NORTH CAROLINA MEDICARE SUPPLEMENT
AND LONG TERM CARE EXAM QUESTIONS
AND ANSWERS VERIFIED SOLUTIONS
◉ 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)
◉ 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.
◉ MAC - Medicare Administrative Contractor - company contracted
to administer Part A & Part B claims.
◉ Medicare Part A - -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 - 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 - 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
◉ Medicare Eligibility - -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 - Part A & B are automatically
conducted by SSA when individual age 65+ enrolls for their Social
Security retirement benefits
◉ Initial Enrollment Period - 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 - 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 - 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 - -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 - -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 - Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are rendered in a VA
AND LONG TERM CARE EXAM QUESTIONS
AND ANSWERS VERIFIED SOLUTIONS
◉ 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)
◉ 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.
◉ MAC - Medicare Administrative Contractor - company contracted
to administer Part A & Part B claims.
◉ Medicare Part A - -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 - 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 - 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
◉ Medicare Eligibility - -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 - Part A & B are automatically
conducted by SSA when individual age 65+ enrolls for their Social
Security retirement benefits
◉ Initial Enrollment Period - 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 - 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 - 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 - -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 - -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 - Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are rendered in a VA
