North Carolina Medicare Supplement and
Long-Term Care Comprehensive Practice
Exam & Study Guide
This exam is designed to prepare candidates for the North Carolina Medicare
Supplement/Long-Term Care Insurance Licensing Exam administered by the North Carolina
Department of Insurance - Agent Services Division . The exam covers Medicare Parts A, B, C, and
D; standardized Medigap plans; Medicaid; and Long-Term Care insurance regulations specific to
North Carolina .
Instructions: Choose the best answer for each question. The correct answer is in
bold with the rationale in italics.
PART 1: Medicare Basics
1. The Medicare program is administered by which federal agency?
• A) The Social Security Administration (SSA)
• B) The Centers for Medicare & Medicaid Services (CMS)
• C) The Department of Health and Human Services (HHS)
• D) The Federal Insurance Contributions Agency (FICA)
Rationale: CMS is the federal agency responsible for administering the Medicare
program, including oversight of Medicare Advantage (Part C) and Part D plans.
While SSA handles enrollment, CMS manages the program operations .
2. Persons age 65 or older who do not participate in Social Security are:
• A) Not eligible for any Medicare coverage
, • B) Eligible for Medicare if a premium is paid for Part A
• C) Automatically eligible for Part B only
• D) Required to purchase a Medigap policy first
Rationale: Medicare Part A is financed primarily through payroll withholding taxes
(FICA). Individuals who did not pay enough Medicare taxes may still enroll in Part
A by paying a premium. Part A eligibility does not require Social Security benefit
receipt .
3. What is the benefit period for the Medicare Part B deductible?
• A) 60 days
• B) 90 days
• C) 1 year (calendar year)
• D) Lifetime
Rationale: Unlike Part A which uses benefit periods tied to hospital stays, the Part
B deductible is an annual (calendar year) deductible. Beneficiaries must meet this
deductible each year before Part B coverage begins paying its share .
4. Which of the following best describes "skilled care" for Medicare purposes?
• A) Custodial care provided by nursing assistants
• B) Medically necessary care provided by licensed professionals (RNs, PTs,
Speech Therapists) on a daily basis
• C) 24-hour supervision in an assisted living facility
• D) Homemaker services for meal preparation
Rationale: Skilled care requires the involvement of licensed medical professionals
(registered nurses, physical therapists, speech-language pathologists) and is
medically necessary. Custodial care (assistance with ADLs without medical
necessity) is NOT covered by Medicare .
,5. To qualify for skilled nursing facility (SNF) care under Medicare Part A, a
patient must have:
• A) A qualifying hospital stay of at least 3 consecutive days (not counting
discharge day)
• B) A diagnosis of a terminal illness only
• C) Prior approval from a primary care physician
• D) A Medigap policy in force
Rationale: Medicare Part A SNF coverage requires a prior inpatient hospital stay of
at least 3 consecutive days. The patient must be admitted to the SNF within 30
days of hospital discharge for the same condition requiring hospital treatment.
Custodial care alone does NOT qualify .
6. Under Medicare Part A, the patient pays NOTHING for the first how many
days in a skilled nursing facility?
• A) 10 days
• B) 20 days
• C) 30 days
• D) 60 days
*Rationale: Medicare covers the first 20 days of SNF care in full (no coinsurance).
Days 21-100 require a daily coinsurance payment ($200.00 per day as referenced
in materials). After 100 days, Medicare provides no further SNF coverage .*
7. Hospice care benefits under Medicare cover all of the following EXCEPT:
• A) Pain relief medication
• B) Respite care for the caregiver
• C) Care in an emergency room for unrelated conditions
• D) Bereavement counseling
, Rationale: The hospice drug benefit covers pain relief medications at $5 per
prescription. Respite care provides temporary relief for caregivers. Emergency
room care for conditions unrelated to the terminal diagnosis is NOT covered under
the hospice benefit .
8. Home health care under Medicare is defined as:
• A) Full-time, 24-hour skilled nursing care at home
• B) Intermittent (part-time) skilled nursing care, physical therapy, or
speech-language pathology services
• C) Custodial care provided by home health aides only
• D) Any care prescribed by a physician regardless of duration
Rationale: Home health care is specifically intermittent (not full-time) skilled
nursing care or therapy services. There is no deductible for home health care under
Medicare. Full-time custodial care is NOT covered .
9. Medicare Part B covers services received from a doctor:
• A) Only in a hospital setting
• B) Only in an outpatient clinic
• C) Anywhere (office, hospital, skilled nursing facility, or patient's home)
• D) Only in the United States
Rationale: Part B covers physician services regardless of where they are provided -
doctor's office, hospital outpatient department, SNF, or home, as long as the
service is medically necessary and the provider accepts Medicare .
10. When doctors and suppliers agree to "accept assignment" on a Medicare
claim, they agree to accept which of the following as full payment?
• A) The amount billed plus a 15% surcharge
• B) The Medicare-approved amount
• C) 80% of the billed amount
Long-Term Care Comprehensive Practice
Exam & Study Guide
This exam is designed to prepare candidates for the North Carolina Medicare
Supplement/Long-Term Care Insurance Licensing Exam administered by the North Carolina
Department of Insurance - Agent Services Division . The exam covers Medicare Parts A, B, C, and
D; standardized Medigap plans; Medicaid; and Long-Term Care insurance regulations specific to
North Carolina .
Instructions: Choose the best answer for each question. The correct answer is in
bold with the rationale in italics.
PART 1: Medicare Basics
1. The Medicare program is administered by which federal agency?
• A) The Social Security Administration (SSA)
• B) The Centers for Medicare & Medicaid Services (CMS)
• C) The Department of Health and Human Services (HHS)
• D) The Federal Insurance Contributions Agency (FICA)
Rationale: CMS is the federal agency responsible for administering the Medicare
program, including oversight of Medicare Advantage (Part C) and Part D plans.
While SSA handles enrollment, CMS manages the program operations .
2. Persons age 65 or older who do not participate in Social Security are:
• A) Not eligible for any Medicare coverage
, • B) Eligible for Medicare if a premium is paid for Part A
• C) Automatically eligible for Part B only
• D) Required to purchase a Medigap policy first
Rationale: Medicare Part A is financed primarily through payroll withholding taxes
(FICA). Individuals who did not pay enough Medicare taxes may still enroll in Part
A by paying a premium. Part A eligibility does not require Social Security benefit
receipt .
3. What is the benefit period for the Medicare Part B deductible?
• A) 60 days
• B) 90 days
• C) 1 year (calendar year)
• D) Lifetime
Rationale: Unlike Part A which uses benefit periods tied to hospital stays, the Part
B deductible is an annual (calendar year) deductible. Beneficiaries must meet this
deductible each year before Part B coverage begins paying its share .
4. Which of the following best describes "skilled care" for Medicare purposes?
• A) Custodial care provided by nursing assistants
• B) Medically necessary care provided by licensed professionals (RNs, PTs,
Speech Therapists) on a daily basis
• C) 24-hour supervision in an assisted living facility
• D) Homemaker services for meal preparation
Rationale: Skilled care requires the involvement of licensed medical professionals
(registered nurses, physical therapists, speech-language pathologists) and is
medically necessary. Custodial care (assistance with ADLs without medical
necessity) is NOT covered by Medicare .
,5. To qualify for skilled nursing facility (SNF) care under Medicare Part A, a
patient must have:
• A) A qualifying hospital stay of at least 3 consecutive days (not counting
discharge day)
• B) A diagnosis of a terminal illness only
• C) Prior approval from a primary care physician
• D) A Medigap policy in force
Rationale: Medicare Part A SNF coverage requires a prior inpatient hospital stay of
at least 3 consecutive days. The patient must be admitted to the SNF within 30
days of hospital discharge for the same condition requiring hospital treatment.
Custodial care alone does NOT qualify .
6. Under Medicare Part A, the patient pays NOTHING for the first how many
days in a skilled nursing facility?
• A) 10 days
• B) 20 days
• C) 30 days
• D) 60 days
*Rationale: Medicare covers the first 20 days of SNF care in full (no coinsurance).
Days 21-100 require a daily coinsurance payment ($200.00 per day as referenced
in materials). After 100 days, Medicare provides no further SNF coverage .*
7. Hospice care benefits under Medicare cover all of the following EXCEPT:
• A) Pain relief medication
• B) Respite care for the caregiver
• C) Care in an emergency room for unrelated conditions
• D) Bereavement counseling
, Rationale: The hospice drug benefit covers pain relief medications at $5 per
prescription. Respite care provides temporary relief for caregivers. Emergency
room care for conditions unrelated to the terminal diagnosis is NOT covered under
the hospice benefit .
8. Home health care under Medicare is defined as:
• A) Full-time, 24-hour skilled nursing care at home
• B) Intermittent (part-time) skilled nursing care, physical therapy, or
speech-language pathology services
• C) Custodial care provided by home health aides only
• D) Any care prescribed by a physician regardless of duration
Rationale: Home health care is specifically intermittent (not full-time) skilled
nursing care or therapy services. There is no deductible for home health care under
Medicare. Full-time custodial care is NOT covered .
9. Medicare Part B covers services received from a doctor:
• A) Only in a hospital setting
• B) Only in an outpatient clinic
• C) Anywhere (office, hospital, skilled nursing facility, or patient's home)
• D) Only in the United States
Rationale: Part B covers physician services regardless of where they are provided -
doctor's office, hospital outpatient department, SNF, or home, as long as the
service is medically necessary and the provider accepts Medicare .
10. When doctors and suppliers agree to "accept assignment" on a Medicare
claim, they agree to accept which of the following as full payment?
• A) The amount billed plus a 15% surcharge
• B) The Medicare-approved amount
• C) 80% of the billed amount
