Medicare Part B

Question 1

Part B annual deductible

Answer 1

$147.00

Question 2

Part B Annual blood deductible

Answer 2

3 pints

Question 3

Part B coinsurance

Answer 3

20%

Question 4

Under Part B, how much can “nonparticipating” physicians charge?

Answer 4

115% of the approved Medicare Part B amount

Question 5

What is the name of the document that must be supplied to the beneficiary if the provider believes a certain requested service will not be covered by Medicare?

Answer 5

Advanced Beneficiary Notice (ABN)

Question 6

Medicare Part B 2014 premiums for people making $85,000 or less

Answer 6

$104.90

Question 7

Failure to enroll in Medicare Part B during their initial Enrollment Period will result in a permanent additional __% premium for EACH full ____ delayed enrollment from the end of the individual’s Initial Enrollment Period

Answer 7

10% for each 12 months

Question 8

Hoqw long do physicians have to file a claim with Medicare without incurring a reduction in payment?

Answer 8

1 year

Question 9

What is the name of the document that must be sent to the beneficiary by the MAC when a claim is filed?

Answer 9

Medicare Summary Notice

Question 10

Medicare will provide coverage for bone mass measurements at lease every ___ for treatment of osteoporosis

Answer 10

24 months

Question 11

Medicare will provide coverage for cardiovascular screenings every ___ years

Answer 11

5

Question 12

Medicare will provide coverage for a colonoscopy once every ___ for high-risk patients

Answer 12

24 months

Question 13

Medicare will provide coverage for mammograms, pap smear/pelvic exams, prostate cancer screenings once every ___

Answer 13

12 months

Question 14

Part B requires a ___% deductible for outpatient mental health services. The initial diagnosis will have ___% coinsurance.

Answer 14

40%; 20%

Question 15

The “Welcome to Medicare” [hysical exam will be free if conducted within ___ of the enrollment

Answer 15

12 months

Question 16

By law, what type of plan cannot be sold to enrollees in Part C

Answer 16

Medicare Supplement

Question 17

T/F: Medicare supplement plans cover hospice

Answer 17

False- Hospice will be covered by Part A

Question 18

Part C Open Enrollment

Answer 18

October 15th to December 7th

Question 19

Part C plan benefits for those who enroll during the general enrollment period will begin on what date?

Answer 19

Jan. 1

Question 20

T/F: Medicare Beneficiaries cannot be solicited to join a Medicare Advantage Plan

Answer 20

True

Question 21

What medical condition will make someone ineligible for Part C?

Answer 21

End Stage Renal Disease, or require kidney dialysis or require a kidney transplant

Question 22

T/F: A beneficiary can enroll in Part C if they aren’t enrolled in Part B

Answer 22

False- Beneficiary must be enrolled in both Parts A & B in order to enroll in Part C.

Question 23

Open enrollment period for Part D

Answer 23

October 15th-December 7th

Question 24

Late enrollment penalty for Part D

Answer 24

1% for each month after end of initial enrollment period

Question 25

Expected average premium for Part D in 2014

Answer 25

$32.42- rates vary depending on coverage

Question 26

Part D "donut hole" boundaries

Answer 26

$2,850-$4,550 (these totals included beneficiary payments PLUS insurer payments)

Question 27

During the Part D "gap," how much coinsurance does the beneficiary have to pay? (for basic PDP)

Answer 27

47.5% for brand name | 79% for generic

Question 28

During the "catastrophic coverage" phase of Part D, how much coinsurance will the beneficiary have to pay? (for basic PDP)

Answer 28

5% or a copayment of: $2.65 for generic $6.60 for others

Question 29

How often can an insurer change its Prescription Drug Plan (PDP)

Answer 29

annually

Question 30

T/F: Medicare beneficiaries enrolled in a Medicare-approved PDP can receive extra help if they are also enrolled in Medicaid AND a Medicare Savings Plan.

Answer 30

True

Question 31

Part D Basic plan deductible

Answer 31

$310

Question 32

Medicare Supplement (Medigap) policies cannot be sold to people who have coverage under which part of Medicare?

Answer 32

Part C

Question 33

T/F: Medicare Supplement policies provide coverage for Part D

Answer 33

False- Medigap is only for Parts A & B

Question 34

T/F: Medicare Supplement policies can be sold to beneficiaries who have at least Part A coverage

Answer 34

False- Beneficiaries must be covered by both Parts A & B in order to purchase Medigap

Question 35

Are Medigap policies sold as individual policies, family policies, or both?

Answer 35

Individual policies only

Question 36

How many Medigap policies are available?

Answer 36

10

Question 37

What Medigap policies no longer sold?

Answer 37

E,H,I,J

Question 38

What percentage does a Medigap Plan K pay?

Answer 38

50%

Question 39

What percentage does a Medigap Plan L pay?

Answer 39

75%

Question 40

Which Medigap Plan(s) offer a high deductible?

Answer 40

Plan F

Question 41

What is the out-of-pocket Maximum for Medigap Plan K?

Answer 41

$4,800

Question 42

What is the out-of-pocket Maximum for Medigap Plan K

Answer 42

$2,400

Question 43

Medigap Plans available to people who have Medicare Coverage due to a disability or end stage renal disease?

Answer 43

Plans A,C,F

Question 44

Open enrollment period for Medicare Supplement Policies

Answer 44

6 months after enrollment in Part B- after this coverage is not guaranteed and one can be denied a policy

Question 45

What is the mandatory loss ratio for Medicare Supplement Policies for individuals?

Answer 45

65%

Question 46

What is the mandatory loss ratio for Medicare Supplement Policies for groups?

Answer 46

75%

Question 47

T/F: Medigap policies can contain limitations or exclusions from coverage that are more restrictive than those of original Medicare

Answer 47

False

Question 48

T/F: Medigap policies are guaranteed renewable?

Answer 48

True

Question 49

Insureds must be notified how many days before changes in the Medicare Program take effect?

Answer 49

30 days

Question 50

If a Medicare Supplement insured begins receiving Medicaid benefits, he or she may within ____ request a suspension of premiums and benefits under the policy for up to ____

Answer 50

90 days; 2 years

Question 51

Medicare Supplement coverage my be automatically reinstated (without conditions) if the insured loses Medicaid eligibility and notifies the insurer within ____ of the lost Medicaid eligibility

Answer 51

90 days

Question 52

Insureds may only have ____ Medigap policy(ies)

Answer 52

One

Question 53

An agent may not earn more than ___% in first year commissions relative to the second year's renewal commissions

Answer 53

200%

Question 54

The renewal commission must be the same in years ___ through ___

Answer 54

2-6

Question 55

How long does a Medicare beneficiary who has switched from Original Medicare to Medicare Advantage or who has enrolled directly into Medicare Advantage have to switch back and be guaranteed reinstatement of a Medigap policy if they want it

Answer 55

12 months

Question 56

Maximum aggregate coverage that can be provided by Medigap for foreign travel emergencies

Answer 56

$50,000

Question 57

Medigap annual deductible for foreign travel emergencies

Answer 57

$250

Question 58

Medigap Coinsurance for foreign travel emergencies

Answer 58

80/20

Question 59

T/F: A person must be certified, in writing, by a physician of the necessity for admission to a nursing home and level of care required in order to be eligible for Medicaid

Answer 59

True

Question 60

A community spouse may keep up to how much of their spouse who is insured through Medicaid

Answer 60

Up to the minimum monthly maintenance needs allowance. If the community spouse has some income, but less than the MMMNA, they will be allowed to keep their spouse's income up to the difference between their own income and the MMMNA

Question 61

A community spouse may keep all of their own assets as well as what percent of co-owned assets between them and their spouse?

Answer 61

50%, subjecy to a minimum and maximum, both of which are established annually

Question 62

The cash surrender value of life insurance policies are not counted by Medicaid in the "spend down" if they have a combined face value of less than what amount?

Answer 62

$1,500

Question 63

T/F: The residence of an insured under Medicaid is counted in the "spend down"

Answer 63

False

Question 64

Penalty period for asset transfers under the Medicaid Policy

Answer 64

60 months prior to application for Medicaid (Before the Deficit Reduction Act of 2005 it was 36 months)

Question 65

Long-Term Care Insurance (LTCI) provides coverage for not less than how many months?

Answer 65

12 months

Question 66

What are the six Activities of Daily Living (ADLs)?

Answer 66

``` Bathing Eating Transferring Dressing Toileting Continence ```

Question 67

T/F: LTCI policies don't have elimination periods

Answer 67

False, most LTCI policies have elimination periods, though it is at the insurer's discretion

Question 68

T/F: NC LTCI regulations require companies to offer applicants a method of increasing the daily benefit amount to offsety the effect of inflation

Answer 68

True

Question 69

Under automatic inflaion protection, benefit amounts increase at a minimum of what percent compounded annually?

Answer 69

5%

Question 70

T/F: NC LTCI insurers don't have to offer non-forfeitures to applicants

Answer 70

False

Question 71

T/F: NC LTCI policies MUST have a provision for having the applicant list a third party to be notified before cancellation or lapse of policy

Answer 71

True, though the applicant can sign a waiver opting out

Question 72

Notice of premium nonpayment cannot be given until how long after the missed due date?

Answer 72

30 days

Question 73

Notice of non-payment of premium for a LTCI policy shall be deemed to have been given as of ___ days after the date of mailing

Answer 73

5 days

Question 74

No LTCI policy can be lapsed or be terminated for nonpayment of premim how many days after the missed due date?

Answer 74

65 days

Question 75

LTCI policy reinstatement must be provided to anyone who furnishes proof of cognitive impairment within how long after policy lapse or termination?

Answer 75

5 months

Question 76

T/F: All NC LTCI policies must be guaranteed renewable

Answer 76

True

Question 77

NC regulations require LTCI policies to provide ___ levels of care for a period of at least ___ consecutive months

Answer 77

3 levels; 12 months

Question 78

LTCI policy-holders must be given ___ days notice before there is a premium increase

Answer 78

45 days

Question 79

All NC LTCI policies must have a free-look period of how many days?

Answer 79

30 days

Question 80

T/F: The six and six rule applies to LTCI

Answer 80

True

Question 81

LTCI policies have a period of incontestibility of how long?

Answer 81

2 years

Question 82

Policies to be issued to anyone age ___ or older must be accompanied by a physical examination of the proposed insured, and assessment of the functional ability of the proposed insured and an attending physician's statement or medical records provided about the insured to the insurance company

Answer 82

80

Question 83

T/F: LTCI is a Medicare Supplement

Answer 83

False

Question 84

In the Outline of Coverage on an LTCI policy must have a font size no smaller than ___ point type

Answer 84

10

Question 85

LTCI Outlines of Coverage on an LTCI policy must provide a comparison covering at least a ___ year period

Answer 85

20 year

Question 86

LTCI Outlines of Coverage must provide premiums charged for what two ages?

Answer 86

75 and 85

Question 87

T/F: An outline of coverage and Shopper's Guide must be provided at the time of application for an LTCI policy

Answer 87

True

Question 88

Individual LTCI policies must have a loss ratio of ___%

Answer 88

60%

Question 89

Group LTCI policies must have a loss ratio of ___%

Answer 89

75%

Question 90

How long does the replacing LTCI insurer have to give notice to the existing insurer after the replacing insurer has received the application for replacement

Answer 90

5 business days

Question 91

In LTCI policies, if home health care benefits are offered, the amount of payment can be no less than how much?

Answer 91

$25 per day

Question 92

How big must a group be to qualify for group LTCI?

Answer 92

100

Question 93

How long must a group have been in existence to qualify for group LTCI?

Answer 93

1 year