North Carolina Medicare Supplement and Long-Term Care Exam Questions With Correct Answers

An individual who is not eligible for premium-free Medicare Part A coverage may apply for coverage during which of the following enrollment periods? A. All of the above B. Initial enrollment period C. General enrollment period D. Special enrollment period - Answer A. All of the above Medicare makes what payment for services in which another payer may be responsible: A. Conditional payment B. Interim payment C. Transitional payment D. Temporary payment - Answer A. Conditional payment Insurers must offer inflation protection in which of the following policies? A. Medicare Part C B. Medigap C. Long-Term Care D. Medicaid - Answer C. Long-Term Care What program safeguards against unnecessary and inappropriate medical care rendered to Medicaid recipients? A. Medicaid review program B. Utilization renew program C. Quality improvement organization D. Utilization review program - Answer D. Utilization review program Which of the following is not a requirement for long-term care plans? A. The individual must be unable to perform at least two ADLs B. Inflation protection must be provided C. Policies must accrue cash value D. Coveraged cannot reimburse insureds for medical expenses or services covered by Medicare. - Answer C. Policies must accrue cash value. Which entity handles claims from hospitals, skilled nursing facilities, home health agencies and hospices? A. Carrier B. Intermediary C. Quality Improvement Organization D. Utilization Review Committee - Answer B. Intermediary What is the term for private organizations that administer Medicare Part B benefits? A. Carriers B. Medical Providers C. Intermediaries D. Peer review organizations - Answer A. Carriers All of the following are requirements for long-term care and medigap policy except: A. The agent must provide the applicant with a notice regarding replacement B. The notice regarding replacement must contain the free look period C. The notice regarding replacement explains the replacing coverage in comparison to the existing coverage D. A 60-day free look period must be provided - Answer D. A 60-day free look period must be provided. Which of the following is not an optional benefit provided by long-term care policies? A. Inflation protection B. Guaranteed insurability C. Nonforfeiture options D. Guaranteed renewable or noncancelable - Answer D. Guaranteed renewable or noncancelable All of the following are required to qualify for Medicare's nursing facility benefit except: A. The patient must spend at least three days in a hospital within 30 past days B. The patient must meet stated income limits C. The patient's physician must certify that skilled care is required D. The patient must enter a Medicare-certified skilled nursing facility - Answer B. The patient must meet stated income limits Medical coverage is provided by: A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D - Answer B. Medicare Part B If an individual enrolls in medicare before their birthday month and their birthday is NOT the first day of the month, when does coverage begin? - Answer The first day of their birthday month B's long-term care insurance policy has a 30-calendar day elimination period. He became eligible for long-term care benefits and started receiving care on May 1. At what point will his policy begin paying benefits? A. After Bill has received 30 days of weekday care B. After Bill has received 30 days of care C. 30 days after the policy is issued D. 30 days after the triggering event - Answer D. 30 days after the triggering event What are the benefit triggers of tax-qualified long-term care insurance policies? - Answer Physical impairment or severe cognitive impairment Hospital coverage is provided by: A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D - Answer A. Medicare Part A What is a system of classifying hospital patients on the basis of diagnosis consisting of distinct groupings? A. Patient diagnostic system B. Distinct grouping assignment C. Patient classification basis D. Diagnosis-related group - Answer D. Diagnosis-related group What two types of long-term care insurance policies resulted from the Health Insurance Portability and Accountability Act? - Answer Tax qualified and non-tax qualified Medicare Part B covers which of the following expenses? A. Hospital care B. Physicians' services C. Hospice care D. Skilled nursing home care - Answer B. Physicians' services Medicare pays the remaining 80% of covered Medicare Part B charges after: A. Premiums are paid B. The annual deductible is met C. The $1,000 deductible is met D. The blood deductible is met - Answer B. The annual deductible is met Medicare Part A covers which of the following services? A. Medications B. Hospital room and board C. Physicians services D. Surgical services - Answer B. Hospital room and board Which of the following services in NOT excluded under Medicare Part B? A. Custodial care B. Skilled nursing care C. Diagnostic tests D. Routine physical exams - Answer C. Diagnostic tests Premiums for Medicare Part B are based on: . - Answer An individual's annual earnings