chap. 8 Flashcards

1
Q

Q: What is the required free-look period for Medicare Supplement policies?

A

A: 30 days

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2
Q

Q: Can Alzheimer’s disease be excluded from coverage under a long-term care policy?

A

A: No, organic cognitive disorders, such as Alzheimer’s or Parkinson’s must be covered

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3
Q

Q: What Medicare part will cover lab services or diagnostic tests?

A

A: Part B

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4
Q

Q: What Medicare part provides a prescription drugs benefit?

A

A: Part D

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5
Q

Q: Medicare Part A will pay for what type of services?

A

A: Inpatient hospital care, skilled nursing facility care, home health care and hospice care

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6
Q

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

A: Medicare SELECT

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7
Q

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

A: The donut hole

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8
Q

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

25%

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9
Q

Q: What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?

A

A: Part A

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10
Q

Q: What benefits are provided by Medicare Part C?

A

A: Expanded benefits for a fee through private insurance programs such as HMOs or PPOs.

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11
Q

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

A: The employer plan

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12
Q

Q: When must the Outline of Coverage be provided to the insured?

A

A: No later than policy delivery

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13
Q

Q: What is the purpose of respite care in long-term care insurance?

A

A: To provide relief for a major caregiver (usually a family member)

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14
Q

Q: What is another name for Medicare Advantage plans?

A

A: Part C

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15
Q

Q: What part of Medicare is known as medical insurance?

A

A: Part B

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16
Q

Q: How many pints of blood will be paid for by Medicare Supplement core benefits?

A

A: First 3 pints

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17
Q

Q: What is another name for Medicare Supplement plans?

A

A: Medigap

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18
Q

Q: When is the initial enrollment period for Medicare Part A?

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

19
Q

Q: What are the activities of daily living?

A

A: Mobility, bathing, dressing, eating, toileting, and continence

20
Q

Q: What part of Medicare is known as hospital insurance?

A

A: Part A

21
Q

Q: Who issues Medigap policies?

A

A: Private insurers

22
Q

Q: Who qualifies for Medicare coverage?

A

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

23
Q

Q: What is the purpose of Medicare Supplement plans?

A

A: To fill in the gaps in Medicare coverage

24
Q

Which of the following is NOT among the goals of a Medicare supplement application?

A

Presuming the applicant is eligible for Medicaid, based on the nature of the policy

25
Q

Q: At what age do individuals qualify for Medicare?

A

A: Age 65

26
Q

Q: How many parts does Medicare have?

A

A: Four: Parts A - D

27
Q

Which of the following is correct about Medicare?

A

The program is divided into four parts (A-D).

28
Q

Q: Who is eligible for Part B Medicare?

A

A: Part B is optional, and is offered to everyone who enrolls in Part A

29
Q

Q: In which Medicare supplemental policies are the core benefits found?

A

A: All plans (A-N)

30
Q

Q: How is Part B Medicare funded?

A

A: By monthly premiums and from the general revenues of the federal government

31
Q

What is the difference between the Medicare approved amount for a service or supply and the actual charge?

A

Excess charge

32
Q

A Medicare SELECT policy does all of the following EXCEPT

A

Prohibit payment for regularly covered services if provided by non-network providers.

33
Q

The Omnibus Budget Reconciliation Act of 1990 requires that large group health plans must provide primary coverage for disabled individuals under

A

Age 65 who are not retired.

34
Q

What is necessary in order to be eligible to receive benefits from a long-term care policy?

A

The insured must be unable to perform some activities of daily living.

35
Q

Regarding the return of the premium option for LTC policies, what happens to the premium if the policy lapses?

A

The insurer will return a percentage of the premiums paid.

36
Q

According to OBRA, what is the minimum number of employees required to constitute a large group?

A

100

37
Q

Which of the following is NOT covered under Part B of a Medicare policy?

A

Routine dental care

38
Q

All of the following statements about Medicare supplement insurance policies are correct EXCEPT

A

They cover the cost of extended nursing home care.

39
Q

In terms of long-term care policies, which of the following are excluded from standard, group policy nonforfeiture benefits?

A

Retirement communities

40
Q

Who is responsible for making sure that agents are properly trained in the use of the suitability standards for LTC policies?

A

Insurer

41
Q

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?

A

Offer the supplement policy on a guaranteed issue basis

42
Q

All of the following qualify for Medicare Part A EXCEPT

A

Anyone who is willing to pay a premium.

43
Q

How long must an insurer retain an advertisement for its long-term care policies?

A

3 years