CH 14 Insurance for Senior Citizens and Special Needs Individuals Flashcards
What part of Medicare is known as medical insurance?
Part B
When must the outline of coverage be provided to the insured?
No later than policy delivery
What is another name for Medicare advantage plans?
Part C
How many pints of blood will be paid for by Medicare supplement core benefits?
First 3 pints
What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?
Part A
What part of Medicare is known as hospital insurance?
Part A
Who is eligible for part B Medicare?
Papi is optional, and is offered to everyone who enrolls in part A.
In which Medicare supplemental policies are the core benefits found?
All plans (A-N)
What is the purpose of respite care in long-term care insurance?
To provide relief for a major caregiver (usually a family member)
How many parts does Medicare have?
Four: parts A-D
When is the initial enrollment period for Medicare part A?
When an individual becomes eligible for Medicare. Three months before and three months after they turn age 65
Who issues Medigap policies?
Private insurers
What are the activities of daily living?
- Mobility
- Bathing
- Dressing
- Eating
- Toileting
- Continence
What Medicare part provides a prescription drug benefit?
Part D
If an individual is covered by Medicare, and is also covered by his employer’s health plan, which plan would be considered primary?
The employer plan
Who qualifies for Medicare coverage?
- People age 65 or older
- Anyone who has been entitled to Social Security disability income benefits for two years
- Anyone who has chronic kidney disease
At what age do individuals qualify for Medicare?
Age 65
What is the purpose of Medicare supplement plans?
To fill in the gaps in Medicare coverage
Medicare part A will pay for what type of services?
- Inpatient hospital care
- Skilled nursing facility care
- Home health care
- Hospice care
What Medicare part will cover lab services or diagnostic test?
Part B
An insured with Medicare part D has reach the initial benefit limit and must now pay a portion of prescription drugs costs. What is the term for this gap in coverage?
The donut hole
What benefits are provided by Medicare part C?
Expanded benefits for a fee through private insurance programs such as HMOs or PPOs.
Can Alzheimer’s disease be excluded from coverage under the sea?
No. Organic cognitive disorders, such as Alzheimer’s or Parkinson’s Must be covered
What type of Medicare policy requires insured’s to use specific healthcare providers and hospitals (in other words, has restricted network provisions)?
Medicare SELECT
How is part B Medicare funded?
By monthly premiums and from the general revenues of the federal government
What is the required free-look period For Medicare supplement policy is?
30 days
What is another name for a Medicare supplement plans?
Medigap
All of the following statements concerning Medicaid are correct EXCEPT
A) Individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care
B) Persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits
C) Medicaid is a state funded program that provides care to persons over 65, only
D) Individual states design and administer the Medicaid program under broad guidelines established by the federal government
Medicaid is a state funded program that provides care to persons over 65, only.
Which of the following long-term care benefits would provide coverage for care for functionally impaired adults on a less than 24-hour basis?
A) Adult day care
B) Residential care
C) Assisted living
D) Home health care
Adult day care.
A) All of the following would fall under the definition of Durable Medical Equipment EXCEPT
A) Wheelchairs
B) Hospital bed
C) Hospital blanket
D) Oxygen equipment
Hospital blanket.
OBRA requires which disease to be covered by an employer for 30 months before Medicare becomes the primary mode of coverage?
A) End-stage heart failure
B) End-stage renal failure
C) Black lung
D) Leukemia
End-stage renal failure.
Medicaid provides all of the following benefits EXCEPT
A) Eyeglasses
B) Family planning services
C) Income assistance for work-related injury
D) Home health care services
Income assistance for work-related injury.
The primary eligibility requirement for Medicaid benefits is based upon
A) Number of dependents
B) Need)
C) Whether the claimant is insurable on the private market
D) Age
Need.
Who does the Oregon Medical Insurance Pool protect?
A) Children
B) People with pre-existing conditions
C) People who have been denied medical coverage
D) Low income state residents
People who have been denied medical coverage.
Which of the following is NOT covered under Plan A in Medigap insurance?
A) The first three pints of blood
B) The medicare Part A deductible
C) Approved hospital costs for 365 additional days after medicare benefits end
D) The 20% Part B coinsurance amounts for Medicare approved services
The medicare Part A deductible.
Most LTC plans have which of the following features?
A) Variable premiums
B) Open enrollment
C) Guaranteed renewability
D) No elimination period
Guaranteed renewability.
Which provision allows a person to return a Medicare supplement policy within 30 days for a full premium refund?
A) Policy review
B) Trial period
C) Refund of premium
D) Free look
Free look.
Which of the following programs expands individual public assistance programs for people with insufficient income and resources?
A) Medicare
B) Social Security
C) Unemployment compensation
D) Medicaid
Medicaid.
What is the duration of the free-look period for Medicare supplement policies?
A) 10 days
B) 15 days
C) 30 days
D) 60 days
30 days.
Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look provision applies. The insured could find that information in the
A) Policy application
B) Buyer’s Guide
C) Certificate of Coverage
D) Notice Regarding Replacement
Notice Regarding Replacement.
Issue age policy premiums increase in response to which of the following factors?
A) Increased deductible
B) Inflation
C) The insured’s age
D) Increased benefits
Increased benefits.
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
A) Coverage options and conditions comply with the law, but will vary from provider to provider
B) All plans must include basic benefits A-N
C) Coverage options and conditions are developed for average individuals
D) All providers will have the same coverage options and conditions for each plan
All providers will have the same coverage options and conditions for each plan.
