1 - Medicare: The Program

Question 1

4 parts of Medicare program:

Answer 1

• Part A: Hospital Insurance
• Part B: Medical Insurance
• Part C: Medicare Advantage
• Part D: Prescription Drug Plan

Question 2

Medicare Part A

Answer 2

• Hospital Insurance Program (HI)

- inpatient hospital care, skilled nursing facility care, home health care and hospice care

Question 3

Medicare Part B

Answer 3

• Medical Insurance program
• doctor’s services and medical supplies
• “doctor’s coverage”

Question 4

Medicare Parts A & B are now often referred to as _____________. The two parts are referred to in the health insurance industry as __________.

Answer 4

• Original or Traditional Medicare

- Fee-for-service plans

Question 5

Medicare Part C

Answer 5

• “Medicare Advantage”

- HMO and PPO

Question 6

Medicare Part D

Answer 6

-Medicare Prescription Drug Program

Question 7

All eligible individuals enrolling in Medicare Part B (Medical Insurance) will pay a current premium unless he or she qualifies for the _____________.

Answer 7

-Medicare Savings Program

Question 8

The Medicare Savings Program in North Carolina is known as __________.

Answer 8

-Medicare-Aid

Question 9

Individuals, age _____ and older, are eligible for all four (4) parts of the Medicare Program. The individual must be a United States citizen or permanent resident of the United States.

Answer 9

-65 years

Question 10

Eligible individuals may enroll in the Medicare Program as early as ________ prior to his or her 65th birthday. Benefits begin on the first day of the _______ if the enrollee’s 65th birthday is any day other the first day of the month.

Answer 10

• 3 months prior

- birth month

Question 11

An individual may qualify for Medicare benefits if he or she is under the age of _______ and is currently receiving Social Security disability benefits or Railroad Board (RRB) disability benefits and has been for the previous _________.

Answer 11

• 65

- 24 months

Question 12

Medicare coverage for kidney related events ends _______ after the end of kidney dialysis or ______ months after a kidney transplant.

Answer 12

• 12 months

- 36 months

Question 13

The Initial Enrollment Period (IEP) is the ________ prior to the eligible individual’s 65th birthday, the month of his or her birthday and the ________ after the month of his or her birthday.

Answer 13

• 3 months

- 3 months

Question 14

An eligible individual cannot be rejected by Medicare due to a ______________. Also, there is _____ waiting period due to a pre-existing medical condition.

Answer 14

• pre-existing medical condition

- no waiting period

Question 15

If an individual is not enrolled during the Initial Enrollment Period (IEP) for Medicare Parts A and B, he or she will have to wait until the next ___________).

Answer 15

• General Enrollment Period

- January 1st to March 31st

Question 16

The General Enrollment Period (GEP) lasts from ________ to _________ annually.

Answer 16

• January 1st

- March 31st

Question 17

Individuals who continue to work past age sixty-five (65) and are enrolled in a _______ employer group health plan or covered under their spouse’s qualified group health plan can delay enrollment (without a penalty) in Medicare Parts B and D until disenrollment or cancellation of coverage under the group health plan.

Answer 17

-“qualified”

Question 18

A qualified group health plan is a plan that has at least ______ covered employees and would qualify under ______.

Answer 18

• 20

- COBRA

Question 19

The Medicare Beneficiary may enroll in Medicare Part B after disenrolling from the qualified group major medical health plan if he or she worked past age _______ or was covered by the spouse’s group plan

Answer 19

-65

Question 20

The Medicare Beneficiary will have a Special Enrollment Period of _______ from the date of disenrollment from the group plan to enroll in Medicare Part B without a penalty.

Answer 20

-8 months

Question 21

The Medicare Beneficiary will receive (upon admittance to a Medicare approved hospital) a document called, __________.

Answer 21

-“An Important Message from Medicare”

Question 22

J a fifty-five (55) year old has been receiving Social Security disability for the past _____ months and is now eligible for Medicare.

Answer 22

-24 months

Question 23

The Special Enrollment Period provides a (n) _____ period to enroll in Medicare without penalty.

Answer 23

-8 month

Question 24

Medicare Part A claims and payments are “handled” by what organization?

Answer 24

-Medicare Administrative Contractors (MAC)

Question 25

Medicare coverage starts the following ______ following the General Enrollment Period (GEP).

Answer 25

-July 1st

Question 26

Medicare is generally the primary coverage in most situations but when is Medicare the secondary?

Answer 26

• Workers’ Compensation
• No-Fault or Liability Insurance
• Black Lung Benefits

Question 27

S worked two (2) years past her age sixty-five (65) for an employer that had fifty (50) employees enrolled in the group health plan. She now wants to enroll in Medicare and is concerned about paying a penalty. What provision in Medicare will allow her to enroll without a penalty?

Answer 27

-Special Enrollment Period (SEP)

Question 28

What is the length of time that the Initial Enrollment Period (IEP) lasts?

Answer 28

-7 months

Question 29

Medicare Beneficiaries will receive what document that indicates the method used in settling a Part B claim?

Answer 29

-Medicare Summary Notice

Question 30

If an enrollee was born on the first day of the month, the Medicare benefits begin when?

Answer 30

-first day of the previous month

Question 31

Congress established the original Medicare program in what year?

Answer 31

-1965

Question 32

The Prospective Payment System under Medicare Part A uses what payment categories to determine payment for covered claims?

Answer 32

-Diagnosis Related Groups

Question 33

Group health care plans that have at least ____ enrollees will require the group plan to be the primary payer.

Answer 33

-20

Question 34

Medicare may pay a claim on a ___________ and recover the payments later from the responsible party.

Answer 34

-Conditional Basis