Ch 8 Quiz Flashcards
An insurer offers a policy very similar to Medicare. An agent tells an applicant that the policy is Medicare, since the policies are similar anyway. Which of the following is true?
A This practice is illegal.
B This is a legal practice.
C This is legal as long as the applicant understands all the benefits.
D This is illegal only if the policy is bought by the applicant.
A This practice is illegal.
A policy may not be advertised as Medicare supplement, Medigap, or Medicare Wrap-Around unless the policy is in full compliance of the law under such labels. In this instance, the insurer misrepresented the policy, which is an illegal practice.
Which of the following programs expands individual public assistance programs for people with insufficient income and resources? A Social Security B Unemployment compensation C Medicaid D Medicare
C Medicaid
Medicaid is a “needs” tested program administered by the states to provide assistance to persons who are not able to provide for themselves.
All of the following statements concerning Medicaid are correct EXCEPT
A Persons, at least 65 years of age, who are blind or disabled and financially unable to pay, may qualify for Medicaid Nursing Home Benefits.
B Medicaid is a state funded program that provides health care to persons over age 65, only.
C Individual states design and administer the Medicaid program under broad guidelines established by the federal government.
D Individuals claiming benefits must prove they do not have the ability or means to pay for their own medical care.
B Medicaid is a state funded program that provides health care to persons over age 65, only.
Medicaid is a government funded (both state and federal) program designed to provide health care to poor people of all ages.
The Medicare supplement renewal commissions paid in the third year must be as high as the commission of which year? A 1st B 2nd C 3rd D 4th
B 2nd
The commission provided in renewal years must be the same as the commission in the second year and must be provided for no fewer than 5 renewal years.
A man is still employed at age 65 and is now eligible for Medicare. He wants to know what health insurance coverage he is eligible to receive. Which of the following options are available to him? A Both group health and Medicare B Continuation of group health only C Reapplication for group health D Medicare only
A Both group health and Medicare
If a person is still employed at the age of 65, he or she may choose to either continue group coverage and defer Medicare until retirement, or switch to Medicare. The employer cannot provide incentives for switching to Medicare.
What type of care is Respite care? A 24-hour care B Relief for a major care giver C Daily medical care, given by medical personnel D Institutional care
B Relief for a major care giver
Respite Care is designed to provide relief to the family care giver, and can include a service such as someone coming to the home while the care giver takes a nap or goes out for a while. Adult day care centers also provide this type of relief for the caregiver.
Which of the following is correct about Medicare?
A Part B is available to the insured at no cost.
B It is a federal program for welfare recipients.
C The program provides complete medical care at no cost.
D The program is divided into four parts (A-D).
D The program is divided into four parts (A-D).
Medicare has four parts: Part A covers hospital expenses; Part B covers doctor expenses; Part C allows people to receive all of their health care services through available provider organizations; and Part D for prescription drug coverage.
The primary eligibility requirement for Medicaid benefits is based upon
A Whether the claimant is insurable on the private market.
B Age.
C Number of dependents.
D Need.
D Need.
Medicaid is a program operated by the state, with some federal funding, to provide medical care for those in need.
When an employee is still employed upon reaching age 65 and eligible for Medicare, which of the following is the employee’s option?
A Wait until the next birthday to enroll
B Remain on the group health insurance plan and defer eligibility for Medicare until retirement
C Enroll in Medicare, while the company must provide additional retirement benefits
D Enroll in Medicare when eligible; otherwise, Medicare benefits will be forfeited.
B Remain on the group health insurance plan and defer eligibility for Medicare until retirement
If an employee is still employed upon reaching age 65, federal laws require keeping the employee on the group health insurance rolls and deferring their eligibility for Medicare until retirement. The employee has the right to reject the company’s plan and elect Medicare but the company can offer no incentives for switching to Medicare.
An insured is covered under a Medicare policy that provides a list of network healthcare providers that the insured must use to receive coverage. In exchange for this limitation, the insured is offered a lower premium. Which type of Medicare policy does the insured own? A Medicare Advantage B Medicare SELECT C Medicare Part A D Medicare Supplement
B Medicare SELECT
Medicare SELECT policies require insureds to use specific healthcare providers and hospitals, except in emergency situations. In return, the insured pays lower premium amounts.
All of the following long-term care coverages would allow an insured to receive care at home EXCEPT A Skilled care. B Custodial care in insured's house. C Respite care. D Home health care.
A Skilled care.
Custodial care, respite care, home health care, and adult day care are all coverages used to reduce the necessity of admission into a care facility. Skilled care is almost always provided in an institutional setting.
How long is an open enrollment period for Medicare supplement policies? A 1 year B 30 days C 90 days D 6 months
D 6 months
An open enrollment period is a 6-month period that guarantees the applicants the right to buy Medigap once they first sign up for Medicare Part B.
All of the following would fall under the definition of Durable Medical Equipment EXCEPT A Hospital blankets. B Oxygen equipment. C Wheel chairs. D Hospital bed.
A Hospital blankets.
Durable Medical Equipment is medical equipment such as oxygen equipment, wheel chairs, and other medically necessary equipment that a doctor prescribes for use in the home.
Occasional visits by which of the following medical professionals will NOT be covered under LTC’s home health care?
A Attending physician
B Registered nurses
C Licensed practical nurses
D Community-based organization professionals
A Attending physician
Home health care is care provided in one’s home and could include occasional visits to the person’s home by registered nurses, licensed practical nurses, licensed vocational nurses, or community-based organizations like hospice. Home health care might include physical therapy and some custodial care such as meal preparations.
An insured has Medicare Part D coverage. Upon reaching the initial benefit limit, what percentage of the prescription drug cost is the insured responsible for paying? A 15% B 16% C 23% D 25%
D 25%
Once the initial benefit limit is reached, an insured is only responsible for 25% of the prescription drug cost. This percentage applies to generic and brand name drugs.
In reference to the standard Medicare Supplement benefits plans, what does the term standard mean?
A Coverage options and conditions are developed for average individuals.
B All providers will have the same coverage options and conditions for each plan.
C Coverage options and conditions comply with the law, but will vary from provider to provider.
D All plans must include basic benefits A–N.
B All providers will have the same coverage options and conditions for each plan.
In reference to the standard Medicare Supplement benefits plans, the term “standard” implies that all providers will have the same coverage options and conditions for each plan.
What is the amount a physician or supplier bills for a particular service or supply? A Actual charge B Assignment C Coinsurance D Approved amount
A Actual charge
Actual Charge is the amount a physician or supplier bills for a particular service or supply.
Which of the following types of LTC is NOT provided in an institutional setting? A Intermediate care B Home health care C Custodial care D Skilled nursing care
B Home health care
Home health care is given in the home, but skilled nursing, intermediate, and custodial care may all be provided in an institutional setting.
Medicaid provides all of the following benefits EXCEPT
A Home health care services.
B Eyeglasses.
C Family planning services.
D Income assistance for work-related injury.
D Income assistance for work-related injury.
Medicaid covers a variety of medical costs, from eyeglasses to hospitalization.
