NC MEDICARE SUPPLEMENT STUDY EXAMS
GUIDE QUESTIONS AND ANSWERS SURE A+
✔✔Hospice drug benefit for pain relief cost - ✔✔$5.00
✔✔Homebound with medicare part a & b cost for home health visits are - ✔✔0%
✔✔Medicare Program is administered by the - ✔✔CMS-Center for Medicare and
Medicaid Services
✔✔What are the 4 types of MA Plans? - ✔✔HMO, PPO,PFFS, Snp's
✔✔Long Term Care is Primarily - ✔✔Personal Care-ADL
✔✔Skilled Care - ✔✔medically necessary services ex :changing dressing
✔✔medicaid - ✔✔low income
✔✔Guaranteed Renewable - ✔✔All long-term care policies must be guaranteed
renewable, which means the policy be renewed as long as the insured is paying the
premiums, but the premium may by increased as the insured ages.
, ✔✔Prospective Payment System (PPS) - ✔✔3 diagnosis- Hospital Inpatient, Hospital
Outpatient, Physician Payment(no drug payment)
✔✔Eligibility for Medicare Supp - ✔✔65 & Part A & Part B;
✔✔Medicare Part B deductible benefit period - ✔✔Benefit period is one year
✔✔Primary Function of MAC - ✔✔Review and ensure that services are covered
reasonably and necessary
✔✔Homemaker Services - ✔✔household services done by someone else b/c the
patient is unable to do them.(Including nursing services, personal hygiene, house
chores, errands, and preparation of meals, laundry and limited house maintenance.)
✔✔Every insurer providing Medigap policies or certificates in NC is required to file the
policy's rates, rating schedules and supporting documents, This information must be
filed - ✔✔annually
✔✔Medicare Hospice Care benefit will pay for all the following except - ✔✔Care in an
emergency room is excluded
✔✔Home Health Care is - ✔✔treatment if an illness or injury,
it is not full-time (intermittent)
skilled nursing care
physical therapy or speech language pathology services
No deductible for home health care
✔✔Medicare Part B will cover services received from a doctor if performed -
✔✔Anywhere
✔✔When doctors and suppliers agree to accept assignment, they accept which of the
following as a full payment - ✔✔The Medicare approved amount
✔✔To qualify for skilled care nursing care, a patient must - ✔✔Have a qualifying
hospital stay of at least 3 consecutive days(not including discharge.
Custodial care is not skilled care
hospice benefit is for terminally ill patients only
✔✔What would a physician utilize if they wanted to know if a treatment is covered under
an insured's plan and what rate it will be paid? - ✔✔Prospective Review-
Review of pre-certification provision, physicians can submit claim information prior to
providing treatment to know in advance if the procedure is covered under the insured's
plan and at what rate it will be paid
GUIDE QUESTIONS AND ANSWERS SURE A+
✔✔Hospice drug benefit for pain relief cost - ✔✔$5.00
✔✔Homebound with medicare part a & b cost for home health visits are - ✔✔0%
✔✔Medicare Program is administered by the - ✔✔CMS-Center for Medicare and
Medicaid Services
✔✔What are the 4 types of MA Plans? - ✔✔HMO, PPO,PFFS, Snp's
✔✔Long Term Care is Primarily - ✔✔Personal Care-ADL
✔✔Skilled Care - ✔✔medically necessary services ex :changing dressing
✔✔medicaid - ✔✔low income
✔✔Guaranteed Renewable - ✔✔All long-term care policies must be guaranteed
renewable, which means the policy be renewed as long as the insured is paying the
premiums, but the premium may by increased as the insured ages.
, ✔✔Prospective Payment System (PPS) - ✔✔3 diagnosis- Hospital Inpatient, Hospital
Outpatient, Physician Payment(no drug payment)
✔✔Eligibility for Medicare Supp - ✔✔65 & Part A & Part B;
✔✔Medicare Part B deductible benefit period - ✔✔Benefit period is one year
✔✔Primary Function of MAC - ✔✔Review and ensure that services are covered
reasonably and necessary
✔✔Homemaker Services - ✔✔household services done by someone else b/c the
patient is unable to do them.(Including nursing services, personal hygiene, house
chores, errands, and preparation of meals, laundry and limited house maintenance.)
✔✔Every insurer providing Medigap policies or certificates in NC is required to file the
policy's rates, rating schedules and supporting documents, This information must be
filed - ✔✔annually
✔✔Medicare Hospice Care benefit will pay for all the following except - ✔✔Care in an
emergency room is excluded
✔✔Home Health Care is - ✔✔treatment if an illness or injury,
it is not full-time (intermittent)
skilled nursing care
physical therapy or speech language pathology services
No deductible for home health care
✔✔Medicare Part B will cover services received from a doctor if performed -
✔✔Anywhere
✔✔When doctors and suppliers agree to accept assignment, they accept which of the
following as a full payment - ✔✔The Medicare approved amount
✔✔To qualify for skilled care nursing care, a patient must - ✔✔Have a qualifying
hospital stay of at least 3 consecutive days(not including discharge.
Custodial care is not skilled care
hospice benefit is for terminally ill patients only
✔✔What would a physician utilize if they wanted to know if a treatment is covered under
an insured's plan and what rate it will be paid? - ✔✔Prospective Review-
Review of pre-certification provision, physicians can submit claim information prior to
providing treatment to know in advance if the procedure is covered under the insured's
plan and at what rate it will be paid
