C) Covered by all Medicare Supplement Plans as a basic or "core" benefit
Coverage for Medicare's Part B co-insurance is covered by all Medicare Supplement plans as a "basic" or "core" benefit.
LTC insurance policies may require an insured to spend at least ____ days in the hospital before they will cover custodial care in a nursing home:
D) 0
Although Medicare still requires a three-day hospital stay in order to be eligible for skilled nursing facility benefits, LTC insurance policies may not condition coverage on a prior hospital stay.
Which of the following provides Medicare Supplement coverage:
C) Private insurers
Policies intended to supplement Medicare are not sold or serviced by any state or the federal government. They are sold by producers of private insurance companies.
On a Long Term Care (LTC) policy, which inflation protection feature is best:
D) Compound rate of 8%
LTC insurers must offer applicants the opportunity to purchase inflation protection which automatically increases benefits each year. LTC policies that increase benefits for inflation may use either simple or compound rates. If the inflation increase is simple, the benefit increases by the same dollar amount each year. If the increase is compounded, the dollar amount of the increase goes up each year, which will result in higher benefits.
When an insured needs care, but not 24 hour care supervised by a physician, they need:
A) Long term care
Although custodial care and LTC are very similar, LTC facilities do provide trained care givers in addition to custodial care.
Medicare Part A will pay costs related to a "Skilled Nursing Facility Stay" for up to ____ days in a benefit period:
B) 100
Medicare Part A will pay costs related to a "Skilled Nursing Facility Stay" up to 100 days in a benefit period.
All of the following are true regarding LTC policies sold in this state, EXCEPT:
B) LTC policies may exclude alcoholism, drug addiction and Alzheimer's disease
LTC insurance policies may not contain an exclusion relating to Alzheimer's disease.
An individual is age 75 and has no health insurance and no assets. They are concerned about the future cost of custodial care. As an insurance producer you would tell them which of the following:
B) Medicaid covers custodial care
Although custodial care is covered by Medicaid, Medicare and Medicare Supplements do not cover it. In order to be eligible for Medicaid a person has to have low income/low assets. Custodial care is also covered by Long Term Care, but since this individual has no assets they would most likely not be able to afford the premium.
Medicare Part A covers all of the following, EXCEPT:
B) Physician's services
Physician's services are covered by Part B of Medicare, not Part A.
Ethel, who is 73 years old, moves into a nursing facility where she has care provided, what level of LTC is she receiving:
A) Custodial care
Custodial care is non-medical care that helps individuals with their activities of daily living, preparation of special diets and self-administration of medication not requiring constant attention of medical personnel. Providers of custodial care are not required to undergo medical training. Custodial care is the most common type of LTC related care needed by the elderly.
Which of the following is covered under Part B of Medicare:
D) Kidney dialysis for those under 65
Although Medicare is generally available to only those who are age 65 or more, kidney dialysis (for those who suffer from End-Stage Renal Disease) is covered regardless of age. Prescription drugs are covered by Part D of Medicare, not Part B. Routine eye and hearing exams are not covered.
Individuals covered under Medicare are called:
B) Beneficiaries
Individuals covered by Medicare are referred to as Beneficiaries. An individual covered by an insurance policy is referred to as an insured/policyholder. Individuals covered by HMOs or PPOs are referred to as subscribers.
Medicare Part A-Hospital Insurance provides coverage for institutional psychiatric care for 190 days per:
A) Lifetime
Medicare Part A provides coverage for inpatient mental health care in a psychiatric facility for up to 190 days per lifetime.
Which of the following may enroll in the Part D Prescription Drug program:
A) Those who are on Medicare
Prescription drug coverage is Part D of Medicare.
At age 65, an individual enrolls in Medicare Part A, but not Part B. At age 67, they elect to enroll in Medicare Part B during its annual open enrollment period. When will their Part B coverage become effective:
B) July 1st
Although most people enroll in both Parts of Medicare at age 65, they don't have to. For those who enroll only in Part A, Medicare holds an annual open-enrollment period between January 1st and March 31st for those who would like to enroll in Part B. Coverage will begin on July 1st.
Medicare Part A-Hospital Insurance will provide coverage for which of the following:
D) Skilled nursing care
Medicare Part A-Hospital Insurance does not cover doctor charges (that's Part B), custodial care, or the first three pints of blood in a blood transfusion (excluded). However, Medicare Part A does cover skilled nursing facility care after a related three-day inpatient hospital stay, for up to 100 days.
Long Term Care (LTC) policies do NOT cover:
A) Acute care
LTC policies do not cover "acute" care in the hospital.
Medicare Part B-Medical Insurance pays a percentage of:
B) The Medicare approved amount
Medicare Part B claims may be assigned or unassigned. Providers who accept assignment agree to accept the Medicare approved amount as total payment for covered services. Medicare pays its percentage of the approved amount directly to the provider. The beneficiary may be billed for unmet portions of the annual deductible and the coinsurance. Doctors who submit unassigned claims have not agreed to accept Medicare's approved amount as payment in full. Generally, Medicare pays the beneficiary 80% of the approved amount after subtracting any part of the annual deductible that has not been met. A doctor who does not accept assignment may charge a beneficiary up to 115% of the Medicare approved amount.
Medicare Part A will pay costs related to inpatient mental health care in a psychiatric hospital for up to ____ days in a lifetime:
D) 190
Medicare Part A will pay costs related to inpatient mental health care in a psychiatric hospital for up to 190 days in a lifetime.
All of the following are true regarding "qualified" Long Term Care (LTC) policies, EXCEPT:
D) They must have a cash value
Qualified LTC policies do not have any cash value, but must offer the option to add a non-forfeiture benefit, most commonly in the form of a "reduced paid-up" policy with a shorter benefit period. Premiums paid for tax qualified LTC policies may be tax deductible and policies must be guaranteed renewable, which means that nothing may be changed except rates by "class" only.
With regard to End Stage Renal Disease, Medicare secondary rules apply to:
D) The rules apply to all employer related groups regardless of size
Medicare is secondary to Employer Group Health Plans for 30 months for employees or their dependents who have Medicare solely because of permanent kidney failure. After 30 months, Medicare becomes the primary payer. This applies to all groups, regardless of size.
All of the following statements about Medicare Supplements are true, EXCEPT:
D) They are approved by Medicare
Medicare Supplements are not approved by Medicare. There are ten standardized plans that are regulated by the National Association of Insurance Commissioners (NAIC). They are sold and underwritten by private insurers and their agents. You cannot sell a person multiple Medicare Supplements if they provide duplicate coverage.
LTC insurance provides coverage for which of the following:
C) Home health care
LTC insurance does not cover acute care in the hospital, disability income, medical bills or pre-existing conditions that reoccur within a specified time after a policy has been issued. LTC does cover skilled nursing care, intermediate nursing care, custodial care and home health care, which includes coverage for visiting nurses, housework, meal preparation and physical therapy.
Although Medicare provides coverage for kidney dialysis regardless of age, a person's group medical expense policy must provide primary coverage for the first ____ months:
A) 30
Although Medicare Part B covers kidney dialysis for people with end-stage renal disease regardless of age, a person's group medical expense policy must provide the primary coverage for the first 30 months.
Home health care provided under an LTC policy will cover all of the following, EXCEPT:
D) Medical bills
LTC insurance is not designed to pay disability income or medical bills. It does cover skilled nursing care, intermediate nursing care, custodial care and home health care.
A program where the federal government pays matching funds to the state in order to insure low income individuals is known as:
D) Medicaid
Medicaid is a medical insurance program for low income individuals. It is funded by both federal and state monies.
Which of the following is NOT correct about the different parts of Medicare:
A) Part C covers Medicare supplements
Part C of Medicare is also known as Medicare Advantage, which is provided by HCSOs as an alternative to original Medicare.
If a producer specializes in selling Medicare Supplements (Medi-gap policies), which of the following is true:
B) The producer must provide the applicant an outline of coverage at the time of application and obtain a written acknowledgment of receipt from the applicant.
When marketing Medicare Supplements to the public the producer is responsible for delivering both a Guide to Health Insurance for People with Medicare and an Outline of Coverage no later than the time of application. The agent is also required to obtain a written acknowledgment of receipt from the applicant for both documents.
Regarding LTC insurance, coverage that will pay for a temporary caregiver while the permanent caregiver takes a vacation is known as:
B) Respite care
An optional coverage available on an LTC policy is "respite care" for caregivers, which will pay the expenses related to hiring a temporary caregiver while the regular caregiver takes a break from their duties.
Author
EdiesTeam
ID
317807
Card Set
D7. Health Insurance for Senior Citizens
Description
Health Insurance for Senior Citizens DISABILITY PORTION
