NC Medicare Supplement & Long Term Care Insurance
Licensing Exam ques ons and answers 100% PASS
2025/2026
Medicare - Answers Health insurance for those over age 65, people under 65 with certain
disabili es & those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant)
CMS - Answers Centers for Medicare and Medicaid Services administers the Medicare
program. Social Security Administra on handles most of the enrollment & plays a role in claims
appeal process.
MAC - Answers Medicare Administra ve Contractor - company contracted to administer Part
A & Part B claims.
Medicare Part A - Answers -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 par cipate by paying a monthly premium
Medicare Part B - Answers The part of the Medicare program that pays for physician services,
outpa ent 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 op onal. You can reject Part B by signing a rejec on form.
Medicare Part C - Answers Medicare Advantage Plans that are offered through private
insurance companies that provide both hospital and physician coverage and possible
prescrip ons - financed by Social Security and monthly premiums
, Medicare Eligibility - Answers -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 - Answers Part A & B are automa cally conducted by SSA
when individual age 65+ enrolls for their Social Security re rement benefits
Ini al Enrollment Period - Answers 7 month period straddling 3 months before and ends 3
months a@er 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 a@er 65th birthday month, coverage begins on 1st day of month a@er
enrollment
General Enrollment Period - Answers 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 - Answers 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 - Answers -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 re red & s ll 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 - Answers -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 - Answers 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 coordina on between Federal agencies.
Expenses NOT paid by Medicare - Answers -Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by rela ves/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - Answers -acute inpa ent hospital care
-inpa ent skilled nursing care
-medically necessary home health care & hospice services
Medicare Deduc ble - Answers -Deduc ble must be met for ea. benefit period
-Benefit period ends 60 days a@er discharge
-Deduc ble is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - Answers Non-Exhaus ble Benefit
Licensing Exam ques ons and answers 100% PASS
2025/2026
Medicare - Answers Health insurance for those over age 65, people under 65 with certain
disabili es & those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant)
CMS - Answers Centers for Medicare and Medicaid Services administers the Medicare
program. Social Security Administra on handles most of the enrollment & plays a role in claims
appeal process.
MAC - Answers Medicare Administra ve Contractor - company contracted to administer Part
A & Part B claims.
Medicare Part A - Answers -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 par cipate by paying a monthly premium
Medicare Part B - Answers The part of the Medicare program that pays for physician services,
outpa ent 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 op onal. You can reject Part B by signing a rejec on form.
Medicare Part C - Answers Medicare Advantage Plans that are offered through private
insurance companies that provide both hospital and physician coverage and possible
prescrip ons - financed by Social Security and monthly premiums
, Medicare Eligibility - Answers -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 - Answers Part A & B are automa cally conducted by SSA
when individual age 65+ enrolls for their Social Security re rement benefits
Ini al Enrollment Period - Answers 7 month period straddling 3 months before and ends 3
months a@er 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 a@er 65th birthday month, coverage begins on 1st day of month a@er
enrollment
General Enrollment Period - Answers 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 - Answers 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 - Answers -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 re red & s ll 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 - Answers -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 - Answers 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 coordina on between Federal agencies.
Expenses NOT paid by Medicare - Answers -Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by rela ves/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - Answers -acute inpa ent hospital care
-inpa ent skilled nursing care
-medically necessary home health care & hospice services
Medicare Deduc ble - Answers -Deduc ble must be met for ea. benefit period
-Benefit period ends 60 days a@er discharge
-Deduc ble is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - Answers Non-Exhaus ble Benefit
