Understanding Medicare and Long-Term Care Insurance Policies, Exams of Nursing

Download Understanding Medicare and Long-Term Care Insurance Policies and more Exams Nursing in PDF only on Docsity! North Carolina Medicare Supplement and Long-Term Care Exam-with 100% verified solutions Tutor verified An individual who is not eligible for premium-free Medicare Part A coverage may apply for coverage during which of the following enrollment periods? A. All of the above B. Initial enrollment period C. General enrollment period D. Special enrollment period A. All of the above Medicare makes what payment for services in which another payer may be responsible: A. Conditional payment B. Interim payment C. Transitional payment D. Temporary payment A. Conditional payment Insurers must offer inflation protection in which of the following policies? A. Medicare Part C B. Medigap C. Long-Term Care D. Medicaid C. Long-Term Care What program safeguards against unnecessary and inappropriate medical care rendered to Medicaid recipients? A. Medicaid review program B. Utilization renew program C. Quality improvement organization D. Utilization review program D. Utilization review program Which of the following is not a requirement for long-term care plans? A. The individual must be unable to perform at least two ADLs B. Inflation protection must be provided C. Policies must accrue cash value D. Coveraged cannot reimburse insureds for medical expenses or services covered by Medicare. C. Policies must accrue cash value. Which entity handles claims from hospitals, skilled nursing facilities, home health agencies and hospices? A. Carrier B. Intermediary C. Quality Improvement Organization D. Utilization Review Committee B. Intermediary What is the term for private organizations that administer Medicare Part B benefits? A. Carriers B. Medical Providers C. Intermediaries D. Peer review organizations B. Medicare Part B C. Medicare Part C D. Medicare Part D A. Medicare Part A What is a system of classifying hospital patients on the basis of diagnosis consisting of distinct groupings? A. Patient diagnostic system B. Distinct grouping assignment C. Patient classification basis D. Diagnosis-related group D. Diagnosis-related group What two types of long-term care insurance policies resulted from the Health Insurance Portability and Accountability Act? Tax qualified and non-tax qualified Medicare Part B covers which of the following expenses? A. Hospital care B. Physicians' services C. Hospice care D. Skilled nursing home care B. Physicians' services Medicare pays the remaining 80% of covered Medicare Part B charges after: A. Premiums are paid B. The annual deductible is met C. The $1,000 deductible is met D. The blood deductible is met B. The annual deductible is met Medicare Part A covers which of the following services? A. Medications B. Hospital room and board C. Physicians services D. Surgical services B. Hospital room and board Which of the following services in NOT excluded under Medicare Part B? A. Custodial care B. Skilled nursing care C. Diagnostic tests D. Routine physical exams C. Diagnostic tests Premiums for Medicare Part B are based on: . An individual's annual earnings Managed care companies have entered the medicare services market through the expansion of which of the following: A. Part A B. Part B C. Part C D. Medicare supplement policies C. Part C A Medicare Medical Savings Account is comprised of what? A high-deductible medicare plan and a savings account All approved charges under Medicare Part A will be covered for ________ after the deductible has been met? A. For days 1 through 60 B For days 91 through 150 C. After 150 days D. For days 61 through 90 A. For days 1 through 60 S is enrolled in a group health plan that is scheduled to terminate on March 1st. When can he enroll in Medicare Part B without having to pay the 10 percent premium surcharge? During the eight month period following the month his group coverage ends. G is applying for Medicare supplement Plan C. At what point must the insurer give her an outline of coverage? At the time of application Long-term coverage differs from Medigap in what way? Long-term care coverage provides custodial care How much is the penalty for delaying in Medicare Part A or Part B beyond the initial enrollment period? 10% Who regionally manages policy and payment related to reimbursement and payment for medicare? Medicare Administrative Contractors Medicare Part B supplement insurance is: Voluntary Individual long-term care policies are generally available to individuals between the ages of 40 and 85 Medicare Parts A and B have gaps in their coverage where subscribers must pay for their coverage. What do these gaps include? The Part A deductible and daily co-payments for hospitalization and nursing home care and the part B deductible, which requires 20% coinsurance or copayments Prescription drug coverage is covered by: Medicare Part D What serves as the primary point of contact for provider enrollment and Medicare coverage: A. LCDs B. AQOs C. QIOs D. MAC's D. MAC's (Medicare Administrative Contractors) For what type of North Carolina residents will Medicare-Aid pay for their Medicare Part B Premiums only? A specified low income beneficiary Medicare supplements Plans K and L pay what percent of Medicare coinsurance, co-pays and deductibles after the insured's annual out-of- pocket limit is reached? 100% G's medicare select plan offers the same benefits as the coverage provided under a standard plan. So why are G's medicare select plan premiums lower than those for a standard Medicare supplement policy? Select plans offer the same coverage that is provided under a standard plan. However, participants must obtain covered services through the plan's network. Another common name for Part C is which of the following: A. Medicare Supplement B. Medicare Advantage C. Medigap D. Medicare + Choice B. Medicare Advantage Which of the following services would not be covered by Medicare Part A? A. Home health aide services B. Full-time skilled care C. Intermittent skilled care D. Durable medical equipment and supplies B. Full-time skilled care Which type of medicare supplement policy provides that as long as the insured pays the premiums, the insurer cannot modify premium, coverage or any provisions of the policy: A. Noncancelable B. Guaranteed renewable C. Conditionally renewable D. Renewable at insurer's option A. Noncancelable A person who is not eligible for premium-free medicare Part A coverage must pay: A. A monthly premium of $115.40 B. A monthly premium of $422 C. A monthly premium of $283 D. A monthly premium of $141.50 B. A monthly premium of $422 At what point during the year can you switch to a different Part D plan? A. Between November 15 and Dec. 31 B. Between June 1 & Sept. 1 C. Any time D. Jan. 1 until March 1 A. Between Nov. 15 and Dec. 31 Which of the following medical services is not covered by Medicare Part B? A. Preventive care B. Private duty nursing C. Physician's fees D. Outpatient care B. Private duty nursing Long-term care policies can limit or exclude coverage for all of the following except: A. Alcohol addiction B. Family history of heart condition C. Free-existing conditions or diseases D. Intentionally self-inflicted injury B. Family history of heart condition How long is the initial enrollment period for enrolling in Parts A and B? A. Six months B. Three months C. Four months D. Seven months D. Seven months Which of the following medical services is not covered by Medicare Part B? A. Preventive care B. Private duty nursing C. Physicians fees D. Outpatient care B. Private duty nursing How can a long-term policy be written? A. Both stand-alone policy & rider B. Stand-alone policy only C. None of the above D. Rider only A. Both stand-alone policy & rider A person who is not eligible for premium-free medicare Part A coverage must pay: A. A monthly premium of $115.40 B. A monthly premium of $422 C. A monthly premium of $283 D. A monthly premium of $141.50 B. A monthly premium of $422 Which type of medicare supplement policy provides that as long as the insured pays the premiums the insurer cannot modify the premium, coverage or any provisions of the policy: