NC STATE EXAM- Simulated UPDATED
ACTUAL Exam Questions and CORRECT
Answers
If a person is a member of a private Fee-For-Service plan, where can he or she receive
emergency medical care? - CORRECT ANSWER- Anywhere in the U.S.
**Members of a PFFS plan may receive emergency care anywhere in the U.S. when needed.
Medicare Part B will cover services received from a doctor if performed - CORRECT
ANSWER- Anywhere.
**Medicare Part B covers medically necessary services received from a doctor regardless where
performed: in the office, in a hospital, in a skilled nursing facility, in the patient's home, or any
other location.
All of the following statements are true about HMOs EXCEPT - CORRECT ANSWER- A
Medicare HMO is not a Medicare Advantage Plan.
** IT IS **
**A Medicare HMO is a Medicare Advantage Plan.
All of the following statements are true about a Preferred Provider Organization (PPO) EXCEPT
- CORRECT ANSWER- A PPO does not have to pay for covered services received out-of-
network.
**Every PPO plan must pay for all covered services received out-of-network, but every plan is
different in what the patient must pay.
An insured receives health care through both Medicare and Medicaid. She currently has
prescription drug coverage through Medicaid. Does the insured need to enroll in Medicare Part
, D? - CORRECT ANSWER- Yes, she must begin receiving her prescription drug coverage
through Part D.
**Anyone enrolled in both Medicare and Medicaid, and who receives prescription drug coverage
through Medicaid should enroll in Medicare Part D for prescription drug coverage. Those with
Medicaid who are not enrolled in Medicare can continue to receive prescription drug coverage
through Medicaid.
When a patient is in a facility receiving care at the Medicaid rate and has limited resources, the
patient's income must be - CORRECT ANSWER- Less than the cost of care at the facility.
**Medicaid pays for medically necessary nursing home care for patients in skilled or
intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The
patient's income must be less than the cost of care in the facility at the Medicaid rate, and there is
a limit on resources.
A long-term care insurance sales representative replaced a long-term care policy belonging to an
elderly insured. The premium and benefits were the same in the new policy as in the old policy.
The agent's first year commission is 60%, and the renewal commission is 4%. What will be the
commission on this sale? - CORRECT ANSWER- 4%
**Unless there is a substantial increase in benefits, agents cannot receive commission on the sale
of a replaced policy that is greater than the renewal commission. The agent's commission is 4%.
Which of the following statements must be prominently displayed on the first page of a Medicare
Supplement policy? - CORRECT ANSWER- "Notice to Buyer: This policy may not cover
all your medical expenses"
**Medicare Supplement insurers must prominently display on the first page of the policy the
following: "Notice to Buyer: This policy may not cover all your medical expenses."
A long-term care policy may limit coverage for which of the following? - CORRECT
ANSWER- Services for which benefits are available under Medicare
ACTUAL Exam Questions and CORRECT
Answers
If a person is a member of a private Fee-For-Service plan, where can he or she receive
emergency medical care? - CORRECT ANSWER- Anywhere in the U.S.
**Members of a PFFS plan may receive emergency care anywhere in the U.S. when needed.
Medicare Part B will cover services received from a doctor if performed - CORRECT
ANSWER- Anywhere.
**Medicare Part B covers medically necessary services received from a doctor regardless where
performed: in the office, in a hospital, in a skilled nursing facility, in the patient's home, or any
other location.
All of the following statements are true about HMOs EXCEPT - CORRECT ANSWER- A
Medicare HMO is not a Medicare Advantage Plan.
** IT IS **
**A Medicare HMO is a Medicare Advantage Plan.
All of the following statements are true about a Preferred Provider Organization (PPO) EXCEPT
- CORRECT ANSWER- A PPO does not have to pay for covered services received out-of-
network.
**Every PPO plan must pay for all covered services received out-of-network, but every plan is
different in what the patient must pay.
An insured receives health care through both Medicare and Medicaid. She currently has
prescription drug coverage through Medicaid. Does the insured need to enroll in Medicare Part
, D? - CORRECT ANSWER- Yes, she must begin receiving her prescription drug coverage
through Part D.
**Anyone enrolled in both Medicare and Medicaid, and who receives prescription drug coverage
through Medicaid should enroll in Medicare Part D for prescription drug coverage. Those with
Medicaid who are not enrolled in Medicare can continue to receive prescription drug coverage
through Medicaid.
When a patient is in a facility receiving care at the Medicaid rate and has limited resources, the
patient's income must be - CORRECT ANSWER- Less than the cost of care at the facility.
**Medicaid pays for medically necessary nursing home care for patients in skilled or
intermediate care nursing homes or in intermediate care facilities for the mentally retarded. The
patient's income must be less than the cost of care in the facility at the Medicaid rate, and there is
a limit on resources.
A long-term care insurance sales representative replaced a long-term care policy belonging to an
elderly insured. The premium and benefits were the same in the new policy as in the old policy.
The agent's first year commission is 60%, and the renewal commission is 4%. What will be the
commission on this sale? - CORRECT ANSWER- 4%
**Unless there is a substantial increase in benefits, agents cannot receive commission on the sale
of a replaced policy that is greater than the renewal commission. The agent's commission is 4%.
Which of the following statements must be prominently displayed on the first page of a Medicare
Supplement policy? - CORRECT ANSWER- "Notice to Buyer: This policy may not cover
all your medical expenses"
**Medicare Supplement insurers must prominently display on the first page of the policy the
following: "Notice to Buyer: This policy may not cover all your medical expenses."
A long-term care policy may limit coverage for which of the following? - CORRECT
ANSWER- Services for which benefits are available under Medicare
