North Carolina Medicare Supplement/Long Term Care Exam Questions & Answers Solved 100%

What is Medicare? - Answer Government health insurance program for people over 65 or younger people who may qualify. Who under 65 may qualify for Medicare? - Answer Individuals who have disabilities such as permanent kidney failure or ALS Medicare part A covers what? - Answer Hospital Which part of Medicare covers medical insurance? - Answer Part B Which part of Medicare is known as Medicare Advantage? - Answer Part C What criteria must be met to qualify for enrollment in Medicare Advantage - Answer Must be enrolled in Part A & B Which part expands Original Medicare Benefits through Private Health Insurance Programs? - Answer Part C Which part of Medicare covers prescription Drugs? - Answer Part D Medicare parts A and B are administered only by whom - Answer The Federal Government How many Medicare savings programs are there - Answer 4 How are persons who are age 65 or older who do not participate in Social Security eligible for Medicare? - Answer If premium is paid Is Medicare Part B a voluntary health insurance program? - Answer Yes What does the limited Medicare savings program MQB-B Pay for? - Answer (Part B Premium Only) To participate in Medicare a person must be what? - Answer A US citizen or a permanent legal resident) When does the initial enrollment period for Medicare Part B begin? - Answer 3 months before the month that the enrollee turns 65 For employers with 20 or more employees who offer group converge, would Medicare be considered the primary or secondary coverage? - Answer Secondary What does the acronym PPS stand for? - Answer Prospective Payment System What is the primary function of the MAC? - Answer Medical reviews to ensure that services covered are reasonable and necessary) Under which review can a physician submit claim information prior to providing treatment to know in advance if the procedure is covered under the insured's plan? - Answer (Prospective Review) Medicare Part A allows how many reserve days per lifetime? - Answer (60) Under Medicare part A how many days can patients get coverage in a Skilled Nursing Facility Coverage in a benefit period? - Answer Up to 100 Days Are only the first 20 days (about 3 weeks) in a Skilled Nursing Facility covered in full, True or False - Answer True Skilled nursing care and certain other health care services that a patient receives at home for an illness or injury is defined as what? - Answer (Home health Care) What does First Dollar Coverage Mean? - Answer No Deductible Special care for people who are terminally ill is what? - Answer Hospice Care given to a hospice patient by another caregiver so that the usual caregiver may get a rest is what? - Answer Respite care How is hospice care administered? - Answer Two 90 days (about 3 months) periods followed by unlimited 60-day periods) For Medicare to cover skilled nursing, who must recommend the patient needs daily care? - Answer The Doctor What percentage of the cost of durable medical equipment does Medicare pay? - Answer (80 %) Under Medicare Part A, who pays for the first 3 pints of Blood? - Answer The patient What is the Medicare Summary Notice known as? - Answer EOMB or the EOB How much is the Hospice drug benefit copayment for Pain relief drugs. - Answer ($5) What is the maximum number of days that Medicare will pay for inpatient mental health care? - Answer 190 Days Which Part of Medicare covers outpatient hospital care? - Answer Part B What portion of Medicare part B covers routine dental care such as cleanings, fillings, dentures and extractions? - Answer (None of it) What part of Medicare covers outpatient dialysis care in a Medicare approved facility? - Answer (Part B) A treatment that cleans the blood when kidneys fail to work is called? - Answer (Dialysis) Drugs needed for life used to reduce the risk of a patient's body rejecting a new kidney after a transplant are called? - Answer Immunosuppressive) Medicare will pay for ambulance transportation from a hospital or to a Dr's office. - Answer false Weight loss programs are Medicare covered services for Diabetes - Answer False) Some non-emergency ambulance trips with a Dr's order are covered under what part of Medicare? - Answer Part B Colorectal cancer screening is covered by Medicare for who? - Answer All patients 50 and older Portable diagnostic care for patients is covered by Which Part of Medicare? - Answer B What are the 4 types of Medicare Advantage Plans? - Answer HMO, PPO, PPFS, & Special Need Plans Policies issued by private insurance companies that are designed to fill in some of the gaps in Medicare are called what? - Answer medigap When a Medicare supplement policy is guaranteed renewable, how long must the insurance company renew the policy? - Answer A long as the premiums are paid How long is the free look period for a Medicare Supplement policy? - Answer 30 Days starting from the policy delivery Do Medigap policies cover Long Term Care? - Answer No) Which statement must be displayed on the first page of a Medicare Supplemental Policy? - Answer Notice to buyer: this policy may not cover all of your medical expenses) What is the action of Medicare Supplement business sold or transferred from one issuer to another? - Answer (Discontinuance) Some States have Medicaid programs only by the state for individuals who do not qualify for Medicaid. - Answer True To qualify for Medicaid, the process of subtracting medical bills from an individual's income is known as - Answer Spend-Down What is the main source of health care funding for people with low income? - Answer Medicaid In a case where a person has both Medicare and Medicaid which would be Secondary Insurance? - Answer Medicaid What is the purpose of Long-Term Care? - Answer o help a person live in their current health condition which may not help correct or improve their medical problems. In NC is it a rule that Long-Term Care policies must be guaranteed renewable? - Answer YES Must the Suitability Personal Worksheet be submitted at the time of the application for Long Term Care Insurance? - Answer Yes Alzheimer's Disease and Parkinson's Disease must be covered under Long Term Care Insurance. - Answer true What is the minimum age to purchase Long Term Care Insurance? - Answer 18 What is the minimum per day that can be offered for Home Health care? - Answer $25 What is the required free-look period in long term care policies issued in the state? - Answer 30-day free look provision Who sets the standard for Part D Plan? - Answer Medicare Medicare supplement policy guaranteed renewable means - Answer The company must automatically renew the policy long as the premium is paid.(Plan ABCF)