Chapter 7

Question 1

Period of time during which benefits are paid under policy

Enrollee
Premium
Waiting period
Benefit period

Answer 1

Benefit period

Question 2

Person enrolled in health ins plan, an insured doesn’t include dependents of insured

Enrollee
Benefit period
Waitin period
Per existing conditions

Answer 2

Enrollee

Question 3

Conditions insured has recd diagnosis for diagnosis advice care or treatment during specific time period prior to Capp for health coverage

Benefit period
Premium
Social security disability insured status
Pre existing conditions

Answer 3

Pre existing conditions

Question 4

Money paid to ins company for ins coverage

Waiting period
Medicare
Premium

Answer 4

Premium

Question 5

Fully insured or currently insured depending on number of coverage credits earned

Social security disability insured status
Medicare
Premium

Answer 5

Social security disability insured status

Question 6

Period of time that must pass after a loss occurs before insurer start paying policy benefits

Waiting period
Trial period
Executive period

Answer 6

Waiting period

Question 7

Federal medical expense ins program for ppl age 65 and older even if individual continues to work

Actual charge insurance
Supplemental ins
Disability ins
Medicare

Answer 7

Medicare

Question 8

Available to anyone regardless of age entitled to social security disability income benefits for two years or has permanent kidney failure

Rehab services
Medicare
Group care

Answer 8

Medicare

Question 9

If already receives social security disability benefits what would need to be done to qualify for Medicare part a once 65

Nothing
Apply for coverage through state
Apply for coverage through social security administration

Answer 9

Nothing

Question 10

Financed through portion of payroll tax FICA

Part a
Part b
Part c
Part d

Answer 10

Part a hospital ins

Question 11

Financed from monthly premiums paid by insureds and from general revenues of federal govt

Part a
Part b
Part c
Part d

Answer 11

Part b

Question 12

Allows ppl to rec all of their health care services through available provider organizations

Part a
Part b
Part c
Part d

Answer 12

Part c

Question 13

Is for prescription drug coverage

Part a
Part b
Part c
Part d

Answer 13

Part d

Question 14

Does not require patient to choose primary care doc nor does it require referral to see specialist as long as specialist is enrolled in Medicare

Ambulatory surgical services
Medicare part d
Original Medicare

Answer 14

Original medicare

Question 15

Amount physician actually bills for particular service or supply

Answer 15

Actual charge

Question 16

Provided at ambulatory center/performed at center that doesnt require hospital stay unlike inpatient hospital surgery

Answer 16

Ambulatory surgical services

Question 17

Amount Medicare determines to be reasonable for service that is covered under part b of Medicare

Assignment
Carriers
Actual charge
Approved amount

Answer 17

Approved amount

Question 18

Physician or medical supplier agrees to accept Medicare approved amount as full payment for covered services

Assignment
Carriers
Excess charge

Answer 18

Assignment

Question 19

Organizations that process claims that are submitted by doctors and suppliers under Medicare

Carriers
Xo insurance
Limiting charge

Answer 19

Carriers

Question 20

Portion of Medicare’s approved amount that beneficiary is responsible for paying

Coinsurance
Deductible
Excess charge

Answer 20

Coinsurance

Question 21

Outpatient services recd from Medicare participating comprehensive outpatient rehab facility

Peer review organization
Pap smear screening
Comprehensive outpatient rehabilitation facility services

Answer 21

Comprehensive outpatient rehabilitation facility services

Question 22

Organizations that process inpatient and outpatient claims on individuals by hospitals skilled nursing facilities home health agencies hospices or other providers of health services

Limiting charge
Intermediaries
Excess charge

Answer 22

Intermediaries

Question 23

Maximum physician may charge Medicare beneficiary

Limiting charge
Peer review organization
Participating doctor or supplier

Answer 23

Limiting charge

Question 24

Program of outpatient mental health care

Peer review organization
Nonparticipating
Limiting charge
Partial hospitalization for mental health care

Answer 24

Partial hospitalization fo mental health care

Question 25

Groups of practicing doctors and other health care professionals who are paid by govt to review care given to Medicare patients Pap smear screening Participating doctor or suppliers Peer review organizations

Answer 25

Peer review organizations

Question 26

Bill confined in skilled nursing facility. Medicare will pay full benefits in facility for how many days 100 80 3 20

Answer 26

20

Question 27

Days 21 through 100 require a daily Threshold Advice Physician’s note Copayment

Answer 27

Copayment

Question 28

Citizen or legal resident of US age 65 or over and qualified for social security or railroad retirement benefits Entitled to monthly social security benefits based upon the spouse’s work record and the spouse is at least 62; younger than 65 but has been entitled to social security disability benefits for 24 months/disabled; has end stage renal disease/permanent kidney failure that requires dialysis or transplant/has als Aleatory eligible Dependent care eligible Hsa eligible Medicare part a eligible

Answer 28

Medicare part a eligible

Question 29

Pays for inpatient care inpatient care in skilled nursing facility home health care and hospice care is known as Part a Part b Part c Part d

Answer 29

Part a

Question 30

Not an enrollment period for Medicare part a applicants Initial enrollment Special enrollment General enrollment Automatic enrollment

Answer 30

Automatic enrollment

Question 31

Three enrollment periods for Medicare part a Initial general special Beginning end middle Moon sun ground

Answer 31

Initial general special

Question 32

All of following qualify for Medicare part a except Someone in renal failure Someone with social security Someone over 65 willing to pay premium Anyone willing to pay premium

Answer 32

Anyone willing to pay premium

Question 33

All following are covered by part a of Medicare except Physician and surgeon services Home health services Post hospital nursing care

Answer 33

Physician and surgeon services

Question 34

To rec benefits under Medicare part a for care in skilled nursing facility which must be met Insured must cover daily copayments Insured must have first been hospitalized for 3 consecutive days Insured must have a Medicare suppplement ins policy

Answer 34

Insured must have first been hospitalized for 3 consecutive days

Question 35

Fully insured under social security means they have earned

Answer 35

40 quarters of coverage equivalent of 10 years of work