NC Medicare/LTC (NC Medicare supplement) Exam Guide with Correct Answers, Exams of Community Corrections

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NC Medicare/LTC (NC Medicare supplement) Exam

Guide 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 What is any contract of insurance offering institutional or non-institutional support in order to restore deteriorating health and to maintain functional independence? - Answer

• Long-term care insurance Hospice coverage excludes what type of care? - Answer - Emergency room services and anything intended to restore the insured's health. Who is required to sign a notice regarding replacement when the insured intends on replacing their current policy? - Answer - The applicant/insured and the agent. How long is the benefit period for Medicare Part B deductible? - Answer - 1 year When is an insured person eligible for Medicare if they have just received Social Security benefits? - Answer - 24 months after receiving disability from Social Security (Exception: A person who is under age 65 with ALS/Lou Gehrig's disease, the benefits are available the first month after receiving Social Security benefits).

Where may a person with a private fee-for-service (PFFS) plan receive emergency care? - Answer - Anywhere in the U.S. T/F. An agent may receive a commission for a Medicare Supplement policy only if the commission in the first year is no more than 200% of the compensation in the second year (renewal commission). - Answer - True How many lifetime days of inpatient mental health care at a specialty hospital will Medicare pay for? - Answer - 190 days How many days does an insured person need to be out of the hospital before the Medicare Part A benefits reset? - Answer - 60 days in a row. Medicare Part B is financed by what? - Answer - Government subsidy and premium payments Allows insured persons who were covered by an employer's group plan a period of 8 months following termination, without penalty, to enroll in Medicare Part B. - Answer - Special enrollment period Medicare Part B Deductible and Coinsurance - Answer - Yearly deductible of $185; 20% coinsurance to be paid by insured thereafter. Doctors and hospitals who join a Medicare HMO are called what? - Answer - Network North Carolina law requires that all LTC policies be what? - Answer - Guaranteed renewable Direct response policies - Answer - Sold strictly by mail or through the media Informational brochures ("Choosing a Medigap Policy") must be delivered to the client by when? - Answer - At their request but no later than the time of delivery. What types of Medicare Supplement policies must be made available to all individuals eligible for Medicare and under the age of 65? - Answer - Plans A, C, and F. Previous health insurance coverage that can be used to shorten or eliminate a pre- existing condition waiting period. - Answer - Creditable coverage Home health care is primarily what kind of care? - Answer - Acute/skilled care (intermittent; not full time) *Not custodial care or ADL. Medicare Supplement Plan A (Core Benefits) - Answer - - Part A coinsurance/copayment

• Part A hospital costs for additional 365 days

• Part A hospice care coinsurance/copayment
• Part B coinsurance/copayment
• First 3 pints of blood Which Medicare Supplement plan provides the most comprehensive coverage? - Answer - Plan F T/F. Skilled nursing care is primarily custodial care. - Answer - False. (It is specialized, acute care that can only be performed by professionals) Long term care is primarily what type of care? - Answer - Personal/custodial care Hospice drug benefits for pain relief/symptom control have a copayment of what? - Answer - $