of the following situations would Social Security Disability benefits NOT cease? A. The individual has undergone therapy and is no longer disabled B. The individual's son gets a part-time job to help support the family C. The individual reaches age 65 D. The individual dies C. The individual's son gets a part-time job to help support the family *Benefits cease when the individual reaches age 65, dies, or is no longer disabled. If a person has been receiving Social Security disability benefits at the time that he or she turns 65, the disability benefits cease, and are replaced by Social Security retirement benefits. At death, family benefits will continue as survivor benefits. Benefits will continue for an adjustment period of three months if an individual no longer satisfies the definition of disability. Which of the following is NOT covered under Part B of a Medicare policy? A. Routine dental care B. Home health care C. Lab services D. Physician expenses. A. Routine dental care *Medicare Part B covers dental expense resulting from an accident only. Which of the following is an eligibility requirement for Social Security Disability income benefits? A. Currently employed status B. Fully insured status C. Experiencing at least on year of disability D. Being at least 50 years of age B. Fully insured status *Social Security Disability benefits are available only if the worker is fully insured. Benefits are provided only after a 5-month waiting period. In which Medicare supplemental policies are the core benefits found? A. Plans A-D only B. All plans C. Plans A and B only D. Plan A only B. All plans *The benefits in Plan A are considered to be core benefits and must be included in the other types. Therefore, all types contain the core benefits offered by Plan A. 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? A. Donut hole B. Bridge C. Blackout period D. Latency period A. 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 costs. |
Which of the following statements is correct concerning the relationship between medicare and hmos
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