NC Medicare/LTC Exam Questions With Correct Answers

Home health care covers occasional visits from who? - Answer Registered nurses, licensed practical nurses, community-based professionals (like hospice). **Does NOT cover visits from attending physicians. Programs that are provided to people who are too poor to qualify for Medicaid. - Answer State-only Medicaid programs LTC provision that provides a guarantee that certain policy benefits will remain available even if the insured stops paying premiums. (Offers option of a paid-up policy providing the same benefits for a shorter period, etc.) - Answer Nonforfeiture When must the outline of coverage for a Medigap policy be provided to the insured? - Answer At the time of application. Home health equipment such as dialysis equipment and supplies are covered under which part of Medicare? - Answer Medicare Part B (Considered an outpatient service) What is the Medicare Part B enrollment period for an individual who is turning 65? - Answer 3 months before the month in which the individual turns 65, as well as the 3 months following that month (7 months). What is the copayment of the Medicare approved amount? - Answer 20% paid by the insured individual. Prospective review (Precertification provision) - Answer Physician submits claim information prior to providing treatment to know in advance if the procedure is covered and what the rate will be. What options does an insured person have for prescription drug coverage if they are enrolled in a Medicare Advantage Plan? - Answer 1) Receive prescription drug coverage through the Medicare Advantage Plan. 2) Sign up for separate prescription drug plan through Medicare Part D. Who facilitates processing Medicare applications, collects Medicare premiums, and provides general information about Medicare? - Answer The Social Security Administration Who administers Medicare? - Answer Centers for Medicare and Medicaid Services (CMS) How are LTC benefits triggered? - Answer Insured must be unable to perform at least 2 ADLs without substantial assistance. (Cannot be triggered solely due to medical necessity) T/F. Relating to a tax qualified LTC policy, the premiums paid for the policy may be a deductible expense, and the benefits paid are also not considered taxable income. - Answer True. Skilled nursing facility coinsurance is how much per day and starts after how many days of care? - Answer $170.50 per day, beginning on after the first 20 days. (100 days of coverage) What is a qualifying hospital stay? - Answer 3 days hospitalization (Provides Medicare coverage after 30 days have elapsed) Qualified medical expenses paid for from a Medical Savings Account (MSA) are taxed how? - Answer Not taxable. (Funds are used to pay deductibles during the year) *Only taxable when funds are used for anything other than qualified medical expenses. Medicare Part A Coverages and Copayment - Answer Days 1-60: All charges covered except for a deductible. Days 61-90: Copayment of $341 per day Days 91-150: (Lifetime reserve days) Copayment of $682 per day. A person who is eligible for Medicare Part B due to end-stage renal disease is NOT eligible for what? - Answer Special enrollment What types of providers manage Medicare Part A and Part B, respectively? - Answer Part A- Intermediary Part B- Carrier