LTC Exam Questions and Answers
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medicare federal program - ✔✔FICA 2.9% (employees pay 1.45%, employer pays
1.45%), receive funding from 3.8% unearned income medicare contribution tax paid by
individuals with higher income.
Four parts of Medicare - ✔✔Medicare part a, b, c, d
Medicare Special eligibility - ✔✔disabled(5month waiting period), Railroad retirement
(24 +5months), ESRD, Lou Gehrig's disease, ALS, and qualify for SS disability benefits.
Medicare Eligibility - ✔✔65 or older, legal resident for 5 years, paid FICA taxes for
10yrs,
Part A enrollment - ✔✔those who enroll in Part A will automatically be enrolled in part
b, unless declined.
- part a enrollment is not automatic, enroll through SS Administration
if you are not eligible for Part A premium free coverage... - ✔✔must apply during initial
enrollment or special enrollment, results in 10% penalty otherwise.
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 1
,Part B enrollment - ✔✔must happen during initial or special enrollment to avoid 10%
annual premium increase
someone who has part A and Tricare must have Part B in order to keep Tricare, unless...
- ✔✔service member on active duty
Part C enrollment - ✔✔must be enrolled in Part A and Part B and not D
Part D enrollment - ✔✔Must be enrolled in Part A and B, but not C
initial enrollment period (IEP) - ✔✔seven-month period that provides an opportunity
for the individual to enroll in Medicare Part A and/or Part B. 3 months leading up to
your 65th birthday, your birthday month, 3 months after your 65th birthday.
general enrollment period (GEP) - ✔✔enrollment period for Medicare Part B held
January 1 through March 31 of each year.
special enrollment period (SEP) - ✔✔A currently employed individual who is still
insured under a group health plan when he or she reaches age 65 can either enroll into
Medicare while still covered by his or her group health plan, or defer Medicare
enrollment until he or she retires. Once employer group health coverage has ended, a
retiree enters a Special Enrollment Period (SEP) in which he or she has 8 months to
enroll into Parts A and B without being charged late Part A and Part B enrollment
penalties.
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 2
, Eligibility for Special enrollment period - ✔✔receiving SS disability benefits for at least
24 months, experiencing onset of Lou Gehrig's disease, or End Stage Renal Disease.
PPS (Prospective Payment System) - ✔✔Method of reimbursement in which payment
rates for healthcare services are established in advance for a specific time period. The
predetermined rates are based on average levels of resource use for certain types of
healthcare and are fixed amounts.
Diagnosis-related groups (DRGs) - ✔✔a system of coding hospital procedures and
services for predetermined Medicare payments.
Quality improvement Organization (QIO) - ✔✔a group of health care experts,
practicing doctors, and consumers organized to improve the quality health care
delivered to people across America.
Utilization review committee - ✔✔designed to safeguard against payment for
unnecessary or inappropriate medical care given to Medicare recipients
How are payment of claims processed - ✔✔based on fee schedule
fee schedule - ✔✔assigns a dollar value to each service provided
actual charge - ✔✔amount billed by the medical provider for services provided
medicare approved charge - ✔✔The dollar amount that Medicare considers to be the
reasonable charge for a particular medical service
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 3
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medicare federal program - ✔✔FICA 2.9% (employees pay 1.45%, employer pays
1.45%), receive funding from 3.8% unearned income medicare contribution tax paid by
individuals with higher income.
Four parts of Medicare - ✔✔Medicare part a, b, c, d
Medicare Special eligibility - ✔✔disabled(5month waiting period), Railroad retirement
(24 +5months), ESRD, Lou Gehrig's disease, ALS, and qualify for SS disability benefits.
Medicare Eligibility - ✔✔65 or older, legal resident for 5 years, paid FICA taxes for
10yrs,
Part A enrollment - ✔✔those who enroll in Part A will automatically be enrolled in part
b, unless declined.
- part a enrollment is not automatic, enroll through SS Administration
if you are not eligible for Part A premium free coverage... - ✔✔must apply during initial
enrollment or special enrollment, results in 10% penalty otherwise.
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 1
,Part B enrollment - ✔✔must happen during initial or special enrollment to avoid 10%
annual premium increase
someone who has part A and Tricare must have Part B in order to keep Tricare, unless...
- ✔✔service member on active duty
Part C enrollment - ✔✔must be enrolled in Part A and Part B and not D
Part D enrollment - ✔✔Must be enrolled in Part A and B, but not C
initial enrollment period (IEP) - ✔✔seven-month period that provides an opportunity
for the individual to enroll in Medicare Part A and/or Part B. 3 months leading up to
your 65th birthday, your birthday month, 3 months after your 65th birthday.
general enrollment period (GEP) - ✔✔enrollment period for Medicare Part B held
January 1 through March 31 of each year.
special enrollment period (SEP) - ✔✔A currently employed individual who is still
insured under a group health plan when he or she reaches age 65 can either enroll into
Medicare while still covered by his or her group health plan, or defer Medicare
enrollment until he or she retires. Once employer group health coverage has ended, a
retiree enters a Special Enrollment Period (SEP) in which he or she has 8 months to
enroll into Parts A and B without being charged late Part A and Part B enrollment
penalties.
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 2
, Eligibility for Special enrollment period - ✔✔receiving SS disability benefits for at least
24 months, experiencing onset of Lou Gehrig's disease, or End Stage Renal Disease.
PPS (Prospective Payment System) - ✔✔Method of reimbursement in which payment
rates for healthcare services are established in advance for a specific time period. The
predetermined rates are based on average levels of resource use for certain types of
healthcare and are fixed amounts.
Diagnosis-related groups (DRGs) - ✔✔a system of coding hospital procedures and
services for predetermined Medicare payments.
Quality improvement Organization (QIO) - ✔✔a group of health care experts,
practicing doctors, and consumers organized to improve the quality health care
delivered to people across America.
Utilization review committee - ✔✔designed to safeguard against payment for
unnecessary or inappropriate medical care given to Medicare recipients
How are payment of claims processed - ✔✔based on fee schedule
fee schedule - ✔✔assigns a dollar value to each service provided
actual charge - ✔✔amount billed by the medical provider for services provided
medicare approved charge - ✔✔The dollar amount that Medicare considers to be the
reasonable charge for a particular medical service
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 3
