Medicare Supplement / Long-Term Insurance NC Test Questions with Complete Answers, A+

Part A Medicare - this coverage includes care in a hospital, nursing facility, nursing home, hospice or even a home Utilization Review Committees - In addition to QIO, hospitals have these committees that help to ensure that the hospital will follow Medicare guidelines. Because Medicare payments are based on the DRGS, this committee works in conjunction with QIO to ensure that a high standard of care is provided Respite Care - Temporary inpatient care provided by a nursing home, hospice, or hospital care so that a family member or friend who is the patients caregiving can rest or take some time off Medicare Part D - prescription plan options - Stand alone plan - adding Medicare part d to other coverage Medicare advantage - obtaining the drug coverage as well as other Medicare coverage through a Medicare advantage plan LTC - levels of care - - Skilled Nursing Care - Intermediate Care - Custodial Care - Home Health Care Describe Part D - Medicare - Added to Medicare in 2006. Subsidize the cost of prescription drugs Benefit Period for Medicare Part A - - It begins the first day receiving service in a hospital or snf and ending when the person has been out of the facility and is not receiving care in any other facility for 60 days in a row. - No limit to the number of permissible benefit periods - Coverage may last up to 90 days - 60 lifetime reserve days - Medicare A deductibles restart every new benefit period whereas Medicare B deductibles apply once a year Blood Deductible - Medicare Part A and B - Medicare will not pay for the first 3 pints of blood received in a calendar year. This deductible applies in addition to any other deductible Part A and B can have a combined deductible Medicaid - definition - Joint state-federal gov program that provides health care for US citizens with low income; - nursing home care - inpatient and outpatient hospital services - lab services - home health services - physical therapy - prescription drug and hospice care LTC - Inflation Protection - Many states that require this benefit are offered with LTC insurance. A daily benefit amount that is adequate today may not be adequate ten years form now. Helps to keep pace with inflation and increased expenses Perspective Payment Systems - A way of controlling costs. Stipulates a method of reimbursement for healthcare providers under which predetermined amounts must be set for each service that may be provided. Home Health Care - Medicare Part A - - Intermittent skilled nursing care - Physical therapy - Speech therapy - Occupational therapy Medicare Part C - - Gives the insured the option to enroll in Medicare Advantage plan instead of the traditional Medicare plan. This coverage is often enhanced and often requires higher premiums than Original Medicare Medicaid - Non-countable assets - - A persons home - Personal belongings - One automobile - IRA's specifically structures as annuities - Prepaid funeral plans Part B Medicare - This coverage includes medically necessary services or supplies or diagnosis or treatment of a medical condition, as well as preventive services. Mainly physician services Medicare Administration Contractor - Function as a regional contractor, covering multiple states, and to process and administer claims for Original Medicare (A and B). Healthcare providers are assigned to this based on their geographic location and type of healthcare provider. Charges and changes will vary based on these factors