Chapter 8 - Social Insurance

Question 1

What are the four parts of Medicare?

Answer 1

Part A (Hospital Insurance) is financed through a portion of the payroll tax (FICA)

Part B (Medical Insurance) is financed from monthly premiums paid by insureds and from the general revenues of the federal government

Part C (Medicare Advantage) allows people to receive all of their health care services through available provider organizations

Part D (Prescription Drugs) is for prescription drug coverage.

Question 2

Medicare Assignment

Answer 2

The physician or a medical supplier agrees to accept the Medicare-approved amount as full payment for the covered services

Question 3

Medicare Limiting Charge

Answer 3

The maximum amount a physician may charge a Medicare beneficiary for a covered service if the physician does not accept assignments

Question 4

What part of Medicare covers hospital outpatient care?

Answer 4

Medicare Part B

Medicare Part A does not cover outpatient hospital care

Question 5

What is covered under Medicare Part A for what periods?

Answer 5

The first 60 days of hospital stays are fully covered with a single deductible

61-90 days are covered with a daily deductible

After 90 days is not covered

Question 6

What does Medicare Part C do?

Answer 6

It expands Original Medicare benefits through private health insurance programs

Question 7

What happens after the initial Medicare Part D benefit limit is reached?

Answer 7

A Prescription Drug Benefit plan will pay 75% of all generic and brand name drug costs

Question 8

What are all Medicare Supplement Plans required to offer?

Answer 8

All Medicare supplement plans must offer the core benefits available in Plan A

Question 9

What is Social Security disability benefits also referred to as?

Answer 9

Old Age, Survivors, and Disability Insurance (OASDI)

Question 10

What three categories of people are eligible for Medicare?

Answer 10

• 65+ years old
• Those eligible for Social Security benefits for two years
• Those with permanent kidney failure (regardless of age)

Question 11

What two types of plans fill the gaps in Medicare coverage?

Answer 11

• Medicare Supplement Policies
• Medigap

Question 12

What happens to the premiums for Medicare Part B if enrollment is delayed until after the initial enrollment period?

Answer 12

They increase

Question 13

What are the enrollment periods for Medicare?

Answer 13

• Initial Enrollment: is the six month period starting three months before your 65th birthday
• General Enrollment: 1/1 - 3/31
• Special Enrollment: eight month period following employment termination, SSDI enrollment

Question 14

What are five areas excluded from Medicare Parts A or B?

Answer 14

• Long-term care
• Eye exams related to prescribing glasses
• Most dental including dentures
• Cosmetic surgery
• Acupuncture
  Etc.

Question 15

What is required in order to be eligible for Medicare Part C?

Answer 15

Enrollment in Parts A and B

Question 16

What is Medicare Part C?

Answer 16

Medicare Advantage - adds many of the services of HMOs and PPOs through those organizations.

Region dependent

Question 17

What is required in order to qualify for Medicare Supplement Policies or Medigap?

Answer 17

Enrollment in Medicare Parts A and B

Question 18

Is it legal to sell Medicare Supplement Policies or Medigap to someone enrolled in Medicare Part C?

Answer 18

No

They serve the same function

Question 19

Are Medicare Supplement Policies or Medigap guaranteed renewable?

Answer 19

Yes

Question 20

How long is the free-look period for Medicare Supplement Policies or Medigap?

Answer 20

30 days

Question 21

What are the three primary ways to get long-term care coverage (LTC)?

Answer 21

• Individual LTC policy
• Group LTC policy
• As a rider on life insurance

Question 22

What is the minimum legal coverage period for long-term care?

Answer 22

12 months

Question 23

What is required for eligibility of long-term care?

Answer 23

Inability to perform two ADLs (activities of daily living.

• Bathing
• Dressing
• Toileting
• Eating
• Transferring
• Continence

Question 24

Six types of LTC exclusions

Answer 24

• Pre-existing conditions
• Mental and nervous disorders
• Alcoholism and drug addiction
• War related illnesses
• Criminal related
• If covered by Medicare or workers comp

Question 25

What are the six levels of LTC?

Answer 25

• Skilled care
• Intermediate care
• Custodial care
• Home health care
• Adult day care
• Respite care

Question 26

How is Part B Medicare funded?

Answer 26

By monthly premiums and from the general revenues of the federal government

Question 27

An insured with Medicare Part D has reached the initial benefit limit and must now pay a portion of prescription drugs costs. What is the term for this gap in coverage?

Answer 27

The donut hole

Question 28

How many pints of blood will be paid for by Medicare Supplement core benefits?

Answer 28

First 3 pints

Question 29

In which Medicare supplemental policies are the core benefits found?

Answer 29

All plans (A-N)

Question 30

Over and above premiums, what must the patient pay under Medicare Part B?

Answer 30

20% of covered charges above the deductible

Question 31

To sign up for a Medicare prescription drug plan, individuals must first be enrolled in

Answer 31

Medicare Part A

Question 32

For how many days of skilled nursing facility care will Medicare pay benefits?

Answer 32

100

Treatment in a skilled nursing facility is covered in full for the first 20 days. From days 21 to 100, the patient must pay the daily copayment. There are no Medicare benefits provided for treatment in a skilled nursing facility beyond 100 days.

Question 33

For the purposes of obtaining benefits, the Social Security Act defines disability as inability to engage in any gainful employment due to a medically determinable physical or mental impairment that is expected to result in what two factors?

Answer 33

• Death
• Last for a continuous period of 12 months

Question 34

How long is an open enrollment period for Medicare supplement policies?

Answer 34

6 months

Question 35

Medicare Part A will pay for up to how many days of inpatient psychiatric hospital care?

Answer 35

190

Question 36

Are home health and physician and surgeon’s services covered under Medicare Part A?

Answer 36

Home health care is covered

Physician and surgeon’s services are NOT

Question 37

How long does the initial enrollment period for Medicare Part B last?

Answer 37

7 months

Question 38

Persons disabled before the age of 24 can qualify for Social Security Benefits with how many work credits over what period of time?

Answer 38

6 work credits earned in the 3 years prior to the start of the disability