Chapter 13: Senior Citizens and Special Needs Individuals

Question 1

________, also referred to as Title 18, is a federally funded social insurance program that provides health insurance for people age 65 and older, regardless of whether they continue to work beyond the age of 65.

Answer 1

Medicare

Question 2

Others who receive Medicare benefits, regardless of age? People who:

Answer 2

Qualify for Social Security,
Qualify for Railroad Retirement Board disability benefits,
Have ESRD (end stage renal disease – permanent kidney failure), or
Have Lou Gehrig’s disease.

Question 3

________ is part of the Social Security Act of 1965 and was signed into law by President Lyndon B. Johnson. It is administered by the CMS (Centers for Medicaid Services). The SSA (Social Security Administration) enrolls individuals in this coverage and processes premium payments.

Answer 3

Medicare

Question 4

Medicare is funded in part by FICA payroll taxes.

The tax is _____%: the employer pays ______% and the employee pays _____%.
Self-employed individuals must pay the entire _____% tax.
Since 2013 an additional tax, called the unearned income Medicare contribution tax, has been levied against individuals with higher incomes. The additional tax is ______%.

Answer 4

2.9%
1.45% and 1.45%
2.9%
3.8%

Question 5

Private organizations are contracted by the CMS to do what 3 things?

These companies function as _____, or middlemen, between Medicare and the medical providers.

Answer 5

Process claims payments,
Enroll medical providers, and
Investigate fraud.
“Intermediaries”

Question 6

When Medicare was first introduced, it was composed of ____ and ____ coverage (only Parts A and B), known as “Original Medicare.” Since then, it has expanded to offer ____ _____ and _____ ____ coverage. The four types of Medicare coverage include:

Part A: Hospital insurance
Part B: Medical insurance
Part C: Managed care (Medicare Advantage)
Part D: Prescription drug coverage

Answer 6

Hospital
Medical
Managed Care
Prescription Drug

Question 7

The two main ways of obtaining Medicare coverage are through ______ ______, or by purchasing a _____ _____ _____. If the latter plan is chosen, _____ ____ is usually included, but not in all cases.

Answer 7

Original Medicare
Medicate Advantage Plan
Part D

Question 8

If Original Medicare is chosen, the beneficiary may choose to purchase _____ ___ coverage, if needed, and may also purchase a _____ plan, if supplemental coverage is needed. However, if the Medicare Advantage route is chosen, a ______ plan may not be purchased.

Answer 8

Part D
Medigap
Medigap

Question 9

Generally, Medicare is available to people ages ____ or older that are U.S citizens or have been continuous permanent legal residents for at least _____ consecutive years. Eligible individuals or their spouses must have paid Medicare taxes for a minimum of _____ years.

Answer 9

65
5
10

Question 10

TF: People of any age can qualify for Medicare coverage for the following:

Be disabled and receive Social Security disability or RRB (Railroad Retirement Board) disability benefits for two years or more,
Be a dependent of someone who is eligible for social security benefits,
Have ESRD, requiring ongoing dialysis or a kidney transplant and be eligible for social security disability benefits, or
Have Lou Gehrig’s disease and qualify for social security disability benefits.

Answer 10

True

Question 11

TF: The following rules apply if an individual has group health coverage through an employer or union, and Medicare coverage:

Medicare is primary if the individual is retired.
Medicare is secondary if the individual is currently employed and insured under his or her own or their spouse’s employer coverage.
Medicare is secondary for the first 30 months an individual has ESRD (kidney failure).
Medicare is secondary to no-fault insurance, liability, lung benefits, and Workers’ Compensation.

Answer 11

True

Question 12

Medicare Part A provides hospital insurance coverage that includes what 4 components?

Funding for Part A comes from _____ payroll taxes

Answer 12

Inpatient hospital care,
Some of the costs associated with skilled nursing,
Hospice, and
Home health care.

FICA

Question 13

TF: Most people enrolled in Part A do not pay premiums because they have met the minimum Medicare tax requirements. This is referred to as premium-free Part A coverage.

Answer 13

True

Question 14

TF: An individual who does not meet the tax requirements, but meets the citizenship and residency requirements and is at least age 65, or is disabled, but working, may purchase Part A coverage by paying monthly premiums.

Answer 14

True

Question 15

TF: The monthly Medicare Part A premium is $471 for people who are not eligible for premium-free hospital insurance. However, some individuals will be eligible for premium-free Medicare Part A. An individual, who is 65 years of age, will qualify for premium-free Medicare Part A if:

He is already receiving retirement benefits from Social Security or the Railroad Retirement Board;
He is eligible to get Social Security or Railroad benefits, but has not yet filed for them; or
They or their spouse had Medicare-covered government employment

Answer 15

True

Question 16

TF: An individual, who is under 65, can get premium-free Medicare Part A if:

He received Social Security or Railroad Retirement Board disability benefits for 24 months; or
He has End-Stage Renal Disease (ESRD) and meets certain requirements.

Answer 16

True

Question 17

TF: People who purchase Part A coverage are usually required to also purchase Part B coverage and pay monthly premiums for both Part A and Part B.

Answer 17

True

Question 18

Medicare Part B provides medical insurance coverage not covered by Part A, which includes what three things?

Answer 18

Medically necessary physician’s services,
Outpatient care, and
Preventive care.

Question 19

TF: Medically necessary physician’s services,
Outpatient care, and
Preventive care.

Answer 19

True

Question 20

TF: People who are covered by Medicare Part A are eligible for Part B. Premiums for Part B are based on an individual’s yearly income. An individual filing a tax return singly with an income of $85,000 or less; or, a couple filing jointly with an income of $85,001 up to $170,000 will pay the standard monthly premium. The standard monthly premium amount is $148.50.

Answer 20

true

Question 21

Medicare ____ __, also referred to as Medicare Advantage, is a managed care plan, offered by Medicare-approved private insurers. Part C encompasses the coverages of Parts A and B, and some plans offer coverage at an additional cost for what three things?

Prescription drugs,
Eye care, and
Dental care.

Answer 21

Part C

Prescription drugs,
Eye care, and
Dental care.

Question 22

A ____ ____ ____ is intended for individuals who are insured under Medicare and Medicaid. One or more medical providers manage a ____ ____ _____. Medical services are received from the plan’s provider(s).

Answer 22

Special needs plan (SNP)
Provide Sponsored Organization (PSO)

Question 23

TF: Part C = Public Insurance

Answer 23

False - PRIVATE insurance

Question 24

TF: An individual can enroll in Part C if he or she has Parts A and B, lives in the plan’s service area, and doesn’t have ESRD. An individual insured under an employer health plan may also be insured under a Part C plan.

Answer 24

True

Question 25

TF: An individual can enroll into, drop, or change Part C plans during the following periods:

Initial Enrollment Period (IEP) - The initial Medicare enrollment period is for a 7 months period that begins 3 months before the month you turn 65 years old, and the three months after your 65th birthday. Coverage begins the first day of the month after you enroll. If you signup in one of the months before your 65th birthday, coverage begins on the first day of the month you turn 65.
General (Annual) Enrollment Period (AEP) – The annual enrollment period is October 15th through December 7th annually. Coverage begins on January 1st the following year.
Special Enrollment Period (SEP)- The SEP varies depending on the situation.

Answer 25

True

Question 26

Medicare ____ ____ provides prescription drug coverage. It was signed into law by the Medicare Modernization Act of 2003 and became effective on January 1, 2006. The coverage is offered through private prescription drug plans, or PDPs, which Medicare has approved.

Answer 26

Part D

Question 27

Two ways Part D Drug coverage may be provided?

Answer 27

A stand-alone plan (fee for service basis) providing prescription drug coverage to Original Medicare, or
Through a Part C plan that includes prescription drug coverage.

Question 28

: TF: Individuals must meet the following requirements to receive Part D benefits:

Be enrolled in Parts A and B
Enroll in a Part D plan in their service area; if no plan is offered in a service area, a federal standard plan will be provided

Answer 28

True

Question 29

Two enrollment options for Medicare Part D?

Answer 29

During the initial enrollment period for Medicare; or
During the annual enrollment period for Part D: October 15th through December 7th. Coverage begins on January 1st of the following year.

Question 30

Generally, Medicare is available to people:
Select one:
a. Age 55 and above
b. Age 59 1/2 and above
c. Age 65 and above
d. Age 70 and above

Answer 30

C

Question 31

Andrea is eligible for Medicare, but is employed and insured under her employer-sponsored group health plan. Which of the following is true?
Select one:
a. Andrea’s employer-sponsored coverage is secondary.
b. Andrea’s employer-sponsored coverage is primary.
c. Andrea cannot enroll in Medicare.
d. Andrea can enroll in Medicare once her employer-sponsored coverage ends.

Answer 31

B

Question 32

Medicare Part C covers:
Select one:
a. Hospital
b. Prescription drugs
c. Managed care (Medicare Advantage)
d. Medical

Answer 32

C

Question 33

Medical coverage is provided by:
Select one:
a. Medicare Part B
b. Medicare Part A
c. Medicare Part D
d. Medicare Part C

Answer 33

A

Question 34

Prescription drug coverage is provided by:
Select one:
a. Medicare Part B
b. Medicare Part D
c. Medicare Part A
d. Medicare Part C

Answer 34

B

Question 35

Hospital coverage is provided by:
Select one:
a. Medicare Part C
b. Medicare Part D
c. Medicare Part A
d. Medicare Part B

Answer 35

C

Question 36

Medicare Part D covers:
Select one:
a. Managed care (Medicare Advantage)
b. Prescription drugs
c. Hospital
d. Medical

Answer 36

B

Question 37

Medicare Part A covers:
Select one:
a. Medical
b. Prescription drugs
c. Managed care (Medicare Advantage)
d. Hospital

Answer 37

D

Question 38

Medicare Part B covers:
Select one:
a. Prescription drugs
b. Medical
c. Hospital
d. Managed care (Medicare Advantage)

Answer 38

B

Question 39

Medicare Part B covers:
Select one:
a. Prescription drugs
b. Medical
c. Hospital
d. Managed care (Medicare Advantage)

Answer 39

B

Question 40

Managed care coverage is provided by:
Select one:
a. Medicare Part A
b. Medicare Part D
c. Medicare Part C
d. Medicare Part B

Answer 40

C