chap. 8 Flashcards
Q: What is the required free-look period for Medicare Supplement policies?
A: 30 days
Q: Can Alzheimer’s disease be excluded from coverage under a long-term care policy?
A: No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered
Q: What Medicare part will cover lab services or diagnostic tests?
A: Part B
Q: What Medicare part provides a prescription drugs benefit?
A: Part D
Q: Medicare Part A will pay for what type of services?
A: Inpatient hospital care, skilled nursing facility care, home health care and hospice care
Q: What type of Medicare policy requires insureds to use specific healthcare providers and hospitals (in other words, has restricted network provisions)?
Q: 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 SELECT
Q: An insured with Medicare Part D has reached the initial benefit limit and must now pay a portion of prescription drugs costs. What is the term for this gap in coverage?
A: The donut hole
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?
25%
Q: What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?
A: Part A
Q: What benefits are provided by Medicare Part C?
A: Expanded benefits for a fee through private insurance programs such as HMOs or PPOs.
Q: If an individual is covered by Medicare, and is also covered by his employer’s health plan, which plan would be considered primary?
A: The employer plan
Q: When must the Outline of Coverage be provided to the insured?
A: No later than policy delivery
Q: What is the purpose of respite care in long-term care insurance?
A: To provide relief for a major caregiver (usually a family member)
Q: What is another name for Medicare Advantage plans?
A: Part C
Q: What part of Medicare is known as medical insurance?
A: Part B
Q: How many pints of blood will be paid for by Medicare Supplement core benefits?
A: First 3 pints
Q: What is another name for Medicare Supplement plans?
A: Medigap
Q: When is the initial enrollment period for Medicare Part A?
A: When an individual first becomes eligible for Medicare, starting 3 months before turning age 65 and ending 3 months after the 65th birthday
Q: What are the activities of daily living?
A: Mobility, bathing, dressing, eating, toileting, and continence
Q: What part of Medicare is known as hospital insurance?
A: Part A
Q: Who issues Medigap policies?
A: Private insurers
Q: Who qualifies for Medicare coverage?
A: People age 65 or older, or anyone who has been entitled to Social Security disability income benefits for 2 years, or who has chronic kidney disease
Q: What is the purpose of Medicare Supplement plans?
A: To fill in the gaps in Medicare coverage
Which of the following is NOT among the goals of a Medicare supplement application?
Presuming the applicant is eligible for Medicaid, based on the nature of the policy
Q: At what age do individuals qualify for Medicare?
A: Age 65
Q: How many parts does Medicare have?
A: Four: Parts A - D
Which of the following is correct about Medicare?
The program is divided into four parts (A-D).
Q: Who is eligible for Part B Medicare?
A: Part B is optional, and is offered to everyone who enrolls in Part A
Q: In which Medicare supplemental policies are the core benefits found?
A: All plans (A-N)
Q: How is Part B Medicare funded?
A: By monthly premiums and from the general revenues of the federal government
What is the difference between the Medicare approved amount for a service or supply and the actual charge?
Excess charge
A Medicare SELECT policy does all of the following EXCEPT
Prohibit payment for regularly covered services if provided by non-network providers.
The Omnibus Budget Reconciliation Act of 1990 requires that large group health plans must provide primary coverage for disabled individuals under
Age 65 who are not retired.
What is necessary in order to be eligible to receive benefits from a long-term care policy?
The insured must be unable to perform some activities of daily living.
Regarding the return of the premium option for LTC policies, what happens to the premium if the policy lapses?
The insurer will return a percentage of the premiums paid.
According to OBRA, what is the minimum number of employees required to constitute a large group?
100
Which of the following is NOT covered under Part B of a Medicare policy?
Routine dental care
All of the following statements about Medicare supplement insurance policies are correct EXCEPT
They cover the cost of extended nursing home care.
In terms of long-term care policies, which of the following are excluded from standard, group policy nonforfeiture benefits?
Retirement communities
Who is responsible for making sure that agents are properly trained in the use of the suitability standards for LTC policies?
Insurer
An applicant is discussing his options for Medicare supplement coverage with his agent. The applicant is 65 years old and has just enrolled in Medicare Part A and Part B. What is the insurance company obligated to do?
Offer the supplement policy on a guaranteed issue basis
All of the following qualify for Medicare Part A EXCEPT
Anyone who is willing to pay a premium.
How long must an insurer retain an advertisement for its long-term care policies?
3 years
