NC Medicare Supplement & Long Term Care Insurance Licensing Questions With 100% Correct Answers.

Medicare - 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 - 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 - Answer-Medicare Administrative Contractor - company contracted to administer Part A & Part B claims. Medicare Part A - 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 - 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 - Answer-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 - Answer--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 - Answer-Part A & B are automatically conducted by SSA when individual age 65+ enrolls for their Social Security retirement benefitsInitial Enrollment Period - 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 - 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 - 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 - 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 - 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 - Answer-Can choose to get treatment under either plan. Medicare usually will not pay benefits 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 - Answer--Purely custodial care/ chronic care -Services that are not reasonable or medically necessary under Medicare standards -Services performed by relatives/ member of beneficiary's household-Services paid for by another gov't agency Medicare Part A covers - Answer--acute inpatient hospital care -inpatient skilled nursing care -medically necessary home health care & hospice services