Medicare, Medicaide, LTC NC Insurance
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Federal Program - CORRECT ANSWER- Medicare is a federal health insurance program.
Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid
Services of the Department of Health and Human Services. Private firms contract with the
federal government to handle the paperwork, review claims, and disburse claim payments.
Medicare Part A - CORRECT ANSWER- Designed primarily to provide hospital insurance
and to pay for certain other types of institutional care.
Medicare Part B - CORRECT ANSWER- Designed primarily to provide medical insurance
for physician visits and other out-patient care.
Medicare Part C - CORRECT ANSWER- Provides expanded coverage through managed
care plans such as Health Maintenance Organizations (HMOs) and Preferred Provider
Organizations (PPOs).
Medicare Part D - CORRECT ANSWER- Provides coverage for prescription drugs.
What is the "original medicare"? - CORRECT ANSWER- Parts A and B because those two
parts were enacted together in the original amendment to Social Security that created the
Medicare program in 1965. Parts C and D were added later (in 1997 and 2003, respectively) to
keep the Medicare program up to date with changes in the health care delivery system.
If someone has Original Medicare, in which part or parts of Medicare is he or she enrolled?
A Parts A, B, and C
B Parts A, B, C, and D
C Part C
D Parts A and B - CORRECT ANSWER- D Parts A and B
,*Parts A and B are referred to as Original Medicare because they were enacted together when the
So-cial Security law was originally amended to create Medicare. Parts C and D were added later.
Qualified Medicare Beneficiary (QMB) - CORRECT ANSWER- Program is for persons
whose monthly income is no more than the Federal Poverty Level (FPL) plus $20. Some states
disregard more than an additional $20 of monthly income. In addition to helping pay the Part B
premium, the QMB program may also help pay a beneficiary's Part A premium (if any) and
Medicare cost-sharing amounts such as deductibles, coinsurance, and copayments.
Specified Low-Income Medicare Beneficiary (SLMB) - CORRECT ANSWER- For persons
whose monthly income is no more than 120% of the FPL plus $20. As with the QMB program,
some states disregard more than an additional $20 of monthly income. The SLMB program helps
pay for only the Part B premium, not other Medicare costs.
Qualifying Individual (QI) - CORRECT ANSWER- For persons whose monthly income is
no more than 135% of the FPL plus $20. Some states disregard more than an additional $20 of
monthly income. The QI program helps pay for only the Part B premium.
An individual has been working for 8 years while the Hospital Insurance tax has been getting
deducted from her paycheck. How many more years must she work before she can get Medicare
Part A coverage premium-free?
A 12
B4
C7
D 2 - CORRECT ANSWER- D2
*Part A coverage is premium-free for workers who have paid the Hospital Tax for 10 years. The
individual has paid for 8 years, so she has 2 more years to go.
Suppose a worker's income is between 120% and 135% of the federal poverty level. What is the
name of the Medicare Savings Program for which she is eligible?
A Specified Low-Income Medicare Beneficiary
B Medicare Advantage
C Qualified Medicare Beneficiary
,D Qualifying Individual - CORRECT ANSWER- D Qualifying Individual
*The Qualifying Individual program pays the Part B premium for persons whose income is less
than 135% of the federal poverty level but higher than the requirements for other Medicare
savings pro-grams.
Medicare Advantage is another name for what part of Medicare?
A Parts A and B
B Part C
C Part D
D Part A - CORRECT ANSWER- B Part C
*Medicare Part C is also called Medicare Advantage.
To be eligible to enroll in Medicare, individuals must fall into one of three groups. They must be:
- CORRECT ANSWER- -Age 65 or Older
-Social Security disability beneficiaries (generally after 2 years)
-Suffering from ESRD (end-stage renal disease—that is, kidney failure)
This is the largest group of Medicare beneficiaries. Most people become eligible for Medicare by
reason of age - CORRECT ANSWER- Age 65 or older group
Description of group 2 Social Security disability beneficiaries (generally after 2 years) -
CORRECT ANSWER- Individuals who have been receiving Social Security benefits
because they are disabled and cannot work can become eligible for Medicare even if they have
not yet turned age 65. Usually, such individuals become eligible for Medicare only after they
have received Social Security disability benefits for a period of 24 continuous months (2 years).
Individuals who are eligible for medicare immediately - CORRECT ANSWER- Individuals
who qualify for Social Security disability benefits because they have ALS (amyotrophic lateral
sclerosis, also called Lou Gehrig's disease)
, Description of group 3 who qualifies for Medicare Suffering from ESRD (end-stage renal
disease—that is, kidney failure) - CORRECT ANSWER- Individuals under age 65 can also
become eligible for Medicare if they have had a kidney transplant or need regular dialysis
because their kidneys no longer work.
Enrollment in Medicare Part A and Part B is automatic for people who are already receiving
Social Security benefits when they become eligible for Medicare. So, enrollment would be
automatic for individuals: - CORRECT ANSWER- -At age 65 if they are receiving Social
Security retirement benefits at that time; or
-After receiving Social Security disability benefits for 2 years (immediately for those with ALS)
even if they are not yet 65 at that time
For people covered by Social Security, which part is premium free? - CORRECT ANSWER-
Part A is premium free, Part B is not
Individuals who are automatically enrolled in Part B have what option if they do not want to pay
the premiun? - CORRECT ANSWER- Drop Medicare part B, However, people who do not
enroll in Medicare Part B when they are first eligible generally have to pay a penalty in the form
of a higher premium if they wish to sign up for it later.==
What is the late enrollment penalty designed to do? - CORRECT ANSWER- Prevent against
adverse selection or —a disproportionately high number of above-average risks in the insurance
pool.
Finish the sentence:
By encouraging everyone to purchase Part B coverage when they are first eligible, -----------------
------ - CORRECT ANSWER- the late enrollment penalty maintains the expected balance of
average and above-average risks in the insurance pool.
What is the additional enrollment penalty for Medicare part B? - CORRECT ANSWER- An
additional charge of 10% of the amount of the individual's Part B premium for every 12-month
period that has elapsed since the individual became eligible for Medicare.
UPDATED ACTUAL Exam Questions and
CORRECT Answers
Federal Program - CORRECT ANSWER- Medicare is a federal health insurance program.
Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid
Services of the Department of Health and Human Services. Private firms contract with the
federal government to handle the paperwork, review claims, and disburse claim payments.
Medicare Part A - CORRECT ANSWER- Designed primarily to provide hospital insurance
and to pay for certain other types of institutional care.
Medicare Part B - CORRECT ANSWER- Designed primarily to provide medical insurance
for physician visits and other out-patient care.
Medicare Part C - CORRECT ANSWER- Provides expanded coverage through managed
care plans such as Health Maintenance Organizations (HMOs) and Preferred Provider
Organizations (PPOs).
Medicare Part D - CORRECT ANSWER- Provides coverage for prescription drugs.
What is the "original medicare"? - CORRECT ANSWER- Parts A and B because those two
parts were enacted together in the original amendment to Social Security that created the
Medicare program in 1965. Parts C and D were added later (in 1997 and 2003, respectively) to
keep the Medicare program up to date with changes in the health care delivery system.
If someone has Original Medicare, in which part or parts of Medicare is he or she enrolled?
A Parts A, B, and C
B Parts A, B, C, and D
C Part C
D Parts A and B - CORRECT ANSWER- D Parts A and B
,*Parts A and B are referred to as Original Medicare because they were enacted together when the
So-cial Security law was originally amended to create Medicare. Parts C and D were added later.
Qualified Medicare Beneficiary (QMB) - CORRECT ANSWER- Program is for persons
whose monthly income is no more than the Federal Poverty Level (FPL) plus $20. Some states
disregard more than an additional $20 of monthly income. In addition to helping pay the Part B
premium, the QMB program may also help pay a beneficiary's Part A premium (if any) and
Medicare cost-sharing amounts such as deductibles, coinsurance, and copayments.
Specified Low-Income Medicare Beneficiary (SLMB) - CORRECT ANSWER- For persons
whose monthly income is no more than 120% of the FPL plus $20. As with the QMB program,
some states disregard more than an additional $20 of monthly income. The SLMB program helps
pay for only the Part B premium, not other Medicare costs.
Qualifying Individual (QI) - CORRECT ANSWER- For persons whose monthly income is
no more than 135% of the FPL plus $20. Some states disregard more than an additional $20 of
monthly income. The QI program helps pay for only the Part B premium.
An individual has been working for 8 years while the Hospital Insurance tax has been getting
deducted from her paycheck. How many more years must she work before she can get Medicare
Part A coverage premium-free?
A 12
B4
C7
D 2 - CORRECT ANSWER- D2
*Part A coverage is premium-free for workers who have paid the Hospital Tax for 10 years. The
individual has paid for 8 years, so she has 2 more years to go.
Suppose a worker's income is between 120% and 135% of the federal poverty level. What is the
name of the Medicare Savings Program for which she is eligible?
A Specified Low-Income Medicare Beneficiary
B Medicare Advantage
C Qualified Medicare Beneficiary
,D Qualifying Individual - CORRECT ANSWER- D Qualifying Individual
*The Qualifying Individual program pays the Part B premium for persons whose income is less
than 135% of the federal poverty level but higher than the requirements for other Medicare
savings pro-grams.
Medicare Advantage is another name for what part of Medicare?
A Parts A and B
B Part C
C Part D
D Part A - CORRECT ANSWER- B Part C
*Medicare Part C is also called Medicare Advantage.
To be eligible to enroll in Medicare, individuals must fall into one of three groups. They must be:
- CORRECT ANSWER- -Age 65 or Older
-Social Security disability beneficiaries (generally after 2 years)
-Suffering from ESRD (end-stage renal disease—that is, kidney failure)
This is the largest group of Medicare beneficiaries. Most people become eligible for Medicare by
reason of age - CORRECT ANSWER- Age 65 or older group
Description of group 2 Social Security disability beneficiaries (generally after 2 years) -
CORRECT ANSWER- Individuals who have been receiving Social Security benefits
because they are disabled and cannot work can become eligible for Medicare even if they have
not yet turned age 65. Usually, such individuals become eligible for Medicare only after they
have received Social Security disability benefits for a period of 24 continuous months (2 years).
Individuals who are eligible for medicare immediately - CORRECT ANSWER- Individuals
who qualify for Social Security disability benefits because they have ALS (amyotrophic lateral
sclerosis, also called Lou Gehrig's disease)
, Description of group 3 who qualifies for Medicare Suffering from ESRD (end-stage renal
disease—that is, kidney failure) - CORRECT ANSWER- Individuals under age 65 can also
become eligible for Medicare if they have had a kidney transplant or need regular dialysis
because their kidneys no longer work.
Enrollment in Medicare Part A and Part B is automatic for people who are already receiving
Social Security benefits when they become eligible for Medicare. So, enrollment would be
automatic for individuals: - CORRECT ANSWER- -At age 65 if they are receiving Social
Security retirement benefits at that time; or
-After receiving Social Security disability benefits for 2 years (immediately for those with ALS)
even if they are not yet 65 at that time
For people covered by Social Security, which part is premium free? - CORRECT ANSWER-
Part A is premium free, Part B is not
Individuals who are automatically enrolled in Part B have what option if they do not want to pay
the premiun? - CORRECT ANSWER- Drop Medicare part B, However, people who do not
enroll in Medicare Part B when they are first eligible generally have to pay a penalty in the form
of a higher premium if they wish to sign up for it later.==
What is the late enrollment penalty designed to do? - CORRECT ANSWER- Prevent against
adverse selection or —a disproportionately high number of above-average risks in the insurance
pool.
Finish the sentence:
By encouraging everyone to purchase Part B coverage when they are first eligible, -----------------
------ - CORRECT ANSWER- the late enrollment penalty maintains the expected balance of
average and above-average risks in the insurance pool.
What is the additional enrollment penalty for Medicare part B? - CORRECT ANSWER- An
additional charge of 10% of the amount of the individual's Part B premium for every 12-month
period that has elapsed since the individual became eligible for Medicare.
