Special Needs And Elderly

Question 1

If an individual is covered by Medicare, and is also covered by his employers health plan, which is considered primary?

Answer 1

The employer plan

Question 2

What is another name for Medicare supplement plans?

Answer 2

Medigap

Question 3

What is the purpose of Medicare supplement plans?

Answer 3

Fill in gaps in Medicare coverage

Question 4

What type of Medicare policy requires insureds to use specific healthcare providers and hospitals (in other words has restricted network provisions)

Answer 4

Medicare SELECT

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 medical insurance?

Answer 6

Part B

Question 7

What are the activities of daily living?

Answer 7

Mobility, bathing, dressing, eating, toileting and continence

Question 8

What is the required free look period for Medicare supplement policies?

Answer 8

30 days

Question 9

Who is eligible for Medicare part B?

Answer 9

Part B is optional and is offered to everyone who enrolls in Part A

Question 10

At what age do individuals qualify for Medicare?

Answer 10

65

Question 11

Who qualifies for Medicare coverage?

Answer 11

People age 65 and older, anyone who has been entitled to SS disability income benefits for 2 years, or who has chronic kidney disease.

Question 12

What is another name for Medicare advantage points?

Answer 12

Part C

Question 13

How many parts does Medicare have?

Answer 13

4, A-D

Question 14

Medicare part A pays for what type of services?

Answer 14

Inpatient hospital care, skilled nursing facility care, home health and hospice

Question 15

How is Part B funded?

Answer 15

By monthly premiums and from general revenues from the federal government

Question 16

What part of Medicare is known as hospital insurance?

Answer 16

Part A

Question 17

Can Alzheimer’s disease be excluded from coverage under a long term care policy?

Answer 17

No organic cognitive disorders like Alzheimer’s or Parkinson’s must be covered

Question 18

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

Answer 18

The donut hole

Question 19

What Medicare part will cover lab services or diagnostic tests?

Answer 19

Part B

Question 20

When is the initial enrollment period for part A?

Answer 20

When an individual first becomes eligible for Medicare, starting 3 mos before turning age 65 and ending 3 months after 65th birthday

Question 21

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

Answer 21

To provide relief for a major caregiver usually a family member

Question 22

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

Answer 22

First 3

Question 23

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

Answer 23

No later than policy delivery

Question 24

Who issues medigap policies?

Answer 24

Private insurers

Question 25

What Medicare part provides a prescription drugs benefit?

Answer 25

Part D think D for drugs

Question 26

What benefits are provided by Medicare part C?

Answer 26

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

Question 27

In which Medicare supplemental policies are the core benefits found?

Answer 27

All plans (A-N)

Question 28

Part A covers hospitals and Part B covers what

Answer 28

Doctors

Question 29

In Medicare, the diff between what the doctor bills and what Medicare pays is called

Answer 29

The excess charge

Question 30

What Medicare part is hospital insurance?

Answer 30

Part A

Question 31

How many days of psychiatric care does part A cover

Answer 31

190 days

Question 32

How many days of skilled nursing per coverage period does part A cover

Answer 32

100 days

Question 33

Under part A, do you have to go to the hospital before you go to skilled nursing?

Answer 33

Yes, a 3 day minimum stay, part A doesn’t cover custodial care

Question 34

What is the coinsurance proportion under part B (physicians services)?

Answer 34

80/20 also has a deductible

Question 35

How do you calculate Medicare part B coinsurance?

Answer 35

Percentage of Medicare’s approved amount not the amount the doctor charges

Question 36

What is Part C Called?

Answer 36

Medicare Advantage

Question 37

What does part C provide?

Answer 37

Managed Care

Question 38

What is Part D Called?

Answer 38

Prescription Drug Insurance

Question 39

What else must you enroll in to be enrolled in Part D

Answer 39

Part A or in Parts A and B

Question 40

Who sells medicare supplements?

Answer 40

Private insurance cos and their agents

Question 41

How long is open enrollment for buying a medigap policy?

Answer 41

6 months

Question 42

Are medicare supplement plans required to be approved by Medicare?

Answer 42

No

Question 43

How many medigap policies can you sell someone?

Answer 43

1

Question 44

Maximum probationary period on medicare supplement policy

Answer 44

6 months

Question 45

Can you replace one medicare supplement with another?

Answer 45

Yes as long as its not detrimental to the insured

Question 46

When someone needs care, but not 24 hour care provided by a doctor, what is this called?

Answer 46

Long Term Care

Question 47

Minimum free look period on a LTC policy?

Answer 47

10 Days

Question 48

Activities of Daily Living

Answer 48

``` Mobility Dressing Bathing Toileting Continence Eating ```

Question 49

Inability to perform how many ADLs triggers benefits?

Answer 49

2

Question 50

Does LTC insurance cover acute care?

Answer 50

No

Question 51

LTC home health care services include

Answer 51

physical therapy, nursing care, home health aides and homemaker services

Question 52

The period of time that a long term care policy will provide custodial care in a nursing home is called

Answer 52

The benefit period

Question 53

LTC policies usually pay a fixed amount per day

Answer 53

While an insured is confined to a custodial nursing home

Question 54

LTC policies may exclude

Answer 54

pre existing illness, acute care, mental disorders, alcohol drug addiction, war related illness and self inflicted injuries

Question 55

LTC policies may not exclude

Answer 55

Alzheimers disease

Question 56

LTC return of premium rider will

Answer 56

refund some or all of the insureds premiums to the insureds estate or benny if the insured dies before age 65