Chapter 15 Flashcards
The highest and most expensive level of nursing care is ____________.
Skilled nursing
Identify the acronym: LTC
Long term care
When is Medicare Part D available?
When there are no private plans in a persons geographic area
Medicare eligibility is based on _____ and _____ contribution, while eligibility for Medicaid is based on _____.
Age; FICA; need
LTC benefit periods may extend from one year to __________ coverage.
Unlimited
Reduced SS retirement benefits may begin as early as age _____.
62
Employer paid LTC premiums are _____________ to the employer and benefits to employees are received on a ___________ basis.
Deductible; tax free
Hospice care involves ___________ treatment, as opposed to _____________ treatment.
Palliative; curative
What is another name for Medicare Part B?
Supplemental Medical Insurance (SMI)
SS disability requires the disability to last at least _____ months or result in ______.
12; death
What is another name for Medicaid?
Temporary Aid for Needy Families
Are immunizations covered under Medicare Part B?
Yes
An LTC policy must have at least a ____- day free look period.
30
When must and LTC outline of coverage be provided to an applicant?
At or before the time of application
What is the name of the prescription drug program under Medicare?
Medicare part d
T/F: Medicare Part A has a deductible per benefit period.
Y
Identify the acronym; ADL
Activities of Daily Living
Medicare Supplement plans must be sold on a _______ renewable basis.
Guaranteed
What is the donut hole?
The gap in Medicare Part D benefits
What is hospice care?
Care provided for those who are terminally ill
Qualification for Medicaid benefits is based on __________ or ________.
Income; need
If an LTC policy pays on a reimbursement basis, benefits go directly to the ____________.
Provider of service
What are the four major benefit categories of an LTC policy?
Skilled nursing care, intermediate care, custodial care, and home health care
What is Home Health Care?
Professional services provided in the home as an alternative to hospital confinement
What is the added benefit of the LTC Guaranteed Insurability Rider?
It allows for additional coverage to be purchased without evidence of insurability
Medicare Supplement plan A is the _______ expensive Medigap Plan.
Least
What is another name for Medicare Supplement Plans?
Medigap Plans
What is Medicare Part A called?
Hospital Insurance (HI)
Dependent benefits under SS may be paid to a child until she reaches age _____.
18
Medicare Supplement Plan A is called the ______ Plan.
Core
What is another name for Medicare Part C?
Medicare Advantage
What does approved and reasonable mean?
The amount Medicare agrees to pay for benefits based in geographic factors and limits
There are ______ standard Medicare Supplement plans called _____ through _____.
12; A; L
How long is the free look period in a Medicare Supplement plan?
No less than 30 days
Activities of Daily Living (ADLs) may also be referred to as ____________.
Benefit triggers
Is Medicare Part A automatic at age 65?
Only if the individual is FICA-qualified
Medicare only provides _________ nursing care for a limited number of days.
Skilled
Which plan would be considered primary — Medicare or a group plan?
Group plans are almost always primary, while Medicare is secondary
Does Medicare part A provide for prescription drugs?
Yea but only for inpatient prescription drugs
Who sells Medicare supplement policies?
Private commercial insurers
The longer the selected LTC elimination period, the _______ expensive the policy.
Less
T/F: Care for those suffering mental dementia is covered under an AD&D policy.
F; coverage is provided under LTC for those suffering mental dementia
What form must be provided to an applicant whenever a Medigap policy is sold to replace an existing plan?
Notice Regarding Replacement Form
T/F: An LTC policy may be issued containing an impairment rider.
F; Impairment riders are not used when issuing LTC policies
What is the primary benefit of Medicare Part B?
Doctor and surgeon fees
What is an alternative to Medicare Parts A and B?
Medicare Advantage or Part C
What is intermediate care?
Occasions nursing and rehabilitation
T/F: Medicare part A primarily pays for inpatient hospital expenses, while part B offsets doctors expenses.
T
LTC policies are primarily sold to the ______ market and are designed to provide benefits for _________ conditions.
Senior; chronic
When a Medicare Supplement policy is sold, a __________ must be provided at the time of application.
Buyers guide
What is skilled nursing care?
Professional care provided on a 24/7 basis
Define SS disability.
Unable to engage in any occupation, disability expected to last 1 year or result in death.
A ________ Care LTC policy allows couples to pool and share benefits from one another LTC plan.
Shared
What is meant by Medicare approved amount?
It represents the amount of the bill Medicare agrees to pay or reimburse
Does Medicare part A have copayments?
Yes
For whom is Medicare primarily designed?
Those over the age of 65 and FICA qualified
Medicare Part A has _____ days of lifetime hospital reserve.
60
The out of pocket expense for Medicare Part D are referred to as the ________.
Donut hole
Which LTC benefit includes a vacation for the individual providing LTC?
The respite care benefit
All LTC policies must be sold in a ____________ renewable basis.
Guaranteed
If a policy is surrendered, this LTC rider allows the owner to purchase another LTC policy with smaller benefits?
The non forfeiture rider
Medicare Part B has a _________ premium, which is typically deducted from the _____________ check.
Monthly; SS
Someone who is fully insured under SS has _____ quarters of contribution credits.
40
Does Medicare Part A provide outpatient prescription drugs?
No. Only certain inpatient drugs are covered; however, Part D provides prescription drug coverage
Which LTC benefit requires the highest level of care and treatment?
Skilled nursing
What is the primary benefit of Medicare Part A?
Hospital benefits, including prescription drugs
T/F: the disability definition used by SS is not very restrictive.
F; the definition is very restrictive
Medicare Supplement Plans _____ and _____ cover ____________ screenings.
E; J; preventative
What benefits are provided by Medicare Plan A?
Part A helps pay inpatient hospital benefits, some skilled nursing, home health care and hospice benefits
What is Home Health Care?
Part time care in the home, which included skilled nursing, therapy treatments, and medically needed care
What nonresidential facility provides activities for elderly or handicapped individuals?
An adult day care
As of 2009, what is the SS death benefit?
$255
Disability benefits under SS begins in the _________ month.
Sixth
List the three categories of Medicare recipients.
Anyone FICA qualified age 65+, or receiving SS disability benefits for 2+ years, or with renal kidney disease
Does Medicare Part B have a deductible?
Yes. Part B had a deductible that increases annually. That deductive for 2010 is $155
To qualify for LTC benefits, and insured must be unable to perform ___ ADL benefits for no less than _____ days.
2 ; 90
What does it mean for a policy to be guaranteed renewable?
The policy MAY NOT be cancelled, but premiums MAY be increased in a class basis only
T/F: Indigent means having low income or being needy.
T
Selling a ___________ Medicare Supplement plan is prohibited and the plan sold must be __________.
Duplicate; suitable
Describe custodial care.
Assistance with bathing, dressing, toileting, eating, walking, and medicating
LTC policies must provide at least ____ months of consecutive benefits.
12
LTC premiums are generally ______ deductible and benefits are received on a _____ basis.
Not; tax free
Medicare Supplement Plans ____ and _____ are high deductible plan options.
F; J
T/F: LTC policies do not provide hospital benefits.
T
To enroll in Medicare Advantage, a person must currently be enrolled in both ____________.
Medicare part A and B
The maximum duration of time for excluding preexisting conditions on a Medicare Supplement plan is ____ months.
6
Define Medicare Assignment.
A doctor has agreed to accept the Medicare reimbursement as paid in full
T/F: an LTC policy’s benefits for skilled nursing are greater than benefits provided for other levels of care.
F; all levels of LTC benefits must be provided equally
What type of nursing care does Medicare Part A provide?
Skilled nursing for up to 100 days
What is the Medicare part B copayment?
20% of approved charges
Under Medicare, the spell of illness benefit period ends _____ days following hospital discharge.
60
Alzheimer’s disease is considered a ____________ impairment.
Cognitive
Which LTC rider provides an increase in daily benefit often on a 5% increase per year basis?
The inflation protection rider
LTC policies may be sold on an ___________ or __________ basis, or as a life insurance ______.
Individual; group; rider
One may buy a Medicare supplement plan without providing insurability for _____ months after Medicare Part B enrollment.
6
SS disability benefits have a ___-month waiting period.
5
Since Medicare Part B is not automatic at age 65, participants must _______ and pay a ________.
Enroll; premium
The purpose of Medicare Supplement plans is to offset the __________ and ________ found in Medicare.
Deductibles; copayments
How long is the initial Medicare enrollment period?
7 months
SS retirement benefits often begin at age _____.
65
