CH 14 Insurance for Senior Citizens and Special Needs Individuals

Question 1

What part of Medicare is known as medical insurance?

Answer 1

Part B

Question 2

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

Answer 2

No later than policy delivery

Question 3

What is another name for Medicare advantage plans?

Answer 3

Part C

Question 4

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

Answer 4

First 3 pints

Question 5

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

Answer 5

Part A

Question 6

What part of Medicare is known as hospital insurance?

Answer 6

Part A

Question 7

Who is eligible for part B Medicare?

Answer 7

Papi is optional, and is offered to everyone who enrolls in part A.

Question 8

In which Medicare supplemental policies are the core benefits found?

Answer 8

All plans (A-N)

Question 9

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

Answer 9

To provide relief for a major caregiver (usually a family member)

Question 10

How many parts does Medicare have?

Answer 10

Four: parts A-D

Question 11

When is the initial enrollment period for Medicare part A?

Answer 11

When an individual becomes eligible for Medicare. Three months before and three months after they turn age 65

Question 12

Who issues Medigap policies?

Answer 12

Private insurers

Question 13

What are the activities of daily living?

Answer 13

• Mobility
• Bathing
• Dressing
• Eating
• Toileting
• Continence

Question 14

What Medicare part provides a prescription drug benefit?

Answer 14

Part D

Question 15

If an individual is covered by Medicare, and is also covered by his employer’s health plan, which plan would be considered primary?

Answer 15

The employer plan

Question 16

Who qualifies for Medicare coverage?

Answer 16

• People age 65 or older
• Anyone who has been entitled to Social Security disability income benefits for two years
• Anyone who has chronic kidney disease

Question 17

At what age do individuals qualify for Medicare?

Answer 17

Age 65

Question 18

What is the purpose of Medicare supplement plans?

Answer 18

To fill in the gaps in Medicare coverage

Question 19

Medicare part A will pay for what type of services?

Answer 19

• Inpatient hospital care
• Skilled nursing facility care
• Home health care
• Hospice care

Question 20

What Medicare part will cover lab services or diagnostic test?

Answer 20

Part B

Question 21

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

Answer 21

The donut hole

Question 22

What benefits are provided by Medicare part C?

Answer 22

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

Question 23

Can Alzheimer’s disease be excluded from coverage under the sea?

Answer 23

No. Organic cognitive disorders, such as Alzheimer’s or Parkinson’s Must be covered

Question 24

What type of Medicare policy requires insured’s to use specific healthcare providers and hospitals (in other words, has restricted network provisions)?

Answer 24

Medicare SELECT

Question 25

How is part B Medicare funded?

Answer 25

By monthly premiums and from the general revenues of the federal government

Question 26

What is the required free-look period For Medicare supplement policy is?

Answer 26

30 days

Question 27

What is another name for a Medicare supplement plans?

Answer 27

Medigap

Question 28

All of the following statements concerning Medicaid are correct EXCEPT A) Individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care B) Persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits C) Medicaid is a state funded program that provides care to persons over 65, only D) Individual states design and administer the Medicaid program under broad guidelines established by the federal government

Answer 28

Medicaid is a state funded program that provides care to persons over 65, only.

Question 29

Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis? A) Adult day care B) Residential care C) Assisted living D) Home health care

Answer 29

Adult day care.

Question 30

A) All of the following would fall under the definition of Durable Medical Equipment EXCEPT A) Wheelchairs B) Hospital bed C) Hospital blanket D) Oxygen equipment

Answer 30

Hospital blanket.

Question 31

OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage? A) End-stage heart failure B) End-stage renal failure C) Black lung D) Leukemia

Answer 31

End-stage renal failure.

Question 32

Medicaid provides all of the following benefits EXCEPT A) Eyeglasses B) Family planning services C) Income assistance for work-related injury D) Home health care services

Answer 32

Income assistance for work-related injury.

Question 33

The primary eligibility requirement for Medicaid benefits is based upon A) Number of dependents B) Need) C) Whether the claimant is insurable on the private market D) Age

Answer 33

Need.

Question 34

Who does the Oregon Medical Insurance Pool protect? A) Children B) People with pre-existing conditions C) People who have been denied medical coverage D) Low income state residents

Answer 34

People who have been denied medical coverage.

Question 35

Which of the following is NOT covered under Plan A in Medigap insurance? A) The first three pints of blood B) The medicare Part A deductible C) Approved hospital costs for 365 additional days after medicare benefits end D) The 20% Part B coinsurance amounts for Medicare approved services

Answer 35

The medicare Part A deductible.

Question 36

Most LTC plans have which of the following features? A) Variable premiums B) Open enrollment C) Guaranteed renewability D) No elimination period

Answer 36

Guaranteed renewability.

Question 37

Which provision allows a person to return a Medicare supplement policy within 30 days for a full premium refund? A) Policy review B) Trial period C) Refund of premium D) Free look

Answer 37

Free look.

Question 38

Which of the following programs expands individual public assistance programs for people with insufficient income and resources? A) Medicare B) Social Security C) Unemployment compensation D) Medicaid

Answer 38

Medicaid.

Question 39

What is the duration of the free-look period for Medicare supplement policies? A) 10 days B) 15 days C) 30 days D) 60 days

Answer 39

30 days.

Question 40

Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the A) Policy application B) Buyer's Guide C) Certificate of Coverage D) Notice Regarding Replacement

Answer 40

Notice Regarding Replacement.

Question 41

Issue age policy premiums increase in response to which of the following factors? A) Increased deductible B) Inflation C) The insured's age D) Increased benefits

Answer 41

Increased benefits.

Question 42

In reference to the standard Medicare Supplement benefits plans, what does the term standard mean? A) Coverage options and conditions comply with the law, but will vary from provider to provider B) All plans must include basic benefits A-N C) Coverage options and conditions are developed for average individuals D) All providers will have the same coverage options and conditions for each plan

Answer 42

All providers will have the same coverage options and conditions for each plan.