MEDICARE SUPPLEMENT AND LONG
TERM CARE INSURANCE LICENSING
CERTIFICATION TEST PAPER COMPLETE
QUESTIONS AND SOLUTIONS
●● CMS
Answer: Centers for Medicare and Medicaid Services administers the
Medicare program. Social Security Administration handles most of the
enrollment & plays a role in claims appeal process.
●● MAC
Answer: Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
●● Medicare Part A
Answer: -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or
Self Employment tax credits.
-Those who don't qualify can voluntarily participate by paying a
monthly premium
●● Medicare Part B
,Answer: The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and
other services and supplies.
-Has a monthly premium of $135.50 in 2019 which is deducted from SS
check.
-Part B enrollment is optional. You can reject Part B by signing a
rejection form.
●● Medicare Part C
Answer: Medicare Advantage Plans that are offered through private
insurance companies that provide both hospital and physician coverage
and possible prescriptions - financed by Social Security and monthly
premiums
●● Medicare Eligibility
Answer: -Over age 65 who have earned 40 "work credits" in order to
receive premium free part A benefits
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant
●● Medicare enrollment requirements
Answer: Part A & B are automatically conducted by SSA when
individual age 65+ enrolls for their Social Security retirement benefits
, ●● Initial Enrollment Period
Answer: 7 month period straddling 3 months before and ends 3 months
after the individual turns 65, including the birthday month.
-If enrollment is during the 3 mos prior to 65th birthday, coverage begins
on 1st day of 65th birthday month
-If enrollment is during or after 65th birthday month, coverage begins on
1st day of month after enrollment
●● General Enrollment Period
Answer: Medicare enrollment period - January 1st through March 31st
annually.
-Coverage begins July 1st of that year
-Monthly premium for part B may go up 10% for each full 12 month
period that you're eligible but didn't sign up.
●● Special Enrollment Period
Answer: Individual can enroll at 8 months beginning with the month
employment ends or when group coverage ends whichever is earlier
without subject to late enrollment surcharge
●● Medicare as a secondary or primary payer
Answer: -Medicare is the secondary payer for the 'working aged' who
has a group health plan if the group has 20+ enrollees
TERM CARE INSURANCE LICENSING
CERTIFICATION TEST PAPER COMPLETE
QUESTIONS AND SOLUTIONS
●● CMS
Answer: Centers for Medicare and Medicaid Services administers the
Medicare program. Social Security Administration handles most of the
enrollment & plays a role in claims appeal process.
●● MAC
Answer: Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
●● Medicare Part A
Answer: -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or
Self Employment tax credits.
-Those who don't qualify can voluntarily participate by paying a
monthly premium
●● Medicare Part B
,Answer: The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and
other services and supplies.
-Has a monthly premium of $135.50 in 2019 which is deducted from SS
check.
-Part B enrollment is optional. You can reject Part B by signing a
rejection form.
●● Medicare Part C
Answer: Medicare Advantage Plans that are offered through private
insurance companies that provide both hospital and physician coverage
and possible prescriptions - financed by Social Security and monthly
premiums
●● Medicare Eligibility
Answer: -Over age 65 who have earned 40 "work credits" in order to
receive premium free part A benefits
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant
●● Medicare enrollment requirements
Answer: Part A & B are automatically conducted by SSA when
individual age 65+ enrolls for their Social Security retirement benefits
, ●● Initial Enrollment Period
Answer: 7 month period straddling 3 months before and ends 3 months
after the individual turns 65, including the birthday month.
-If enrollment is during the 3 mos prior to 65th birthday, coverage begins
on 1st day of 65th birthday month
-If enrollment is during or after 65th birthday month, coverage begins on
1st day of month after enrollment
●● General Enrollment Period
Answer: Medicare enrollment period - January 1st through March 31st
annually.
-Coverage begins July 1st of that year
-Monthly premium for part B may go up 10% for each full 12 month
period that you're eligible but didn't sign up.
●● Special Enrollment Period
Answer: Individual can enroll at 8 months beginning with the month
employment ends or when group coverage ends whichever is earlier
without subject to late enrollment surcharge
●● Medicare as a secondary or primary payer
Answer: -Medicare is the secondary payer for the 'working aged' who
has a group health plan if the group has 20+ enrollees
