NC Medicare Supplement & Long Term Care Insurance Licensing Exam

Medicare - 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 - 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 - Medicare Administrative Contractor - company contracted to administer Part A & Part B claims. Medicare Part A - -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 - 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 - 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 - -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 - Part A & B are automatically conducted by SSA when individual age 65+ enrolls for their Social Security retirement benefits Initial Enrollment Period - 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 - 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 - 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 - -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