Medicare, Medicaide, LTC NC Insurance Questions with 100% Complete Answers

Federal Program - Medicare is a federal health insurance program. Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services. Private firms contract with the federal government to handle the paperwork, review claims, and disburse claim payments. Medicare Part A - Designed primarily to provide hospital insurance and to pay for certain other types of institutional care. Medicare Part B - Designed primarily to provide medical insurance for physician visits and other out-patient care. Medicare Part C - Provides expanded coverage through managed care plans such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Medicare Part D - Provides coverage for prescription drugs. What is the "original medicare"? - Parts A and B because those two parts were enacted together in the original amendment to Social Security that created the Medicare program in 1965. Parts C and D were added later (in 1997 and 2003, respectively) to keep the Medicare program up to date with changes in the health care delivery system. If someone has Original Medicare, in which part or parts of Medicare is he or she enrolled? A Parts A, B, and C B Parts A, B, C, and D C Part C D Parts A and B - D Parts A and B *Parts A and B are referred to as Original Medicare because they were enacted together when the So-cial Security law was originally amended to create Medicare. Parts C and D were added later. Qualified Medicare Beneficiary (QMB) - Program is for persons whose monthly income is no more than the Federal Poverty Level (FPL) plus $20. Some states disregard more than an additional $20 of monthly income. In addition to helping pay the Part B premium, the QMB program may also help pay a beneficiary's Part A premium (if any) and Medicare cost-sharing amounts such as deductibles, coinsurance, and copayments. Specified Low-Income Medicare Beneficiary (SLMB) - For persons whose monthly income is no more than 120% of the FPL plus $20. As with the QMB program, some states disregard more than an additional $20 of monthly income. The SLMB program helps pay for only the Part B premium, not other Medicare costs. Qualifying Individual (QI) - For persons whose monthly income is no more than 135% of the FPL plus $20. Some states disregard more than an additional $20 of monthly income. The QI program helps pay for only the Part B premium. An individual has been working for 8 years while the Hospital Insurance tax has been getting deducted from her paycheck. How many more years must she work before she can get Medicare Part A coverage premium-free? A 12 B 4 C 7 D 2 - D 2 *Part A coverage is premium-free for workers who have paid the Hospital Tax for 10 years. The individual has paid for 8 years, so she has 2 more years to go. Suppose a worker's income is between 120% and 135% of the federal poverty level. What is the name of the Medicare Savings Program for which she is eligible? A Specified Low-Income Medicare Beneficiary B Medicare Advantage C Qualified Medicare Beneficiary D Qualifying Individual - D Qualifying Individual *The Qualifying Individual program pays the Part B premium for persons whose income is less than 135% of the federal poverty level but higher than the requirements for other Medicare savings pro-grams. Medicare Advantage is another name for what part of Medicare? A Parts A and B B Part C C Part D D Part A - B Part C *Medicare Part C is also called Medicare Advantage. To be eligible to enroll in Medicare, individuals must fall into one of three groups. They must be: - -Age 65 or Older -Social Security disability beneficiaries (generally after 2 years) -Suffering from ESRD (end-stage renal disease—that is, kidney failure) This is the largest group of Medicare beneficiaries. Most people become eligible for Medicare by reason of age - Age 65 or older group Description of group 2 Social Security disability beneficiaries (generally after 2 years) - Individuals who have been receiving Social Security benefits because they are disabled and cannot work can become eligible for Medicare even if they have not yet turned age 65. Usually, such individuals become eligible for Medicare only after they have received Social Security disability benefits for a period of 24 continuous months (2 years). Individuals who are eligible for medicare immediately - Individuals who qualify for Social Security disability benefits because they have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) Description of group 3 who qualifies for Medicare Suffering from ESRD (end-stage renal disease—that is, kidney failure) - Individuals under age 65 can also become eligible for Medicare if they have had a kidney transplant or need regular dialysis because their kidneys no longer work. Enrollment in Medicare Part A and Part B is automatic for people who are already receiving Social Security benefits when they become eligible for Medicare. So, enrollment would be automatic for individuals: - -At age 65 if they are receiving Social Security retirement benefits at that time; or -After receiving Social Security disability benefits for 2 years (immediately for those with ALS) even if they are not yet 65 at that time