Medicare Supplement / Long-Term
Insurance NC UPDATED ACTUAL Exam
Questions and CORRECT Answers
Part A Medicare - CORRECT ANSWER- this coverage includes care in a hospital, nursing
facility, nursing home, hospice or even a home
Utilization Review Committees - CORRECT ANSWER- In addition to QIO, hospitals have
these committees that help to ensure that the hospital will follow Medicare guidelines. Because
Medicare payments are based on the DRGS, this committee works in conjunction with QIO to
ensure that a high standard of care is provided
Respite Care - CORRECT ANSWER- Temporary inpatient care provided by a nursing home,
hospice, or hospital care so that a family member or friend who is the patients caregiving can rest
or take some time off
Medicare Part D - prescription plan options - CORRECT ANSWER- Stand alone plan -
adding Medicare part d to other coverage
Medicare advantage - obtaining the drug coverage as well as other Medicare coverage through a
Medicare advantage plan
LTC - levels of care - CORRECT ANSWER- - Skilled Nursing Care
- Intermediate Care
- Custodial Care
- Home Health Care
Describe Part D - Medicare - CORRECT ANSWER- Added to Medicare in 2006. Subsidize
the cost of prescription drugs
, Benefit Period for Medicare Part A - CORRECT ANSWER- - It begins the first day
receiving service in a hospital or snf and ending when the person has been out of the facility and
is not receiving care in any other facility for 60 days in a row.
- No limit to the number of permissible benefit periods
- Coverage may last up to 90 days
- 60 lifetime reserve days
- Medicare A deductibles restart every new benefit period whereas Medicare B deductibles apply
once a year
Blood Deductible - Medicare Part A and B - CORRECT ANSWER- Medicare will not pay
for the first 3 pints of blood received in a calendar year. This deductible applies in addition to any
other deductible
Part A and B can have a combined deductible
Medicaid - definition - CORRECT ANSWER- Joint state-federal gov program that provides
health care for US citizens with low income;
- nursing home care
- inpatient and outpatient hospital services
- lab services
- home health services
- physical therapy
- prescription drug and hospice care
LTC - Inflation Protection - CORRECT ANSWER- Many states that require this benefit are
offered with LTC insurance. A daily benefit amount that is adequate today may not be adequate
ten years form now. Helps to keep pace with inflation and increased expenses
Perspective Payment Systems - CORRECT ANSWER- A way of controlling costs. Stipulates
a method of reimbursement for healthcare providers under which predetermined amounts must
be set for each service that may be provided.
Insurance NC UPDATED ACTUAL Exam
Questions and CORRECT Answers
Part A Medicare - CORRECT ANSWER- this coverage includes care in a hospital, nursing
facility, nursing home, hospice or even a home
Utilization Review Committees - CORRECT ANSWER- In addition to QIO, hospitals have
these committees that help to ensure that the hospital will follow Medicare guidelines. Because
Medicare payments are based on the DRGS, this committee works in conjunction with QIO to
ensure that a high standard of care is provided
Respite Care - CORRECT ANSWER- Temporary inpatient care provided by a nursing home,
hospice, or hospital care so that a family member or friend who is the patients caregiving can rest
or take some time off
Medicare Part D - prescription plan options - CORRECT ANSWER- Stand alone plan -
adding Medicare part d to other coverage
Medicare advantage - obtaining the drug coverage as well as other Medicare coverage through a
Medicare advantage plan
LTC - levels of care - CORRECT ANSWER- - Skilled Nursing Care
- Intermediate Care
- Custodial Care
- Home Health Care
Describe Part D - Medicare - CORRECT ANSWER- Added to Medicare in 2006. Subsidize
the cost of prescription drugs
, Benefit Period for Medicare Part A - CORRECT ANSWER- - It begins the first day
receiving service in a hospital or snf and ending when the person has been out of the facility and
is not receiving care in any other facility for 60 days in a row.
- No limit to the number of permissible benefit periods
- Coverage may last up to 90 days
- 60 lifetime reserve days
- Medicare A deductibles restart every new benefit period whereas Medicare B deductibles apply
once a year
Blood Deductible - Medicare Part A and B - CORRECT ANSWER- Medicare will not pay
for the first 3 pints of blood received in a calendar year. This deductible applies in addition to any
other deductible
Part A and B can have a combined deductible
Medicaid - definition - CORRECT ANSWER- Joint state-federal gov program that provides
health care for US citizens with low income;
- nursing home care
- inpatient and outpatient hospital services
- lab services
- home health services
- physical therapy
- prescription drug and hospice care
LTC - Inflation Protection - CORRECT ANSWER- Many states that require this benefit are
offered with LTC insurance. A daily benefit amount that is adequate today may not be adequate
ten years form now. Helps to keep pace with inflation and increased expenses
Perspective Payment Systems - CORRECT ANSWER- A way of controlling costs. Stipulates
a method of reimbursement for healthcare providers under which predetermined amounts must
be set for each service that may be provided.
