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Insurance > Special Needs And Elderly > Flashcards

Special Needs And Elderly Flashcards

1
Q

If an individual is covered by Medicare, and is also covered by his employers health plan, which is considered primary?

A

The employer plan

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2
Q

What is another name for Medicare supplement plans?

A

Medigap

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3
Q

What is the purpose of Medicare supplement plans?

A

Fill in gaps in Medicare coverage

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4
Q

What type of Medicare policy requires insureds to use specific healthcare providers and hospitals (in other words has restricted network provisions)

A

Medicare SELECT

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5
Q

What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?

A

Part A

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6
Q

What part of Medicare is known as medical insurance?

A

Part B

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7
Q

What are the activities of daily living?

A

Mobility, bathing, dressing, eating, toileting and continence

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8
Q

What is the required free look period for Medicare supplement policies?

A

30 days

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9
Q

Who is eligible for Medicare part B?

A

Part B is optional and is offered to everyone who enrolls in Part A

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10
Q

At what age do individuals qualify for Medicare?

A

65

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11
Q

Who qualifies for Medicare coverage?

A

People age 65 and older, anyone who has been entitled to SS disability income benefits for 2 years, or who has chronic kidney disease.

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12
Q

What is another name for Medicare advantage points?

A

Part C

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13
Q

How many parts does Medicare have?

A

4, A-D

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14
Q

Medicare part A pays for what type of services?

A

Inpatient hospital care, skilled nursing facility care, home health and hospice

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15
Q

How is Part B funded?

A

By monthly premiums and from general revenues from the federal government

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16
Q

What part of Medicare is known as hospital insurance?

A

Part A

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17
Q

Can Alzheimer’s disease be excluded from coverage under a long term care policy?

A

No organic cognitive disorders like Alzheimer’s or Parkinson’s must be covered

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18
Q

An insured with Medicare part D has reached the initial benefit limit and must now pay a portion of prescription drug costs. What is the term for the gap in coverage?

A

The donut hole

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19
Q

What Medicare part will cover lab services or diagnostic tests?

A

Part B

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20
Q

When is the initial enrollment period for part A?

A

When an individual first becomes eligible for Medicare, starting 3 mos before turning age 65 and ending 3 months after 65th birthday

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21
Q

What is the purpose of respite care in long term care insurance?

A

To provide relief for a major caregiver usually a family member

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22
Q

How many pints of blood will be paid for by Medicare Supplement core benefits?

A

First 3

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23
Q

When must the outline of coverage be provided to the insured?

A

No later than policy delivery

24
Q

Who issues medigap policies?

A

Private insurers

25
Q

What Medicare part provides a prescription drugs benefit?

A

Part D think D for drugs

26
Q

What benefits are provided by Medicare part C?

A

Expanded benefits for a fee through private insurance programs such as HMOs or PPOs

27
Q

In which Medicare supplemental policies are the core benefits found?

A

All plans (A-N)

28
Q

Part A covers hospitals and Part B covers what

A

Doctors

29
Q

In Medicare, the diff between what the doctor bills and what Medicare pays is called

A

The excess charge

30
Q

What Medicare part is hospital insurance?

A

Part A

31
Q

How many days of psychiatric care does part A cover

A

190 days

32
Q

How many days of skilled nursing per coverage period does part A cover

A

100 days

33
Q

Under part A, do you have to go to the hospital before you go to skilled nursing?

A

Yes, a 3 day minimum stay, part A doesn’t cover custodial care

34
Q

What is the coinsurance proportion under part B (physicians services)?

A

80/20 also has a deductible

35
Q

How do you calculate Medicare part B coinsurance?

A

Percentage of Medicare’s approved amount not the amount the doctor charges

36
Q

What is Part C Called?

A

Medicare Advantage

37
Q

What does part C provide?

A

Managed Care

38
Q

What is Part D Called?

A

Prescription Drug Insurance

39
Q

What else must you enroll in to be enrolled in Part D

A

Part A or in Parts A and B

40
Q

Who sells medicare supplements?

A

Private insurance cos and their agents

41
Q

How long is open enrollment for buying a medigap policy?

A

6 months

42
Q

Are medicare supplement plans required to be approved by Medicare?

A

No

43
Q

How many medigap policies can you sell someone?

A

1

44
Q

Maximum probationary period on medicare supplement policy

A

6 months

45
Q

Can you replace one medicare supplement with another?

A

Yes as long as its not detrimental to the insured

46
Q

When someone needs care, but not 24 hour care provided by a doctor, what is this called?

A

Long Term Care

47
Q

Minimum free look period on a LTC policy?

A

10 Days

48
Q

Activities of Daily Living

A 
Mobility
Dressing
Bathing
Toileting
Continence
Eating
49
Q

Inability to perform how many ADLs triggers benefits?

A

2

50
Q

Does LTC insurance cover acute care?

A

No

51
Q

LTC home health care services include

A

physical therapy, nursing care, home health aides and homemaker services

52
Q

The period of time that a long term care policy will provide custodial care in a nursing home is called

A

The benefit period

53
Q

LTC policies usually pay a fixed amount per day

A

While an insured is confined to a custodial nursing home

54
Q

LTC policies may exclude

A

pre existing illness, acute care, mental disorders, alcohol drug addiction, war related illness and self inflicted injuries

55
Q

LTC policies may not exclude

A

Alzheimers disease

56
Q

LTC return of premium rider will

A

refund some or all of the insureds premiums to the insureds estate or benny if the insured dies before age 65

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