Chapter 5 Review (Health): Private Insurance

Question 1

This insurance is specifically designed for individuals by the age of 65 who have enrolled in Medicare however, anyone currently receiving Medicare Parts A and B is eligible to participate in a _____ policy

Answer 1

Medicare Supplement (Medigap)

Question 2

A _____ policy is a Medicare supplement insurance policy sold by private insurance companies to cover medical costs not covered by the government in Medicare Parts A and B.

Answer 2

Medigap

Question 3

Medigap policies do not

Answer 3

pay costs for Medicare Parts C and D

Question 4

As of _____ _____, there are _____ standardized Medigap plans. Each of the _____ plans has a letter designation of

Answer 4

June 2010,

10

A, B, C, D, F, G, K, L, M, or N

Question 5

A Medicare Supplement policy must NOT contain benefits which

Answer 5

duplicate Medicare benefits

Question 6

Individuals over 65 who have just enrolled in Medicare Part B for the first time _____ _____ _____ a Medicare Supplement policy and _____ _____ _____ if they apply for coverage within _____ _____ of Part B enrollment (in other words, Medicare Supplements must be guaranteed issue during open enrollment)

Answer 6

cannot be refused

cannot be rated

6 months

Question 7

All Medicare supplement policies must be _____ _____ and can only be canceled by the insurer for nonpayment of premiums

Answer 7

guaranteed renewable

Question 8

Medicare Supplement Plans _____ and _____ are the only Medicare Supplement insurance plans that cover costs known as Medicare Part B excess charges

Answer 8

F and G

Question 9

An _____ _____ is the difference between what a doctor or provider charges and the amount Medicare will pay

Answer 9

excess charge

Question 10

o The policy must supplement both Part A and Part B of Medicare

o The policy must automatically adjust its benefits to reflect statutory changes in Medicare

o The policy must cover all expenses not covered by Part A from the 61st to the 90th day. Furthermore, it must cover the lifetime reserve copayment and must provide full coverage for an additional 365 days after Medicare benefits are exhausted.

o If the policy excludes coverage for preexisting conditions, the exclusion cannot exist for longer than six months. That is, no coverage can be denied as a preexisting condition after the policy has been in effect for six months.

o Part B expenses not covered by Medicare (that is, the 20% co-payment) must be covered by the Medigap policy. However, policies may include a deductible before this benefit becomes payable.

o The policy must include a minimum 30 day free-look provision.

Answer 10

six minimum standards applying to all policies designated as Medicare Supplement Insurance.

Question 11

All Medicare Supplement plans cover coinsurance on hospital costs, up to an additional 365 days after Medicare Part A hospital benefits run out. All Medigap policies also cover at least part of these costs:

Answer 11

• Medicare Part A hospice coinsurance or copayment
• Medicare Part B coinsurance or copayment
• First 3 pints of blood received as a hospital inpatient

Question 12

With a _____ _____ plan, the insured agrees to use preferred providers, and in exchange, pay a lower premium

Answer 12

Medicare Select

Question 13

There are a number of _____ _____ _____ that have contracted with the Health Care Financing Administration to provide both Part A and Part B services to Medicare recipients. Medicare _____ _____ _____ are offered by private companies, which can decide each year to join or leave Medicare.

Answer 13

Managed Care Organizations (MCOs)

managed care plans

Question 14

These plans are Medicare provided by an approved Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), or Private Fee For Service (PFFS) Plan

Answer 14

Medicare Advantage Plans (Medicare Part C)

Question 15

Another choice is a _____ _____ _____ _____. In this type of plan an individual may go to any Medicare-approved doctor or hospital that accepts Medicare payments. The insurance plan, rather than the Medicare Program, decides how much it will pay and what the Medicare enrollee pays for the services rendered. The plan could include extra benefits that are not covered under the original Medicare plan.

Answer 15

Private Fee For Service (PFFS) Plan

Question 16

In addition to the premium, Medicare Advantage enrollees normally must pay a _____ _____ per visit or per service

Answer 16

small copayment

Question 17

Medicare Part C does NOT cover

Answer 17

long-term care

Question 18

LTC refers to care provided for an

Answer 18

extended period of time (normally more than 90 days).

Question 19

Most LTC policies pay the insured a _____ _____ ______ for each day the policy covers, regardless of what the care costs

Answer 19

fixed dollar amount

Question 20

An _____ illness is a serious condition, such as pneumonia or influenza, from which the body can fully recover with proper medical attention

Answer 20

acute

Question 21

Some people will suffer from chronic conditions, such as arthritis, heart disease, or hypertension, which are

Answer 21

treatable but not curable illnesses

Question 22

Most long-term care insurance policies will pay benefits when you cannot perform at least

Answer 22

two Activities of Daily Living (ADL).

Question 23

1. Personal hygiene - bathing, grooming and oral care
2. Dressing - the ability to make appropriate clothing decisions and physically dress oneself
3. Eating - the ability to feed oneself though not necessarily to prepare food
4. Maintaining continence - both the mental and physical ability to use a restroom
5. Transferring - moving oneself from seated to standing and get in and out of bed

These are the

Answer 23

Five basic categories of “The Activities of Daily Living” (ADL)

Question 24

This is continuous, around-the-clock care provided by licensed medical professionals under the direct supervision of a physician. It is usually administered in nursing homes.

Answer 24

Skilled nursing care

Question 25

This is provided by registered nurses, licensed practical nurses, and nurse’s aides under the supervision of a physician. It’s provided in nursing homes for stable medical conditions that require daily, but not 24-hour, supervision.

Answer 25

Intermediate nursing care

Question 26

This kind of care provides assistance in meeting daily living requirements, such as bathing, dressing, getting out of bed, toileting, and so on.

Answer 26

Custodial care

Question 27

Home health care can include

Answer 27

skilled care and unskilled care.

Question 28

This form of care is designed to provide a short rest period for a family caregiver.

Answer 28

Respite care

Question 29

Amounts received under an LTC contract are _____ _____ _____ because they are considered amounts received for personal injuries and sickness

Answer 29

excluded from income

Question 30

This is a Federally-supported, state-operated initiative that allows individuals who purchase a qualified long-term care insurance policy or coverage to protect a portion of their assets that they would typically need to spend down prior to qualifying for _____ coverage.

Answer 30

The Long-Term Care Partnership Program

Medicaid

Question 31

The difference between a Long- Term Care Partnership Plan and a Non-Partnership Plan is

Answer 31

asset protection

Question 32

Which Long Term Care insurance statement true?

Answer 32

Pre-existing conditions must be covered after the coverage has been in force for six months.

(Pre-existing conditions are those for which medical advice or treatment was recommended by or received from a health provider within 6 months preceding the effective date of an individual long-term care policy.)

Question 33

A reimbursement policy pays what amount of covered long-term care expenses?

Answer 33

Actual covered expenses up to the daily maximum