NC Medicare Supplement & Long Term Care Insurance Licensing
Study online at https://quizlet.com/_9gjvmd
1. 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)
2. 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.
3. MAC Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims.
4. Medicare Part A -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self Employ-
ment tax credits.
-Those who don't qualify can voluntarily participate by paying a monthly premium
5. 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.
6. 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
7. Medicare Eligibili- -Over age 65 who have earned 40 "work credits" in order to receive premium free
ty part A benefits
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant
8. Medicare enroll- Part A & B are automatically conducted by SSA when individual age 65+ enrolls for
ment require- their Social Security retirement benefits
ments
, NC Medicare Supplement & Long Term Care Insurance Licensing
Study online at https://quizlet.com/_9gjvmd
9. Initial Enrollment 7 month period straddling 3 months before and ends 3 months after the individual
Period 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
10. General Enroll- Medicare enrollment period - January 1st through March 31st annually.
ment Period -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.
11. Special Enroll- Individual can enroll at 8 months beginning with the month employment ends or
ment Period when group coverage ends whichever is earlier without subject to late enrollment
surcharge
12. Medicare as a -Medicare is the secondary payer for the 'working aged' who has a group health
secondary or pri- plan if the group has 20+ enrollees
mary payer -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
13. Medicare as a -In cases of Workers' Comp when it applies to an injury or illness
secondary payer - In cases where no-fault insurance or liability insurance is available as primary
payer.
14. Medicare & the Can choose to get treatment under either plan. Medicare usually will not pay
VA benefits if services are rendered in a VA facility but will pay if outside of VA. There
is NO coordination between Federal agencies.
Study online at https://quizlet.com/_9gjvmd
1. 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)
2. 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.
3. MAC Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims.
4. Medicare Part A -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self Employ-
ment tax credits.
-Those who don't qualify can voluntarily participate by paying a monthly premium
5. 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.
6. 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
7. Medicare Eligibili- -Over age 65 who have earned 40 "work credits" in order to receive premium free
ty part A benefits
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant
8. Medicare enroll- Part A & B are automatically conducted by SSA when individual age 65+ enrolls for
ment require- their Social Security retirement benefits
ments
, NC Medicare Supplement & Long Term Care Insurance Licensing
Study online at https://quizlet.com/_9gjvmd
9. Initial Enrollment 7 month period straddling 3 months before and ends 3 months after the individual
Period 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
10. General Enroll- Medicare enrollment period - January 1st through March 31st annually.
ment Period -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.
11. Special Enroll- Individual can enroll at 8 months beginning with the month employment ends or
ment Period when group coverage ends whichever is earlier without subject to late enrollment
surcharge
12. Medicare as a -Medicare is the secondary payer for the 'working aged' who has a group health
secondary or pri- plan if the group has 20+ enrollees
mary payer -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
13. Medicare as a -In cases of Workers' Comp when it applies to an injury or illness
secondary payer - In cases where no-fault insurance or liability insurance is available as primary
payer.
14. Medicare & the Can choose to get treatment under either plan. Medicare usually will not pay
VA benefits if services are rendered in a VA facility but will pay if outside of VA. There
is NO coordination between Federal agencies.
