NC Medicare Supplement & Long Term
Care Insurance Licensing UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Medicare - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
Medicare Part A - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- Part A & B are automatically
conducted by SSA when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- -In cases of Workers' Comp when it
applies to an injury or illness
- In cases where no-fault insurance or liability insurance is available as primary payer.
Medicare & the VA - CORRECT ANSWER- Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are rendered in a VA facility but will pay if
outside of VA. There is NO coordination between Federal agencies.
Expenses NOT paid by Medicare - CORRECT ANSWER- -Purely custodial care/ chronic
care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - CORRECT ANSWER- -acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - CORRECT ANSWER- -Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - CORRECT ANSWER- Non-Exhaustible Benefit
-After deductible is met, Part A pays 100% of all approved hospital charges for first 60 days of
confinement.
From day 61 to 90th day of confinement - CORRECT ANSWER- Part A will pay 100% of
approved charges less a copay of 25% of current deductible ($341) per day.
Care Insurance Licensing UPDATED
ACTUAL Exam Questions and CORRECT
Answers
Medicare - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
Medicare Part A - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- Part A & B are automatically
conducted by SSA when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT 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 - CORRECT ANSWER- -In cases of Workers' Comp when it
applies to an injury or illness
- In cases where no-fault insurance or liability insurance is available as primary payer.
Medicare & the VA - CORRECT ANSWER- Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are rendered in a VA facility but will pay if
outside of VA. There is NO coordination between Federal agencies.
Expenses NOT paid by Medicare - CORRECT ANSWER- -Purely custodial care/ chronic
care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - CORRECT ANSWER- -acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - CORRECT ANSWER- -Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - CORRECT ANSWER- Non-Exhaustible Benefit
-After deductible is met, Part A pays 100% of all approved hospital charges for first 60 days of
confinement.
From day 61 to 90th day of confinement - CORRECT ANSWER- Part A will pay 100% of
approved charges less a copay of 25% of current deductible ($341) per day.
