Medicare and Medicaid Flashcards
According to the National Association of Insurance Commissioners’ standardized model Medicare supplement policy, insurers must offer coverage for all of the following core benefits EXCEPT?
- Medicare Part A eligible hospital expenses not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period
- the medicare Part A deductible
- the coinsurance amount of medicare part B eligible expenses, regardless of hospital confinement, subject to Medicare part B deductible
- coverage under medicare Parts a and B for the first 3 months of blood or equivalent (unless replaced according to federal regulations)
the medicare Part A deductible
To be eligible for medicare’s skilled nursing facility care benefit, the claimant must do all of the following EXcEPT
- meet the acceptable income limits
- have a physician certify that skilled care is required
- spend at least 3 days in a hospital
- enter a Medicare-certified skilled nursing facility
- meet the acceptable income limits
Tom is covered under medicare Part A. He spends 1 week in the hospital for some minor surgery and returns home on July 10. it was his first hospital stay in years. Which of the following statements regarding his Medicare coverage is CORRECT?
- Medicare Part A will not cover Tom’s hospital expenses because he was not hospitalized for 10 consecutive days.
- Medicare Part A will pay benefits, but Tom must make a daily co-payment
- After Tom pays the deductible, Medicare Part A will pay 100% pf all coverage
- After Tom pays the deductible, Medicare Part A will pay 100% pf all coverage
Individuals claiming a need for medicaid must prove that they cannot pay for their own nursing home care. In addition, the potential recipient must
- be at least 70 years old
- be receiving Social Secuirty
- need the type of care that is provided only i n a nursing home
- be a long-term care insurance policyowner
- need the type of care that is provided only i n a nursing home
Which of the following statements regarding medicare supplement insurance is INCORRECT?
- it is illegal to sell a Medicare supplement policy to a person who is a Medicare Advantage plan
- All standard Medigap plans must include 100% of the Part A hospital coinsurance
- The number of standard Medigap plans changes every year
- Medicare supplement policies cover co-payments, coinsurance and deductibles
- The number of standard Medigap plans changes every year
Under Medicare Part B, the participant must pay
- have physician verify that skilled care is required
- a per benefit deductible
- 20%of covered charges above the deductible
- 80% of covered charges above the deductible
- 20%of covered charges above the deductible
All Medicare supplement policies must cover 100% of the Part A hospital coinsurance amount for each day used from
- the 45th through the 90th day in any Medicare benefit period
- the 61st through the 90th day in any Medicare benefit period
- the 30th through the 90th day in any Medicare benefit period
- the 1st through the 60th day in any Medicare benefit period
- the 61st through the 90th day in any Medicare benefit period
Skilled nursing care differs form the intermediate care in which of the following ways?
- Skilled nursing care must be performed by skilled medical professionals, whereas intermediate care does not require medical training
- Skilled nursing care is typically given in a nursing home, whereas intermediate care is usually given at home
- Skilled nursing care must be available 24 hours a day, whereas intermediate care is daily, but not 24-hour care.
- Skilled nursing care encompassed rehabilitation, whereas intermediate care is for meeting daily personal needs, such as bathing and dressing
- Skilled nursing care must be available 24 hours a day, whereas intermediate care is daily, but not 24-hour care.
Medicare supplement (or Medigap) policies pay
- benefits provided under Medicare Part A
- all or most of Medicare’s deductibles
- medical costs arising from extended custodial (nursing home) care
- benefits to those who cannot afford Medicare Part B coverage
- all or most of Medicare’s deductibles
A 65 year old employee of a company with 90 employees suffers a heart attack and, as a result become totally disabled. Which of the following statements describes how his benefits will be paid?
- medicare pays most of the benefits. After that, his employer sponsored health insurance pays the remainder
- his employer is the primary payer and Medicare pays the remaining eligible expenses
- because he’s over age 65, Medicare is responsible for paying all benefits
- As an active employee, his employer sponsored health insurance will pay all benefits
his employer is the primary payer and Medicare pays the remaining eligible expenses
The core policy (Plan A) developed by NAIC as a standard Medicare supplement policy include all o f the following except
- coverage for the first 3 pints of blood each year
- coverage for the Medicare Part A deductible
- coverage for the Part A coinsurance amounts
- coverage for the 20% Part B coinsurance amounts for Medicare approved services
- coverage for the Medicare Part A deductible
An individual who chooses not to enroll in Part B when first applying for Medicare may do so
- during an annual open enrollment period
- between July and September of each year
- on the anniversary of his Part A enrollment date
- at any time after enrolling in Part A
during an annual open enrollment period
Lynn is insured under Medicare Part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that Medicare will pay for hospital bills?
- 60 days
- 90 days
- 120 days
- 150 days
- 150 days
Which of the following is NOT covered by Medicare Part A?
- a skilled nursing facility
- an outpatient medical facility
- home health care
- hospice care
- an outpatient medical facility
A Medicare supplement policy that contains restricted network provisions is known as
- a Medicare select policy
- an HMO
- an individual health policy
- a long-term care policy
- a Medicare select policy
