Medicare and Medicaid

Question 1

Medicare pays a large portion of the health care bill for persons who:

Answer 1

-are age 65 or over
-have end-stage renal disease
-have been receiving Social Security disability benefits for at least 24 months

Question 2

Qualification for Medicare requires:

Answer 2

-individual to be “fully insured” according to social security
-accumulating at least 40 credits by generating a minimum amount of work-related income over at least the past 10 years and paying social security (FICA) taxes

Question 3

Private healthcare insurance companies process medical claims for Medicare and are known as:

Answer 3

Medicare Administrative Contractors (MAC)

Question 4

The initial enrollment for Medicare is a _____-month prior that begins _____ months before the month an individual turns 65, includes the month they turn 65, and ends ___ months after the month they turn 65

Answer 4

Seven; three; three

Question 5

Medicare part A covers:

Answer 5

Hospital, skilled nursing facility, hospice, and home health care

Question 6

Medicare part B covers:

Answer 6

Medical care provided by physicians and other medical servicesp

Question 7

Medicare part C covers:

Answer 7

Health care delivered by managed care plans

Question 8

Medicare part D covers:

Answer 8

Prescription drugs

Question 9

For people age 65 and covered by Social Security, enrollment in Medicare Part A is _______ on the first day of the month that they reach age 65 and is _____

Answer 9

Automatic; free

Question 10

Medicare Part A hospital coverage is based on _______ _______ rather than the calendar year

Answer 10

Benefit periods

Question 11

A Medicare part A inpatient hospital benefit period begins when:

Answer 11

Someone is admitted to the hospital and ends 60 days after discharge

Question 12

For each Medicare part A inpatient hospital benefit period, coverage and cost-sharing amounts are as follows:

Answer 12

-the patient pays a deductible, which changes annually
-days 1-60: fully paid by Medicare (after the deductible)
-days 61-90: Medicare pays most of the cost, and the patient pays a daily co-pay amount which changes each year

Question 13

_______ care and _______ care are NOT covered by Medicare

Answer 13

Intermediate; custodial

Question 14

Medicare covers skilled nursing facility care if:

Answer 14

-it is a Medicare-approved facility
-the SNF stay begins immediately after release from a hospital stay of at least 3 days

Question 15

Medicare coverage and cost-sharing amounts for a skilled nursing facility are:

Answer 15

-day 1-20: fully paid by Medicare
-days 21-100: Medicare pays most of the cost and the patient pays a daily co-pay amount which changes each year
-after day 100, Medicare pays nothing

Question 16

If a patient is confined at home, Medicare Part A’s home health care benefit covers:

Answer 16

-visits by a home health aide to provide medical services such as part-time nursing care and physical, occupational, or speech therapy
-80% of the cost of durable medical equipment such as hospital beds or wheelchairs

Question 17

Medicare part A exclusions:

Answer 17

-first 3 pints of blood
-private duty nursing
-non-medical services
-intermediate care
-custodial care

Question 18

Individuals who enroll in Medicare Part A are ______ enrolled in Part B unless they request otherwise

Answer 18

Automatically

Question 19

Medicare Part B is ______ and required a monthly ________

Answer 19

Optional; premium

Question 20

The Medicare Part B premium is tied to;

Answer 20

An individual’s income level and is deducted from the social security monthly benefit check

Question 21

If an individual initially declines Medicare Part B enrollment, they can enroll during the general enrollment period that occurs each year from ______ _ through _____ __ and coverage starts at the beginning of the following month

Answer 21

January 1; March 31

Question 22

Medicare Part B provides coverage for 3 general kinds of medical services:

Answer 22

Inpatient and outpatient physician services, home health care if not covered by Part A, and outpatient medical services and supplies

Question 23

Some preventative care is included under Medicare Part B:

Answer 23

-an initial routine physical exam within the first 6 months of enrollment
-screening tests for cholesterol, diabetes, and colorectal cancer
-annual mammograms (age 40+), Pap tests, pelvic exams, and clinic breast exams for women
-annual prostate cancer screenings for men age 50+
-glaucoma testing one ever 12 months
-Bone mass measurements for qualified individuals
-flu shots

Question 24

Medicare part B has an annual deductible that changes each year and also a __% coinsurance

Answer 24

20

Question 25

Medicare assignment

Answer 25

Means that the doctor or supplier will accept Medicare’s approved amounts as full payments and cannot legally bill the patient for anything above that amount

Question 26

Medicare Part B exclusions:

Answer 26

-routine foot, vision, dental or hearing care
-most immunizations
-most outpatient prescription drugs
-physician charges above Medicare’s approved amount
-private-duty nursing
-cosmetic surgery
-most care received outside the US
-expenses incurred as a result of war or act of war

Question 27

Medicare beneficiaries can choose to receive their benefits from a Medicare Advantage plan but they still must:

Answer 27

Enroll in Part A, Part B, pay the Part B premium, and pay the Medicare Advantage Plan Premium

Question 28

Medicare Part C- Advantage Plans

Answer 28

-Medicare contracts with and pays private companies
-enrollees medical expenses paid by the private plan
-enrollee must be enrolled in Medicare part A & B
-private company may charge the enrollee a fee
-may provide outpatient drug coverage

Question 29

There are four types of Medicare Advantage Plans:

Answer 29

-Medicare-managed care plans
-Medicare preferred provider organization plans (PPO)
-Medicare private fee-for-service (PFFS) plans
-Medicare specialty plans

Question 30

Medicare Part D costs:

Answer 30

-a monthly premium- high income beneficiaries may be a relatively higher premium
-an annual deductible with a max amount- not all PDPs have a deductible, or charge the max deductible
-25% coinsurance- until total expenditures reach the threshold amount for the coverage gap

Question 31

Beginning in 2020, once the insured reaches the Medicare coverage gap, they will pay no more than __% of the cost for the plan’s covered brand-name prescription drugs and generic prescription drugs

Answer 31

25

Question 32

If individual is over 65 and works for an employer with less than 20 employers that sponsors a group plan, Medicare is the ________

Answer 32

Primary

Question 33

A Medicare supplement insurance (Medical) policy, sold by private companies, can help pay some of health care cost that Original Medicare doesn’t cover like:

Answer 33

Co-payments, coinsurance, and deductibles

Question 34

Medigap policies must be at least _______ ________

Answer 34

Guaranteed renewable

Question 35

Medigap policy benefits must be __________ _______ for changes in Medicare

Answer 35

Automatically adjusted

Question 36

Medigap policies may not _________ benefits provided by Medicare

Answer 36

Duplicate

Question 37

Medigap policies must have a __-day free look period

Answer 37

30

Question 38

If a Medigap policy is replaced, the applicant must be given:

Answer 38

-a refund of unearned premium on the replaced policy
-credit under the new policy for any time elapsed under the pre-existing condition provision of the replaced policy

Question 39

Medicare SELECT is coverage offered through:

Answer 39

A restricted provider network, like a managed care plan

Question 40

Insurers may not sell Medicare SELECT policies to individual’s outside:

Answer 40

The network service area

Question 41

Medicare SELECT policyholder must have the option to switch to:

Answer 41

A Medigap policy without a restricted provider network

Question 42

To receive Medicaid, a person must qualify for:

Answer 42

-Temporary Assistance for Needy Families (TANF/Welfare)
-supplemental security income (SSI) assistance program for people living at or near the poverty line who are age 65+, blind or disabled