NORTH CAROLINA MEDICARE SUPPLEMENT
AND LONG TERM CARE EXAMS SET
UPDATED QUESTIONS AND FULL SOLUTION
◉ Medicare. Answer: Health insurance for those over age 65, people
under 65 with certain disabilities & those with ESRD (end stage renal
disease - permanent kidney failure requiring dialysis or kidney
transplant)
◉ 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
-For single employer with <20 employees with a group health plan,
Medicare is the primary payer.
-If individual retains coverage thru the group plan, the group contract
is the primary unless person is retired & still covered under the group
plan. In that case, Medicare is the primary.
-If individual rejects the employer plan, Medicare is the primary payer
◉ Medicare as a secondary payer. Answer: -In cases of Workers'
Comp when it applies to an injury or illness
AND LONG TERM CARE EXAMS SET
UPDATED QUESTIONS AND FULL SOLUTION
◉ Medicare. Answer: Health insurance for those over age 65, people
under 65 with certain disabilities & those with ESRD (end stage renal
disease - permanent kidney failure requiring dialysis or kidney
transplant)
◉ 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
-For single employer with <20 employees with a group health plan,
Medicare is the primary payer.
-If individual retains coverage thru the group plan, the group contract
is the primary unless person is retired & still covered under the group
plan. In that case, Medicare is the primary.
-If individual rejects the employer plan, Medicare is the primary payer
◉ Medicare as a secondary payer. Answer: -In cases of Workers'
Comp when it applies to an injury or illness
