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Accident And Health > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

The highest and most expensive level of nursing care is ____________.

A

Skilled nursing

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2
Q

Identify the acronym: LTC

A

Long term care

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3
Q

When is Medicare Part D available?

A

When there are no private plans in a persons geographic area

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4
Q

Medicare eligibility is based on _____ and _____ contribution, while eligibility for Medicaid is based on _____.

A

Age; FICA; need

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5
Q

LTC benefit periods may extend from one year to __________ coverage.

A

Unlimited

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6
Q

Reduced SS retirement benefits may begin as early as age _____.

A

62

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7
Q

Employer paid LTC premiums are _____________ to the employer and benefits to employees are received on a ___________ basis.

A

Deductible; tax free

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8
Q

Hospice care involves ___________ treatment, as opposed to _____________ treatment.

A

Palliative; curative

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9
Q

What is another name for Medicare Part B?

A

Supplemental Medical Insurance (SMI)

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10
Q

SS disability requires the disability to last at least _____ months or result in ______.

A

12; death

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11
Q

What is another name for Medicaid?

A

Temporary Aid for Needy Families

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12
Q

Are immunizations covered under Medicare Part B?

A

Yes

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13
Q

An LTC policy must have at least a ____- day free look period.

A

30

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14
Q

When must and LTC outline of coverage be provided to an applicant?

A

At or before the time of application

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15
Q

What is the name of the prescription drug program under Medicare?

A

Medicare part d

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16
Q

T/F: Medicare Part A has a deductible per benefit period.

A

Y

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17
Q

Identify the acronym; ADL

A

Activities of Daily Living

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18
Q

Medicare Supplement plans must be sold on a _______ renewable basis.

A

Guaranteed

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19
Q

What is the donut hole?

A

The gap in Medicare Part D benefits

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20
Q

What is hospice care?

A

Care provided for those who are terminally ill

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21
Q

Qualification for Medicaid benefits is based on __________ or ________.

A

Income; need

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22
Q

If an LTC policy pays on a reimbursement basis, benefits go directly to the ____________.

A

Provider of service

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23
Q

What are the four major benefit categories of an LTC policy?

A

Skilled nursing care, intermediate care, custodial care, and home health care

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24
Q

What is Home Health Care?

A

Professional services provided in the home as an alternative to hospital confinement

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25
Q

What is the added benefit of the LTC Guaranteed Insurability Rider?

A

It allows for additional coverage to be purchased without evidence of insurability

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26
Q

Medicare Supplement plan A is the _______ expensive Medigap Plan.

A

Least

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27
Q

What is another name for Medicare Supplement Plans?

A

Medigap Plans

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28
Q

What is Medicare Part A called?

A

Hospital Insurance (HI)

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29
Q

Dependent benefits under SS may be paid to a child until she reaches age _____.

A

18

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30
Q

Medicare Supplement Plan A is called the ______ Plan.

A

Core

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31
Q

What is another name for Medicare Part C?

A

Medicare Advantage

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32
Q

What does approved and reasonable mean?

A

The amount Medicare agrees to pay for benefits based in geographic factors and limits

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33
Q

There are ______ standard Medicare Supplement plans called _____ through _____.

A

12; A; L

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34
Q

How long is the free look period in a Medicare Supplement plan?

A

No less than 30 days

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35
Q

Activities of Daily Living (ADLs) may also be referred to as ____________.

A

Benefit triggers

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36
Q

Is Medicare Part A automatic at age 65?

A

Only if the individual is FICA-qualified

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37
Q

Medicare only provides _________ nursing care for a limited number of days.

A

Skilled

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38
Q

Which plan would be considered primary — Medicare or a group plan?

A

Group plans are almost always primary, while Medicare is secondary

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39
Q

Does Medicare part A provide for prescription drugs?

A

Yea but only for inpatient prescription drugs

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40
Q

Who sells Medicare supplement policies?

A

Private commercial insurers

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41
Q

The longer the selected LTC elimination period, the _______ expensive the policy.

A

Less

42
Q

T/F: Care for those suffering mental dementia is covered under an AD&D policy.

A

F; coverage is provided under LTC for those suffering mental dementia

43
Q

What form must be provided to an applicant whenever a Medigap policy is sold to replace an existing plan?

A

Notice Regarding Replacement Form

44
Q

T/F: An LTC policy may be issued containing an impairment rider.

A

F; Impairment riders are not used when issuing LTC policies

45
Q

What is the primary benefit of Medicare Part B?

A

Doctor and surgeon fees

46
Q

What is an alternative to Medicare Parts A and B?

A

Medicare Advantage or Part C

47
Q

What is intermediate care?

A

Occasions nursing and rehabilitation

48
Q

T/F: Medicare part A primarily pays for inpatient hospital expenses, while part B offsets doctors expenses.

A

T

49
Q

LTC policies are primarily sold to the ______ market and are designed to provide benefits for _________ conditions.

A

Senior; chronic

50
Q

When a Medicare Supplement policy is sold, a __________ must be provided at the time of application.

A

Buyers guide

51
Q

What is skilled nursing care?

A

Professional care provided on a 24/7 basis

52
Q

Define SS disability.

A

Unable to engage in any occupation, disability expected to last 1 year or result in death.

53
Q

A ________ Care LTC policy allows couples to pool and share benefits from one another LTC plan.

A

Shared

54
Q

What is meant by Medicare approved amount?

A

It represents the amount of the bill Medicare agrees to pay or reimburse

55
Q

Does Medicare part A have copayments?

A

Yes

56
Q

For whom is Medicare primarily designed?

A

Those over the age of 65 and FICA qualified

57
Q

Medicare Part A has _____ days of lifetime hospital reserve.

A

60

58
Q

The out of pocket expense for Medicare Part D are referred to as the ________.

A

Donut hole

59
Q

Which LTC benefit includes a vacation for the individual providing LTC?

A

The respite care benefit

60
Q

All LTC policies must be sold in a ____________ renewable basis.

A

Guaranteed

61
Q

If a policy is surrendered, this LTC rider allows the owner to purchase another LTC policy with smaller benefits?

A

The non forfeiture rider

62
Q

Medicare Part B has a _________ premium, which is typically deducted from the _____________ check.

A

Monthly; SS

63
Q

Someone who is fully insured under SS has _____ quarters of contribution credits.

A

40

64
Q

Does Medicare Part A provide outpatient prescription drugs?

A

No. Only certain inpatient drugs are covered; however, Part D provides prescription drug coverage

65
Q

Which LTC benefit requires the highest level of care and treatment?

A

Skilled nursing

66
Q

What is the primary benefit of Medicare Part A?

A

Hospital benefits, including prescription drugs

67
Q

T/F: the disability definition used by SS is not very restrictive.

A

F; the definition is very restrictive

68
Q

Medicare Supplement Plans _____ and _____ cover ____________ screenings.

A

E; J; preventative

69
Q

What benefits are provided by Medicare Plan A?

A

Part A helps pay inpatient hospital benefits, some skilled nursing, home health care and hospice benefits

70
Q

What is Home Health Care?

A

Part time care in the home, which included skilled nursing, therapy treatments, and medically needed care

71
Q

What nonresidential facility provides activities for elderly or handicapped individuals?

A

An adult day care

72
Q

As of 2009, what is the SS death benefit?

A

$255

73
Q

Disability benefits under SS begins in the _________ month.

A

Sixth

74
Q

List the three categories of Medicare recipients.

A

Anyone FICA qualified age 65+, or receiving SS disability benefits for 2+ years, or with renal kidney disease

75
Q

Does Medicare Part B have a deductible?

A

Yes. Part B had a deductible that increases annually. That deductive for 2010 is $155

76
Q

To qualify for LTC benefits, and insured must be unable to perform ___ ADL benefits for no less than _____ days.

A

2 ; 90

77
Q

What does it mean for a policy to be guaranteed renewable?

A

The policy MAY NOT be cancelled, but premiums MAY be increased in a class basis only

78
Q

T/F: Indigent means having low income or being needy.

A

T

79
Q

Selling a ___________ Medicare Supplement plan is prohibited and the plan sold must be __________.

A

Duplicate; suitable

80
Q

Describe custodial care.

A

Assistance with bathing, dressing, toileting, eating, walking, and medicating

81
Q

LTC policies must provide at least ____ months of consecutive benefits.

A

12

82
Q

LTC premiums are generally ______ deductible and benefits are received on a _____ basis.

A

Not; tax free

83
Q

Medicare Supplement Plans ____ and _____ are high deductible plan options.

A

F; J

84
Q

T/F: LTC policies do not provide hospital benefits.

A

T

85
Q

To enroll in Medicare Advantage, a person must currently be enrolled in both ____________.

A

Medicare part A and B

86
Q

The maximum duration of time for excluding preexisting conditions on a Medicare Supplement plan is ____ months.

A

6

87
Q

Define Medicare Assignment.

A

A doctor has agreed to accept the Medicare reimbursement as paid in full

88
Q

T/F: an LTC policy’s benefits for skilled nursing are greater than benefits provided for other levels of care.

A

F; all levels of LTC benefits must be provided equally

89
Q

What type of nursing care does Medicare Part A provide?

A

Skilled nursing for up to 100 days

90
Q

What is the Medicare part B copayment?

A

20% of approved charges

91
Q

Under Medicare, the spell of illness benefit period ends _____ days following hospital discharge.

A

60

92
Q

Alzheimer’s disease is considered a ____________ impairment.

A

Cognitive

93
Q

Which LTC rider provides an increase in daily benefit often on a 5% increase per year basis?

A

The inflation protection rider

94
Q

LTC policies may be sold on an ___________ or __________ basis, or as a life insurance ______.

A

Individual; group; rider

95
Q

One may buy a Medicare supplement plan without providing insurability for _____ months after Medicare Part B enrollment.

A

6

96
Q

SS disability benefits have a ___-month waiting period.

A

5

97
Q

Since Medicare Part B is not automatic at age 65, participants must _______ and pay a ________.

A

Enroll; premium

98
Q

The purpose of Medicare Supplement plans is to offset the __________ and ________ found in Medicare.

A

Deductibles; copayments

99
Q

How long is the initial Medicare enrollment period?

A

7 months

100
Q

SS retirement benefits often begin at age _____.

A

65

Accident And Health (6 decks)

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