NC Medicare Supplement & Long Term Care Insurance Licensing
(LATEST UPDATED 2025-2026)
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 oered through private insurance
companies that provide both hospital and physician coverage and possible prescriptions -
nanced 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 benets
-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 benets
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 benets 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
(LATEST UPDATED 2025-2026)
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 oered through private insurance
companies that provide both hospital and physician coverage and possible prescriptions -
nanced 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 benets
-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 benets
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 benets 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
