North Carolina Medicare Supplement & Long-term Care Exam Solved 100%

Z sells a MSP to a sick 72-year-old person, that he knows already has a Medicare supplement. The sale is - Answer Not allowed because a person cant have multiple MSPs Which of the following does not qualify for Medicare under 65 years old? - Answer Z who has pancreatic cancer All of the following are NOT correct regarding Medicare Advantage HMO and PPO plans EXCEPT: - Answer Medicare Advantage PPOs do NOT use a gatekeeper. Which of the following is the primary point of contact to enroll Medicare providers? - Answer a. MACs What coverage under Medicare Part A covers 80% of the cost for durable medical equipment? - Answer Home Health Care Most people become eligible for Medicare at what age? - Answer c. 65 After the deductible is paid, which is true regarding expenses paid by Medicare Part B? - Answer a. Part B pays 80%. Which of the following dos not receive Medicaid payments directly? - Answer b. A patient in hospice What type renewability provision states that a policy can't be cancelled or changed except for an unpaid premium but premiums can be raised? - Answer a. Guaranteed renewable D's Medicare Supplement premium is based on her age when the policy started. Why can't the insurer increase the premium for inflation? - Answer It uses issue age. With Medicare Part A, how many skilled nursing facility days are fully covered? - Answer 20 A long-term care policy that is tax-qualified by HIPAA, the premiums and benefits are considered? - Answer Tax-favored If C did not sign up for Medicare Part B when she was initially eligible, when can she sign up? - Answer d. During the General Enrollment Period (AEP) Policy rates and schedules must be filed with the Commissioner - Answer Annually In order to make sure Medicare provides appropriate, quality and effective care to patients, which group is used as a monitor? - Answer a. A Quality Improvement Organization (QIO) What is true about a Medicare Select policy? - Answer The insured won't be covered for out-of-network expenses. Preexisting conditions coverage in a Long-term Care or Medicare Supplement policy cant be denied or for more than: - Answer a. 6 months after effective date of coverage X is a 40-year-old factory worker with kidney disease that has a great group health plan through his employer. Why would he be on Medicare? - Answer d. His employer group policy has paid for at least 30 months, and then he moved to Medicare. A Medicare Advantage Prescription Drug Plan offers which of the following? - Answer Part D prescription drug coverage, Part A, and Part B benefits in one plan. Home health care will be provided by Medicare Part B if which condition is met? - Answer a. The care is ordered by doctor or health provider. This type temporary care gives a caregiver rest or time off? - Answer a. Respite Care What type marketing fails to disclose the reason for contacting a person is to sell insurance? - Answer d. Cold Lead Advertising Which is true, if T was injured and needed a blood transfusion? - Answer d. Medicare Part A and B will make B pay for the first three pints. Which of the following can't be excluded in a Medicare Supplement Policy? - Answer d. Alzheimers P has a Medicare Supplement Policy, it: - Answer Cannot be more restrictive than Medicare. Medicare does not pay for any part of which of the following? - Answer d. Eyeglasses K's mother needs medical and personal care all the time. Which care is best suited? - Answer d. Skilled Nursing Care Which of the following Medicare-Aid pays only the premiums for Medicare Part B? - Answer c. Specified Low-Income Beneficiary (SLMB) The term for when a medical provider or doctor agrees to accept Medicare payments is - Answer c. Medicare Assignment D bought a Medicare supplement policy. It must be guaranteed renewable for any reason EXCEPT: - Answer a. Nonpayment of premium What was done to fill in the costs or gaps in Medicare Part A and B coverage? - Answer The private insurance companies created Medicare Supplement Policies. Medicare Part B covers which of the following? - Answer b. Doctors, medical services What is it called when a person's assets are above the limits for Medicaid and they start exhausting them to qualify? - Answer a. Spending Down What are decisions made by a Medicare Administrative Contractor (MAC) whether to cover a particular item or service in a MACs jurisdiction (region) called? - Answer a. Local Coverage Determination Which of the following will Medicare-Aid NOT pay for if K is a Qualified Medicare Beneficiary (QMB)? - Answer Part D prescriptions 100% After a surgery, T stayed in the hospital for 5 days. Medicare Part A will cover all of the following EXCEPT: - Answer Doctor's bill If an LTC policy has a return of premium option, the amount returned to the beneficiaries is based on which of the following? - Answer d. The amount of benefits the person used. Cash was injured in a car crash. Medicare paid his medical bills, but it was determined that the other driver was at fault. What allows Medicare to be repaid? - Answer Medicare Conditional Payments Which is NOT true regarding Medicare Part A home health care? - Answer It pays for 60% of common medical supplies like bandages and gauze. After an accident, P stayed in the hospital for a week. Medicare Part A will cover all of the following EXCEPT: - Answer Doctor's bill