Chapter 7 Part 3 Flashcards
Medicare adv is also known as
Medicare part c
Medicare part d
Medicare part a
Medicare part c
All of the following are advantages of an hmo or ppo for a Medicare recipient except
There are no claims forms required
Elective cosmetic procedures are covered
Prescriptions might be covered unlike Medicare
Healthcare costs can be budgeted
Elective cosmetic procedures are covered
Which is NOT correct re Medicare
Medicare a provides hospital care
Medicare b provides physician services
Medicare advantage must be provided through HMO
Medicare advantage must be provided through hmo
To be eligible for Medicare advantage beneficiaries must also be enrolled in
All plans
Consideration plan
Medicare part c
Medicare parts a and b
Medicare part a and b
Health maintenance program aka
PPO preferred provider organization
Medicare adv plan offered by a private insurance company
Medicare private fee for service plan
PPO
Special needs plan
Medicare private fee for service plan
Medicare pays a set amount of money every month to the what to provide health care coverage in a private fee for service plan
Hmo
Ppo
Private ins company
Private ins company
More focused and specialized health care fo specific groups of ppl such as who have both Medicare and medicaid who reside in nursing home or have certain chronic medical conditions
Freedom plan
Catastrophic plan
Special needsplan
Special needs plan
What was passed to add part d prescription drug benefit to standard Medicare coverages
Stand alone plan
Integrated plan
Medicare prescription drug improvement and modernization act of 2003
Medicare prescription drug improvement and modernization act of 2003
Once this amount is reached by beneficiary and their plan combined on drugs (including deductible) beneficiary will pay no more than 25% of cost for prescription drugs until their out of pocket spending is reached
4660
Out of pocket spending for drug benefit plan
7400
Once beneficiary has reached their out of pocket spending on drug benefit program what begins automatically
Primary Medicare
Secondary Medicare
Catastrophic coverage
Catastrophic coverage
Catastrophic =
95%
For individual eligible for Medicare at age 65, who is still employed and covered under employer’s plan, which is true
Plan is primary coverage and Medicare is secondary coverage
Employer plan is secondary coverage and Medicare is primary coverage
Employer plan is discontinued and Medicare is primary coverage
Employer plan is primary coverage and Medicare is secondary coverage
Medicare is part of health insurance market place which is key component of affordable care act that allows qualified individual families and employees of small businesses to obtain health ins
True or false
False
When considered eligible for Medicare part a person will not qualify for marketplace tax credits to help pay for premiums or reductions in
Cost sharing
Premium
Catastrophic
Cost sharing
Which is not covered under medical ins plan a
Medicare part a deductible
First tree pints of blood each year
Approved hospital costs for 365 additional days after Medicare benefits end
Medicare part a deductible
Provides core or basic benefits established by law
Medicare supplement plan a
Omnibus budget reconciliation act of 1990
Globe life
Medicare supplement plan a
Policies issued by private ins companies that are designed to fill in some of the gaps in Medicare
Medicare supplement plans aka medigap
Globe life
All state
Geico
Medigap
In which Medicare supplemental policies are core benefits found?
All plans
Plan a only
Plan b only
All plans
What pays all or some of Medicare’s deductibles and copayments
Medicare supplement
Cobra
Obra
Medicare supplement policies
Omnibus budget reconciliation act of 1990 =
Obra
Medicare supplement ins may not discriminate in pricing or be denied on basis of an applican’ts health status claims experience recipient of health care of medical condition
Cobra
Medicare part f
Obra
Obra
Prior to purchasing a medigap policy must be enrolled in which of the following
Any private ins
All four parts of Medicare
Parts a and b of Medicare
Parts a and be of Medicare
Medicare supplement plan must have at least which of the following
Noncancellable
Conditionally renewable
Guaranteed renewable
Guaranteed renewable
All correct statements about Medicare supplement ins policies are correct except
Supplement Medicare benefits
Issued by private insurers
Cover cost of extended nursing home care
Cover cost of extended nursing home care
Re Medicare supplement benefits plans what does term standard mean
Coverage options and conditions are developed for average individuals
All plans must include basic benefits a-n
All providers will have the same coverage options a nd conditions for each plan
All providers will have the same coverage options and conditions for each plan
Plan implies that all providers will have the same coverage options and conditions for each plan
Standard
Substandard
Standard
How long is I open enrollment period for Medicare supplement policies
Six months
Six weeks
One year
Six months
These benefits are aka basic benefits
Core benefits
How many pints of blood will be paid for by Medicare supplement core benefits
1
3
None
3
Which is not covered under plan a in medigap ins
Medicare part a deductible
First three pints of blood each year
Approved hospital costs for 365 days after Medicare benefits end
Medicare part a deductible
Supplement plan must have at least which of the following renewal provisions
Guaranteed renewable
Conditionally renewable
Non renewable
Guaranteed renewable
Applicant discussing his options for Medicare supp coverage w his agent. Applicant is 65 and has just enrolled in Medicare part a and b
What is the ins company obligated to do
Offer supplement policy on a guaranteed issue basis
Look at the applicant’s medical history to decide what premium to change send the applicant to a doc for a physical. Nothing can happen with the results
Offer supplement policy on a guaranteed issue basis
Medicaid provides all of following benefits except
Home health care services
Eyeglasses
Braces
Income assistance for work related injury
Income assistance for work related injury
Skilled nursing facility coisurance 100% of Medicare art b excess charges a nd foreign travel benefit. This plan must pay for services of activities of daily living that Medicare doesn’t cover
Plan a
Plan d
Plan g
Plan g
Lower premium plans with higher out of pocket costs
Core benefits are different in these two plans
K and l
Medicaid benefits is based upon
Age
Dependents
Need
Need
Requirement for social sec disability income benefits
50 years of age
Currently employed status
Fully insured status
Fully insured status
Not a factor in determining qualifications for social security disability benefits
Age
Work credits
Occupation
Occupation
Which benefit is based on the persona’s primary PIA
Long term care benefit
Social security disability benefit
Death benefit
Social security disability benefit
Those who apply for social security disability benefits are referred to the sate agency called
Dds
Executive office
Insurance office
Dds disability determination services
How many work credits can be earned per year
2
4
6
8
4
Disabled becomes disabled at 22 and ca no longer work. Meets def of total disability under social security. What requirement must she have to meet social security disability benefits req
6 work credits in past 3 years
20 work credits in past 10 years
40 work credits
Reached age of 25
6 work credits in the past 3 years
Once person meets req for disability benefits under social security how long is waiting period before any benefits will be paid
Paid immediately
90 days
5 months
12 months
5 months
Primary insurance a mount =
Pia
