NC MEDICARE SUPPLEMENT LONG TERM CARE
EXAMS SCRIPT ALL QUESTIONS AND ANSWERS
SURE A+
✔✔Home Health Care - ✔✔Individual must be confined to home & under care of
physician who has establish a necessary home health care plan.
-Prior hospitalization not required
-First dollar coverage (no deductible will apply)
-Providers must be approved by CMS
-Patient must be unable to leave house without assistance
✔✔Charges covered under Home Health Care - ✔✔-Part-time or intermittent skilled
nursing care ( Up to 8h per day for 21 consecutive days )
-Physical, occupational or speech therapy
-Medical social services
-Consumable medical supplies e.g. bandages
-80% of costs of DMEs (Durable Medical Equipments) e.g. wheelchairs, hospital beds
✔✔Home Health Care will NOT cover - ✔✔-Full time nursing services
-Drugs & biologicals (covered under part D)
-Homemaker & shopping services
-Meal prep or delivery
-Blood transfusions
, -Assistance with ADLs (Activities of Daily Living)
✔✔Hospice Care (Medicare Part A) - ✔✔Hospice is for those in final stages (last 6
months) of terminal illness. Palliative care (pain relief, symptom mgmt & support) vs.
curative care.
-Hospice must be provided by CMS certified hospice.
-Doctor must certify that patient is terminal with < 6 mo life expectancy
-Patient choose hospice instead of standard hospital care
-Part A pays 100% as long as beneficiary remains alive & terminally ill.
-Benefit is provided thru 2 x 90 day and unlimited # of 60 day election benefit periods.
-No deductible for hospice
✔✔inpatient respite care - ✔✔A 5-day inpatient stay, provided on occasional basis to
relieve the primary caregiver of terminally ill patient to give caregivers a break
-Pays 95% if Medicare approved charge with patient paying 5%.
✔✔Hospice benefits include - ✔✔-Nursing & doctors' services
-Home health aide & homemaker services
-Drugs used for pain or symptom relief (If drugs are administered on outpatient basis,
patient must pay 5% but no more than $5 per Rx)
-Medical supplies & appliances
-Physical, occupational & speech therapy
-Medical social services & counseling
✔✔Medicare Part B benefits - ✔✔-Optional with premium payments
-Annual deductible of $185 plus 3 pt blood deductible.
-After deductible, 80/20 coinsurance
-Benefit is based on approved charges (UCR)
✔✔Participating Doctor - ✔✔Agrees to accept Medicare assignment payment method.
-Patient pays 20% coinsurance after deductible.
✔✔Non-Participating Doctor - ✔✔Doctor does not accept Medicare assignment
-Allowed to charge more i.e. "Excess Charge" that what Medicare approves
-Patient responsible for all charges in excess of the 80% approved charge by Medicare
-Can accept assignment on a case by case basis
✔✔Limiting charge (Medicare) - ✔✔The cap on the amount that can be charged above
Medicare's approved amount by a Medicare NON-PAR provider that does not accept
assignment on a claim.
-Limited to charging an additional 15% over/ above Medicare approved charge
✔✔Medicare Part B covers - ✔✔-Medical & surgical services incl. anesthesia, x-rays,
med supplies, phys therapy, administered drugs
-Diagnostic tests & procedures that are part of tx
EXAMS SCRIPT ALL QUESTIONS AND ANSWERS
SURE A+
✔✔Home Health Care - ✔✔Individual must be confined to home & under care of
physician who has establish a necessary home health care plan.
-Prior hospitalization not required
-First dollar coverage (no deductible will apply)
-Providers must be approved by CMS
-Patient must be unable to leave house without assistance
✔✔Charges covered under Home Health Care - ✔✔-Part-time or intermittent skilled
nursing care ( Up to 8h per day for 21 consecutive days )
-Physical, occupational or speech therapy
-Medical social services
-Consumable medical supplies e.g. bandages
-80% of costs of DMEs (Durable Medical Equipments) e.g. wheelchairs, hospital beds
✔✔Home Health Care will NOT cover - ✔✔-Full time nursing services
-Drugs & biologicals (covered under part D)
-Homemaker & shopping services
-Meal prep or delivery
-Blood transfusions
, -Assistance with ADLs (Activities of Daily Living)
✔✔Hospice Care (Medicare Part A) - ✔✔Hospice is for those in final stages (last 6
months) of terminal illness. Palliative care (pain relief, symptom mgmt & support) vs.
curative care.
-Hospice must be provided by CMS certified hospice.
-Doctor must certify that patient is terminal with < 6 mo life expectancy
-Patient choose hospice instead of standard hospital care
-Part A pays 100% as long as beneficiary remains alive & terminally ill.
-Benefit is provided thru 2 x 90 day and unlimited # of 60 day election benefit periods.
-No deductible for hospice
✔✔inpatient respite care - ✔✔A 5-day inpatient stay, provided on occasional basis to
relieve the primary caregiver of terminally ill patient to give caregivers a break
-Pays 95% if Medicare approved charge with patient paying 5%.
✔✔Hospice benefits include - ✔✔-Nursing & doctors' services
-Home health aide & homemaker services
-Drugs used for pain or symptom relief (If drugs are administered on outpatient basis,
patient must pay 5% but no more than $5 per Rx)
-Medical supplies & appliances
-Physical, occupational & speech therapy
-Medical social services & counseling
✔✔Medicare Part B benefits - ✔✔-Optional with premium payments
-Annual deductible of $185 plus 3 pt blood deductible.
-After deductible, 80/20 coinsurance
-Benefit is based on approved charges (UCR)
✔✔Participating Doctor - ✔✔Agrees to accept Medicare assignment payment method.
-Patient pays 20% coinsurance after deductible.
✔✔Non-Participating Doctor - ✔✔Doctor does not accept Medicare assignment
-Allowed to charge more i.e. "Excess Charge" that what Medicare approves
-Patient responsible for all charges in excess of the 80% approved charge by Medicare
-Can accept assignment on a case by case basis
✔✔Limiting charge (Medicare) - ✔✔The cap on the amount that can be charged above
Medicare's approved amount by a Medicare NON-PAR provider that does not accept
assignment on a claim.
-Limited to charging an additional 15% over/ above Medicare approved charge
✔✔Medicare Part B covers - ✔✔-Medical & surgical services incl. anesthesia, x-rays,
med supplies, phys therapy, administered drugs
-Diagnostic tests & procedures that are part of tx
