2022 Wellcare ACT Mastery Exam-Teleagent
deductible - Answer - Amount you must pay before you begin receiving any
benefits from your insurance company
Medicare - Answer - A national health insurance program in the United
States, begun in 1965 under the Social Security Administration and now
administered by the Centers for Medicare and Medicaid Services.
Medicare Advantage - Answer - Medicare plans other than the Original
Medicare Plan
Medicaid - Answer - A federal and state assistance program that pays for
health care services for people who cannot afford them.
Medicare requirements - Answer - -must be 65 or older, disabled, or have
end-stage renal disease
-have to be under a licensed physician
-home care recipients must also be homebound and in need of skilled
nursing or therapy services on an intermittent basis
Medigap - Answer - a private insurance policy that pays the difference
between the medical charge and the amount that Medicare pays
Medigap Eligibility and Enrollment - Answer - Unlike Part C which 'disenrolls'
an individual from Parts A and Part B, a Medigap plan works with Part A and
Part B, requiring recipients to first enroll into the Original Medicare program
and then supplement it with a Medigap plan. Individuals who are enrolled in
Part C cannot also receive coverage from a Medigap plan and must re-enroll
into Parts A and B in order to purchased a Medigap plan. All Medigap
insurers are required to offer a one-time, 6- month enrollment period after
turning age 65 for individuals who have already enrolled in Medicare Part B
that guarantees an enrollee the right to purchase any part of a Medicare
supplement insurance policy, regardless of his or her health status. Beyond
the initial enrollment period, an insurer can require a paramedical exam or
an attending physician's statement if needed to ensure the health of the
enrollee.
End-stage renal disease - Answer - the final stage of chronic kidney disease
Medicare Coverage - Answer - Hospital services, some home health,
hospice, religiously-associated facilities
If a beneficiary requests to discuss other products not originally documented
on the SOA, must youdocument a second SOA for the additional product
type before the appointment may continue? - Answer -
, Part A coverage - Answer - Inpatient hospital care, skilled nursing facility care,
home health care and hospice care
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.
Part C coverage - Answer - (medicare advantage) managed care alternative to
original medicare. provided through commercial insurers
Part D of Medicare - Answer - Prescription drug coverage
Original Medicare - Answer - Medicare Parts A and B providing only hospital
and medical coverage.
Employer Group Health Coverage - Answer - Employer Group Health Coverage
AHIP, MUnder Original Medicare, the inpatient hospital co-payment is a flat
per-day amount that remains the same throughout the first 60 days of a
beneficiary's stay. After day 60 the amount gradually increases until day 90.
After 90 days he would pay the full amount of all costs. - Answer -
c. - Answer -
Under Original Medicare, if the inpatient hospital service is provided by a
participating Medicare provider, the co-payment is waived. Co-payments
are only charged when a beneficiary opts to receive care from a non-
participating provider. - Answer -
Incorrect: Beneficiaries are responsible for a single deductible amount for
each benefit period, followed by a per day coinsurance amount through day
90. For day 91 and beyond, there is a charge for each "lifetime reserve day"
up to 60 days over a beneficiary's lifetime. After this, he would be
responsible for all costs. - Answer -
d. - Answer -
Under Original Medicare, there is a single deductible amount due for the first
60 days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible
for all costs. - Answer -
Feedback - Answer -
Source: Module 1, Slide - Medicare Part A - Original Medicare Cost-Sharing for
Inpatient Hospital Care - Answer -
Question 13 - Answer -
deductible - Answer - Amount you must pay before you begin receiving any
benefits from your insurance company
Medicare - Answer - A national health insurance program in the United
States, begun in 1965 under the Social Security Administration and now
administered by the Centers for Medicare and Medicaid Services.
Medicare Advantage - Answer - Medicare plans other than the Original
Medicare Plan
Medicaid - Answer - A federal and state assistance program that pays for
health care services for people who cannot afford them.
Medicare requirements - Answer - -must be 65 or older, disabled, or have
end-stage renal disease
-have to be under a licensed physician
-home care recipients must also be homebound and in need of skilled
nursing or therapy services on an intermittent basis
Medigap - Answer - a private insurance policy that pays the difference
between the medical charge and the amount that Medicare pays
Medigap Eligibility and Enrollment - Answer - Unlike Part C which 'disenrolls'
an individual from Parts A and Part B, a Medigap plan works with Part A and
Part B, requiring recipients to first enroll into the Original Medicare program
and then supplement it with a Medigap plan. Individuals who are enrolled in
Part C cannot also receive coverage from a Medigap plan and must re-enroll
into Parts A and B in order to purchased a Medigap plan. All Medigap
insurers are required to offer a one-time, 6- month enrollment period after
turning age 65 for individuals who have already enrolled in Medicare Part B
that guarantees an enrollee the right to purchase any part of a Medicare
supplement insurance policy, regardless of his or her health status. Beyond
the initial enrollment period, an insurer can require a paramedical exam or
an attending physician's statement if needed to ensure the health of the
enrollee.
End-stage renal disease - Answer - the final stage of chronic kidney disease
Medicare Coverage - Answer - Hospital services, some home health,
hospice, religiously-associated facilities
If a beneficiary requests to discuss other products not originally documented
on the SOA, must youdocument a second SOA for the additional product
type before the appointment may continue? - Answer -
, Part A coverage - Answer - Inpatient hospital care, skilled nursing facility care,
home health care and hospice care
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.
Part C coverage - Answer - (medicare advantage) managed care alternative to
original medicare. provided through commercial insurers
Part D of Medicare - Answer - Prescription drug coverage
Original Medicare - Answer - Medicare Parts A and B providing only hospital
and medical coverage.
Employer Group Health Coverage - Answer - Employer Group Health Coverage
AHIP, MUnder Original Medicare, the inpatient hospital co-payment is a flat
per-day amount that remains the same throughout the first 60 days of a
beneficiary's stay. After day 60 the amount gradually increases until day 90.
After 90 days he would pay the full amount of all costs. - Answer -
c. - Answer -
Under Original Medicare, if the inpatient hospital service is provided by a
participating Medicare provider, the co-payment is waived. Co-payments
are only charged when a beneficiary opts to receive care from a non-
participating provider. - Answer -
Incorrect: Beneficiaries are responsible for a single deductible amount for
each benefit period, followed by a per day coinsurance amount through day
90. For day 91 and beyond, there is a charge for each "lifetime reserve day"
up to 60 days over a beneficiary's lifetime. After this, he would be
responsible for all costs. - Answer -
d. - Answer -
Under Original Medicare, there is a single deductible amount due for the first
60 days of any inpatient hospital stay, after which it converts into a per-day
coinsurance amount through day 90. After day 90, he would pay a daily
amount up to 60 days over his lifetime, after which he would be responsible
for all costs. - Answer -
Feedback - Answer -
Source: Module 1, Slide - Medicare Part A - Original Medicare Cost-Sharing for
Inpatient Hospital Care - Answer -
Question 13 - Answer -
