NC MEDICARE SUPPLEMENT & LONG TERM CARE INSURANCE LICENSING
EXAM NEWEST 2025 COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW
VERSION!!
Medicare - CORRECT ANSWER-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)
CMS - CORRECT ANSWER-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.
MAC - CORRECT ANSWER-Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
Medicare Part A - CORRECT ANSWER--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 B - CORRECT ANSWER-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 C - CORRECT ANSWER-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 Eligibility - CORRECT ANSWER--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 enrollment requirements - CORRECT ANSWER-Part A & B are automatically conducted
by SSA when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - CORRECT ANSWER-7 month period straddling 3 months before and
ends 3 months after the individual turns 65, including the birthday month.
-If enrollment is during the 3 mos prior to 65th birthday, coverage begins on 1st day of 65th
birthday month
-If enrollment is during or after 65th birthday month, coverage begins on 1st day of month after
enrollment
General Enrollment Period - CORRECT ANSWER-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.
Special Enrollment Period - CORRECT ANSWER-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
, Medicare as a secondary or primary payer - CORRECT ANSWER--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 payer - CORRECT ANSWER--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 & the VA - CORRECT ANSWER-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.
Expenses NOT paid by Medicare - CORRECT ANSWER--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
Medicare Part A covers - CORRECT ANSWER--acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - CORRECT ANSWER--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.
Days 1 to 60 - CORRECT ANSWER-Non-Exhaustible Benefit
EXAM NEWEST 2025 COMPLETE QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+||BRAND NEW
VERSION!!
Medicare - CORRECT ANSWER-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)
CMS - CORRECT ANSWER-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.
MAC - CORRECT ANSWER-Medicare Administrative Contractor - company contracted to
administer Part A & Part B claims.
Medicare Part A - CORRECT ANSWER--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 B - CORRECT ANSWER-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 C - CORRECT ANSWER-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 Eligibility - CORRECT ANSWER--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 enrollment requirements - CORRECT ANSWER-Part A & B are automatically conducted
by SSA when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - CORRECT ANSWER-7 month period straddling 3 months before and
ends 3 months after the individual turns 65, including the birthday month.
-If enrollment is during the 3 mos prior to 65th birthday, coverage begins on 1st day of 65th
birthday month
-If enrollment is during or after 65th birthday month, coverage begins on 1st day of month after
enrollment
General Enrollment Period - CORRECT ANSWER-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.
Special Enrollment Period - CORRECT ANSWER-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
, Medicare as a secondary or primary payer - CORRECT ANSWER--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 payer - CORRECT ANSWER--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 & the VA - CORRECT ANSWER-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.
Expenses NOT paid by Medicare - CORRECT ANSWER--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
Medicare Part A covers - CORRECT ANSWER--acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - CORRECT ANSWER--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.
Days 1 to 60 - CORRECT ANSWER-Non-Exhaustible Benefit
