Ch 8 Medicare and long-Term Care Insurance

Question 1

The insurance age at the time the policy is issued or renewed

Answer 1

Attained age

Question 2

A period of time during which benefits are paid under the policy

Answer 2

Benefit period

Question 3

Sharing of expenses between the insured and the insurance company through deductibles, co-pays and coinsurance

Answer 3

Cost sharing

Question 4

A person enrolled in a health insurance plan, and insured (doesn’t include dependence of the insured)

Answer 4

Enrollee

Question 5

a prepaid medical service plan in which specified medical service providers contract with the HMO and which focuses on preventative care

Answer 5

Health maintenance organization (HMO)

Question 6

A provider who enters into contractual arrangement with other providers to provide medical services to the networks subscribers

Answer 6

Network provider

Question 7

A cash or insurance benefit received via policyholder who no longer wishes to make payments after making premium payments for at least a minimum period

Answer 7

Nonforfeiture benefit

Question 8

a document required in all health insurance policies that provides a full coverage disclosure to the applicant

Answer 8

Outline of coverage

Question 9

Part A is ________________; Part B is _________________.

Answer 9

Hospital insurance; medical insurance.

Question 10

Medicare part C expand original Medicare benefits to private health insurance programs

Answer 10

True

Question 11

After the initial benefit limit is reached, the prescription drug benefit plan will pay 75% of all generic and brand-name drug cost.

Answer 11

True

Question 12

Medicare supplement plans are sold through private insurers, not federal health insurance programs.

Answer 12

True

Question 13

All Medicare supplement plans must offer the core benefits available in Plan A.

Answer 13

True

Question 14

Anyone over the age of 65 may choose to either keep the employers group health coverage or elect coverage through Medicare.

Answer 14

True

Question 15

LTC policies must be guaranteed renewable

Answer 15

True

Question 16

Skilled care and intermediate care requires the assistance of medically licensed personnel. Custodial care maybe administered by non-medical personnel.

Answer 16

True

Question 17

Hospital insurance, finance through payroll tax (FICA)

Answer 17

Part A

Coverage:

• inpatient hospital care
• skilled nursing facility care
• home health care
• hospice care

Question 18

Medical insurance, finance by insurance and general revenues

Answer 18

Part B

• optional to those who enroll in Part A
• doctor services
• outpaitent hospital services
• home health visits
• other medical and health services

Question 19

Medicare advantage, allows for receipt of healthcare services through available provide organizations

Answer 19

Part C

• requires enrollment in parts A and B
• Provided by an approved HMO or PPO

Question 20

Prescription drug coverage

Answer 20

Part D

• Optional coverage through private prescription plans that contract with medicare.

Question 21

For individuals eligible for Medicare coverage to continue to work, the employers health plan will be primary coverage while Medicare would be secondary coverage

Answer 21

Primary, secondary payor

Question 22

• Referred to as Medigap
• policies issued by private insurance companies to fill in gaps in Medicare
• open enrollment period of six months

Answer 22

Basics

Medicare supplement policies

Question 23

Plan a core benefits, such as coinsurance/copayment; additional pate hospital cost; hospice care coinsurance/copayment; part B coinsurance/copayment; 3 pints of blood other parts a and B
- plans B – 10: core benefits + various additional benefits

Answer 23

Coverage

Medicare supplement policies

Question 24

Employer Group Health Plans

Answer 24

Disabled employees under age 65, employees with kidney failure, individual age 65 or older

Question 25

Medicaid

Answer 25

• medical care for those whose income and resources are insufficient
• Federal and state funded

Question 26

Daily nursing and rehabilitation caper divided by medical personnel

Answer 26

Skilled care

Question 27

Occasional nursing or rehabilitative care provider for stable conditions that require daily medical assistance on a less frequent basis than skilled nursing care

Answer 27

Intermediate care

Question 28

Care for persons activities of daily living provided in an institutional setting or in the patient’s home

Answer 28

Custodial care

Question 29

Provided by registered nurses, license practical nurses, license vocational nurses, or community-based organizations like hospice in one’s home

Answer 29

Home healthcare

Question 30

Provided by the insured resides in a retirement community

Answer 30

Residential care

Question 31

Provides for functionally impaired adults unless in a 24 hour basis

Answer 31

Adult daycare

Question 32

Provide relief to the family caregiver; adult daycare centers may also provide this type of relief

Answer 32

Respite care

Question 33

Provides help with non-medical daily activities

Answer 33

Assisted living

Question 34

Long term care required provisions

Answer 34

Must be guaranteed renewable

• must offer inflation protection
• free look. 30 days
• pre-existing conditions exclusion - no more than six months
• must cover Alzheimer’s disease
• disclosure requirements - outline of coverage and policy summary

Question 35

Long-term care coverage and benefits

Answer 35

• 12 consecutive months
• elimination period of 30 days or more
• benefit period of 2 to 5 years; some offering lifetime coverage
• longer benefit. Result in higher premium
• trigger in ability to perform ADLs (usually 2-3)

Question 36

Who is eligible for Medicare?

Answer 36

People age 65 and older, those entitled to Social Security disability income benefits for two years, are those with permanent kidney failure (regardless of age)

Question 37

What plans fill in the gaps in Medicare coverage?

Answer 37

Medicare Supplement Policies, or Medigap

Question 38

What is the name of the benefits provided by Medicare supplement part A?

Answer 38

Core benefits