Chapter 7 Part 3 Flashcards

1
Q

Medicare adv is also known as

Medicare part c
Medicare part d
Medicare part a

A

Medicare part c

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2
Q

All of the following are advantages of an hmo or ppo for a Medicare recipient except

There are no claims forms required
Elective cosmetic procedures are covered
Prescriptions might be covered unlike Medicare
Healthcare costs can be budgeted

A

Elective cosmetic procedures are covered

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3
Q

Which is NOT correct re Medicare

Medicare a provides hospital care
Medicare b provides physician services
Medicare advantage must be provided through HMO

A

Medicare advantage must be provided through hmo

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4
Q

To be eligible for Medicare advantage beneficiaries must also be enrolled in

All plans
Consideration plan
Medicare part c
Medicare parts a and b

A

Medicare part a and b

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5
Q

Health maintenance program aka

A

PPO preferred provider organization

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6
Q

Medicare adv plan offered by a private insurance company

Medicare private fee for service plan
PPO
Special needs plan

A

Medicare private fee for service plan

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7
Q

Medicare pays a set amount of money every month to the what to provide health care coverage in a private fee for service plan

Hmo
Ppo
Private ins company

A

Private ins company

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8
Q

More focused and specialized health care fo specific groups of ppl such as who have both Medicare and medicaid who reside in nursing home or have certain chronic medical conditions

Freedom plan
Catastrophic plan
Special needsplan

A

Special needs plan

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9
Q

What was passed to add part d prescription drug benefit to standard Medicare coverages

Stand alone plan
Integrated plan
Medicare prescription drug improvement and modernization act of 2003

A

Medicare prescription drug improvement and modernization act of 2003

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10
Q

Once this amount is reached by beneficiary and their plan combined on drugs (including deductible) beneficiary will pay no more than 25% of cost for prescription drugs until their out of pocket spending is reached

A

4660

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11
Q

Out of pocket spending for drug benefit plan

A

7400

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12
Q

Once beneficiary has reached their out of pocket spending on drug benefit program what begins automatically

Primary Medicare
Secondary Medicare
Catastrophic coverage

A

Catastrophic coverage

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13
Q

Catastrophic =

A

95%

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14
Q

For individual eligible for Medicare at age 65, who is still employed and covered under employer’s plan, which is true

Plan is primary coverage and Medicare is secondary coverage
Employer plan is secondary coverage and Medicare is primary coverage
Employer plan is discontinued and Medicare is primary coverage

A

Employer plan is primary coverage and Medicare is secondary coverage

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15
Q

Medicare is part of health insurance market place which is key component of affordable care act that allows qualified individual families and employees of small businesses to obtain health ins

True or false

A

False

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16
Q

When considered eligible for Medicare part a person will not qualify for marketplace tax credits to help pay for premiums or reductions in

Cost sharing
Premium
Catastrophic

A

Cost sharing

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17
Q

Which is not covered under medical ins plan a

Medicare part a deductible
First tree pints of blood each year
Approved hospital costs for 365 additional days after Medicare benefits end

A

Medicare part a deductible

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18
Q

Provides core or basic benefits established by law

Medicare supplement plan a
Omnibus budget reconciliation act of 1990
Globe life

A

Medicare supplement plan a

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19
Q

Policies issued by private ins companies that are designed to fill in some of the gaps in Medicare

Medicare supplement plans aka medigap
Globe life
All state
Geico

20
Q

In which Medicare supplemental policies are core benefits found?

All plans
Plan a only
Plan b only

21
Q

What pays all or some of Medicare’s deductibles and copayments

Medicare supplement
Cobra
Obra

A

Medicare supplement policies

22
Q

Omnibus budget reconciliation act of 1990 =

23
Q

Medicare supplement ins may not discriminate in pricing or be denied on basis of an applican’ts health status claims experience recipient of health care of medical condition

Cobra
Medicare part f
Obra

24
Q

Prior to purchasing a medigap policy must be enrolled in which of the following

Any private ins
All four parts of Medicare
Parts a and b of Medicare

A

Parts a and be of Medicare

25
Medicare supplement plan must have at least which of the following Noncancellable Conditionally renewable Guaranteed renewable
Guaranteed renewable
26
All correct statements about Medicare supplement ins policies are correct except Supplement Medicare benefits Issued by private insurers Cover cost of extended nursing home care
Cover cost of extended nursing home care
27
Re Medicare supplement benefits plans what does term standard mean Coverage options and conditions are developed for average individuals All plans must include basic benefits a-n All providers will have the same coverage options a nd conditions for each plan
All providers will have the same coverage options and conditions for each plan
28
Plan implies that all providers will have the same coverage options and conditions for each plan Standard Substandard
Standard
29
How long is I open enrollment period for Medicare supplement policies Six months Six weeks One year
Six months
30
These benefits are aka basic benefits
Core benefits
31
How many pints of blood will be paid for by Medicare supplement core benefits 1 3 None
3
32
Which is not covered under plan a in medigap ins Medicare part a deductible First three pints of blood each year Approved hospital costs for 365 days after Medicare benefits end
Medicare part a deductible
33
Supplement plan must have at least which of the following renewal provisions Guaranteed renewable Conditionally renewable Non renewable
Guaranteed renewable
34
Applicant discussing his options for Medicare supp coverage w his agent. Applicant is 65 and has just enrolled in Medicare part a and b What is the ins company obligated to do Offer supplement policy on a guaranteed issue basis Look at the applicant’s medical history to decide what premium to change send the applicant to a doc for a physical. Nothing can happen with the results
Offer supplement policy on a guaranteed issue basis
35
Medicaid provides all of following benefits except Home health care services Eyeglasses Braces Income assistance for work related injury
Income assistance for work related injury
36
Skilled nursing facility coisurance 100% of Medicare art b excess charges a nd foreign travel benefit. This plan must pay for services of activities of daily living that Medicare doesn’t cover Plan a Plan d Plan g
Plan g
37
Lower premium plans with higher out of pocket costs Core benefits are different in these two plans
K and l
38
Medicaid benefits is based upon Age Dependents Need
Need
39
Requirement for social sec disability income benefits 50 years of age Currently employed status Fully insured status
Fully insured status
40
Not a factor in determining qualifications for social security disability benefits Age Work credits Occupation
Occupation
41
Which benefit is based on the persona’s primary PIA Long term care benefit Social security disability benefit Death benefit
Social security disability benefit
42
Those who apply for social security disability benefits are referred to the sate agency called Dds Executive office Insurance office
Dds disability determination services
43
How many work credits can be earned per year 2 4 6 8
4
44
Disabled becomes disabled at 22 and ca no longer work. Meets def of total disability under social security. What requirement must she have to meet social security disability benefits req 6 work credits in past 3 years 20 work credits in past 10 years 40 work credits Reached age of 25
6 work credits in the past 3 years
45
Once person meets req for disability benefits under social security how long is waiting period before any benefits will be paid Paid immediately 90 days 5 months 12 months
5 months
46
Primary insurance a mount =
Pia