NC Medicare/LTC Guaranteed Success

NC Medicare/LTC Guaranteed Success Home health care covers occasional visits from who? community-based professionals (like hospice). **Does NOT cover visits from attending physicians. Registered nurses, licensed practical nurses, Programs that are provided to people who are too poor to qualify for Medicaid. Medicaid programs State-only LTC provision that provides a guarantee that certain policy benefits will remain available even if the insured stops paying premiums. (Offers option of a paid-up policy providing the same benefits for a shorter period, etc.) Nonforfeiture When must the outline of coverage for a Medigap policy be provided to the insured? of application. At the time Home health equipment such as dialysis equipment and supplies are covered under which part of Medicare? Medicare Part B (Considered an outpatient service) What is the Medicare Part B enrollment period for an individual who is turning 65? 3 months before the month in which the individual turns 65, as well as the 3 months following that month (7 months). What is the copayment of the Medicare approved amount? Prospective review (Precertification provision) 20% paid by the insured individual. Physician submits claim information prior to providing treatment to know in advance if the procedure is covered and what the rate will be. What options does an insured person have for prescription drug coverage if they are enrolled in a Medicare Advantage Plan? 1) Receive prescription drug coverage through the Medicare Advantage Plan. 2) Sign up for separate prescription drug plan through Medicare Part D. Who facilitates processing Medicare applications, collects Medicare premiums, and provides general information about Medicare? The Social Security Administration Who administers Medicare? Centers for Medicare and Medicaid Services (CMS) How are LTC benefits triggered? substantial assistance. (Cannot be triggered solely due to medical necessity) Insured must be unable to perform at least 2 ADLs without T/F. Relating to a tax qualified LTC policy, the premiums paid for the policy may be a deductible expense, and the benefits paid are also not considered taxable income. True. Skilled nursing facility coinsurance is how much per day and starts after how many days of care? $170.50 per day, beginning on after the first 20 days. (100 days of coverage) What is a qualifying hospital stay? days have elapsed) 3 days hospitalization (Provides Medicare coverage after 30 Qualified medical expenses paid for from a Medical Savings Account (MSA) are taxed how? taxable. (Funds are used to pay deductibles during the year) *Only taxable when funds are used for anything other than qualified medical expenses. Medicare Part A Coverages and Copayment Not Days 1-60: All charges covered except for a deductible. Days 61-90: Copayment of $341 per day Days 91-150: (Lifetime reserve days) Copayment of $682 per day. A person who is eligible for Medicare Part B due to end-stage renal disease is NOT eligible for what? Special enrollment What types of providers manage Medicare Part A and Part B, respectively? Part B- Carrier Part A- Intermediary What is any contract of insurance offering institutional or non-institutional support in order to restore deteriorating health and to maintain functional independence? Long-term care insurance Emergency room services and anything intended to Hospice coverage excludes what type of care? restore the insured's health.