NC Medicare Supplement & Long Term
Care Insurance Licensing 2025 Real Exam
Questions And Answers
Health insurance for those over age 65, people under 65 with certain disabilities
📌📌
& those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant) - - Medicare
Centers for Medicare and Medicaid Services administers the Medicare program.
📌📌
Social Security Administration handles most of the enrollment & plays a role in
claims appeal process. - - CMS
📌📌
Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims. - - MAC
-hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self
Employment tax credits.
📌📌
-Those who don't qualify can voluntarily participate by paying a monthly premium
- - Medicare Part A
The part of the Medicare program that pays for physician services, outpatient
hospital services, durable medical equipment, and other services and supplies.
-Has a monthly premium of $135.50 in 2019 which is deducted from SS check.
📌📌
-Part B enrollment is optional. You can reject Part B by signing a rejection form. -
- Medicare Part B
Medicare Advantage Plans that are offered through private insurance companies
📌📌
that provide both hospital and physician coverage and possible prescriptions -
financed by Social Security and monthly premiums - - Medicare Part C
-Over age 65 who have earned 40 "work credits" in order to receive premium free
part A benefits
📌📌
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant - - Medicare
Eligibility
📌📌
Part A & B are automatically conducted by SSA when individual age 65+ enrolls
for their Social Security retirement benefits - - Medicare enrollment
requirements
7 month period straddling 3 months before and ends 3 months after the individual
, Medicare enrollment period - January 1st through March 31st annually.
-Coverage begins July 1st of that year
📌📌
-Monthly premium for part B may go up 10% for each full 12 month period that
you're eligible but didn't sign up. - - General Enrollment Period
Individual can enroll at 8 months beginning with the month employment ends or
📌📌
when group coverage ends whichever is earlier without subject to late enrollment
surcharge - - Special Enrollment Period
-Medicare is the secondary payer for the 'working aged' who has a group health
plan if the group has 20+ enrollees
-For single employer with <20 employees with a group health plan, Medicare is
the primary payer.
-If individual retains coverage thru the group plan, the group contract is the
primary unless person is retired & still covered under the group plan. In that case,
📌📌
Medicare is the primary.
-If individual rejects the employer plan, Medicare is the primary payer - -
Medicare as a secondary or primary payer
-In cases of Workers' Comp when it applies to an injury or illness
📌📌
- In cases where no-fault insurance or liability insurance is available as primary
payer. - - Medicare as a secondary payer
Can choose to get treatment under either plan. Medicare usually will not pay
📌📌
benefits if services are rendered in a VA facility but will pay if outside of VA.
There is NO coordination between Federal agencies. - - Medicare & the VA
-Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare
standards
📌📌
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency - - Expenses NOT paid by
Medicare
-acute inpatient hospital care
📌📌- Medicare
-inpatient skilled nursing care
-medically necessary home health care & hospice services -
Part A covers
-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
📌📌
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar
year. - - Medicare Deductible
Care Insurance Licensing 2025 Real Exam
Questions And Answers
Health insurance for those over age 65, people under 65 with certain disabilities
📌📌
& those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant) - - Medicare
Centers for Medicare and Medicaid Services administers the Medicare program.
📌📌
Social Security Administration handles most of the enrollment & plays a role in
claims appeal process. - - CMS
📌📌
Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims. - - MAC
-hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self
Employment tax credits.
📌📌
-Those who don't qualify can voluntarily participate by paying a monthly premium
- - Medicare Part A
The part of the Medicare program that pays for physician services, outpatient
hospital services, durable medical equipment, and other services and supplies.
-Has a monthly premium of $135.50 in 2019 which is deducted from SS check.
📌📌
-Part B enrollment is optional. You can reject Part B by signing a rejection form. -
- Medicare Part B
Medicare Advantage Plans that are offered through private insurance companies
📌📌
that provide both hospital and physician coverage and possible prescriptions -
financed by Social Security and monthly premiums - - Medicare Part C
-Over age 65 who have earned 40 "work credits" in order to receive premium free
part A benefits
📌📌
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant - - Medicare
Eligibility
📌📌
Part A & B are automatically conducted by SSA when individual age 65+ enrolls
for their Social Security retirement benefits - - Medicare enrollment
requirements
7 month period straddling 3 months before and ends 3 months after the individual
, Medicare enrollment period - January 1st through March 31st annually.
-Coverage begins July 1st of that year
📌📌
-Monthly premium for part B may go up 10% for each full 12 month period that
you're eligible but didn't sign up. - - General Enrollment Period
Individual can enroll at 8 months beginning with the month employment ends or
📌📌
when group coverage ends whichever is earlier without subject to late enrollment
surcharge - - Special Enrollment Period
-Medicare is the secondary payer for the 'working aged' who has a group health
plan if the group has 20+ enrollees
-For single employer with <20 employees with a group health plan, Medicare is
the primary payer.
-If individual retains coverage thru the group plan, the group contract is the
primary unless person is retired & still covered under the group plan. In that case,
📌📌
Medicare is the primary.
-If individual rejects the employer plan, Medicare is the primary payer - -
Medicare as a secondary or primary payer
-In cases of Workers' Comp when it applies to an injury or illness
📌📌
- In cases where no-fault insurance or liability insurance is available as primary
payer. - - Medicare as a secondary payer
Can choose to get treatment under either plan. Medicare usually will not pay
📌📌
benefits if services are rendered in a VA facility but will pay if outside of VA.
There is NO coordination between Federal agencies. - - Medicare & the VA
-Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare
standards
📌📌
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency - - Expenses NOT paid by
Medicare
-acute inpatient hospital care
📌📌- Medicare
-inpatient skilled nursing care
-medically necessary home health care & hospice services -
Part A covers
-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
📌📌
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar
year. - - Medicare Deductible
