Insurance for Senior Citizens

Question 1

How many parts are there to Medicare?

Answer 1

4 parts
A, B, C, D

Question 2

What is Medicare part A and what does it cover?

Answer 2

Part A= Hospital insurance
Covers- inpatient hospital care, nursing home, post-hospital home health, hospice.

Question 3

What age is medicare automatically granted?

Answer 3

65

Question 4

What is medicare part B? what does it cover?

Answer 4

Part B= Medical insurance
Covers-physician services, outpatient hospital care, physical therapy, ambulance, medical equipment, some preventive services.

Question 5

What makes up “original medicare”

Answer 5

Part A and B

Question 6

What is Medicare part C?

Answer 6

Part C= Medicare Advantage
It is a managed care plan ALTERNATIVE to Original medicare(Parts A+B)

Question 7

What is Medicare Part D?

Answer 7

Part D= adds prescription drug coverage to Original medicare(Parts A+B)

Question 8

How many Medicare Enrollment periods are there?

Answer 8

4

Question 9

1. Initial Enrollment period (IEP)
   What is the timeframe?

Answer 9

Up to 3 months before or after a person turns 65 (7 month total period)

Question 10

2. General Enrollment period
   What is the timeframe and purpose?

Answer 10

From Jan 1 -March 31 each year
when a person can enroll if they did not enroll during the IEP

Question 11

3. Special Enrollment period
   What is the timeframe and purpose?

Answer 11

When group coverage has ended, and individuals who delayed enrolling in part B may enroll WITHOUT penalty.
8 month period starting 1 month after group coverage ended.

Question 12

4. Annual Election Period
   What is the timeframe and purpose?

Answer 12

October 15-December 7 each year
it is for individuals who want to change medicare advantage plans, switch from original medicare to an advantage plan, or change Part D prescription drug plans.

Question 13

Permanent legal residents must live in the United States for how long to qualify for Medicare?

Answer 13

at least 5 years

Question 14

Unlike Medicare Part A, Part B requires what?

Answer 14

Part B requires a premium

Question 15

Medicare part A coverage is also free to those under the age of 65 for who?

Answer 15

Have qualified for social security disability benefits for at least two years, have been diagnosed with ESRD, or have been diagnosed with ALS or Lou Gehrig’s disease.

Question 16

True or False-
Two people who enroll in Medicare Part B on the same date may pay different premiums?

Answer 16

True.
Part B requires a monthly premium that is based on the insured’s reported income in the two years before enrollment.

Question 17

Part A covers how many days of hospitalization in any one benefit period, with an additional 60 lifetime reserve days?

Answer 17

Part A pays full benefits for 60 days hospitalization and then partial benefits for 61st-90th day.
90 days total covered -only first 60 days fully paid for

Question 18

For Part A, a new benefit period begins when?

Answer 18

after AT LEAST 60 days have passed since the last hospitalization

Question 19

Part A does not cost a premium, only ___?

Answer 19

an annual deductible and coinsurance

Question 20

True or False-
Persons who apply for social security retirement benefits at age 65 are automatically enrolled in Medicare Parts A and B

Answer 20

True

Question 21

A person can still receive Medicare at age 65 without applying for social security retirement benefits, but it is not automatic enrollment. How come?

Answer 21

B/C medicare enrollment is not automatic if done BEFORE a person applies for social security retirement.

Question 22

Medicare supplement policies fill the coverage gaps of Original Medicare (Part A+B)..Why are medicare supplements not available for Medicare Advantage Part C?

Answer 22

B/C Part C plans already cover many of the gaps.

Question 23

Any Original medicare insured can buy a Medicare supplement as long as they are at least age 65 and apply within how long after enrolling in part B?

Answer 23

Within 6 months.

Question 24

True or False-
Medicare supplement policies are guaranteed renewable.

Answer 24

True

Question 25

Which of the Medicare supplement plans (A-N) must include all of the Part A core benefits?

Answer 25

All 10 plan types must include the Part A core benefits
***The other Medicare Supplement plans add benefits to Plan A’s core benefits

Question 26

What is a managed care plan alternative to Medicare supplement insurance.

Answer 26

Medicare Select - Insured’s get care exclusively from the plans network of providers

Question 27

What are the Part A core benefits of a Medicare supplement plan?

Answer 27

1.Part A hospital coinsurance
2. Additional Part A hospital benefits
3. 365 days of ‘additional’ hospital care after depletion of the Original Medicare hospital benefits
4. Part B coinsurance after the annual deductible is met.
5. Parts A+B “Blood coverage” for the the first 3 pints of blood per calendar year.

Question 28

ALL Medigap/“Medicare supplement” insurance must include coverage for what kind of care?

Answer 28

Hospice care.

Question 29

States do not have to allow all ten standardized Medigap plans to be sold within their boundaries. However, all states must allow insurers to sell at least what?

Answer 29

All states must allow insurers to sell plan A and its core benefits.

Question 30

Medicare SUPPLEMENT plans sold today cannot include what kind of coverage?

Answer 30

Prescription drug coverage - PART D

Question 31

All Medicare supplement plans are guaranteed renewable- a policy can NOT be canceled due to?

Answer 31

Can NOT be canceled b/c The insureds health.
Premiums can go up but has to apply
To all policies, not just that particular insured.

Question 32

An insurer cannot issue a Medicare supplement policy to a person enrolled in Medicare Part C (Medicare advantage) UNLESS?

Answer 32

Unless the Medigap plan’s effective date is AFTER the termination date of the Part C coverage.

Question 33

Every Medicare select plan must be labeled with what?

Answer 33

The type of medigap plan on which it is based and it MUST include the word SELECT

Question 34

While it offers essentially the same benefits as a Medigap policy, a Medicare SELECT policy is less expensive…why?

Answer 34

B/c participants must be “in-network”

Question 35

Medicare SELECT only supplements Medicare Parts?

Answer 35

Parts A+B
Medicare select can NOT supplement Part C (advantage plan)

Question 36

All insurance companies selling Medicare supplement policies must sell plan___?

Answer 36

Plan A

Question 37

Which of the two is a managed care policy? Medigap or Medicare SELECT?

Answer 37

Medicare SELECT

Question 38

True or False- Medigap is a managed care policy.

Answer 38

FALSE-
Medigap is a traditional indemnity policy.

Question 39

All Medicare supplement plans cover the hospital coinsurance for what amount of days?

Answer 39

ALL plans pay the 61st through the 90th days’ hospitalization, as well as the 91st through 150th days’ for each lifetime reserve day, and additional hospital costs up to 365 days after depletion of Original medicare hospital benefits

Question 40

What is the name of when an applicant deplete’s/exhaust’s their asset’s to become eligible for medicaid, if these assets are above the allowable limit ?

Answer 40

Spending Down

Question 41

The concept of “spending down” is especially significant with respect to what in kind of care with senior citizens? why?

Answer 41

-long term care
even financially stable people have a hard time paying for long term care without turning to medicaid for help.Depleting their assets will help them qualify for medicaid

Question 42

Children that are in families whose income is less than the federal poverty level are eligible for Medicaid coverage through?

Answer 42

Childrens Health Insurance Program (CHIP)

Question 43

Medicare is a Primary insurer, Medicaid is a ____ insurer?

Answer 43

Secondary

Question 44

When a person applies for medicaid, the limits and types of income and assets counted vary, depending on more than one thing… What is an example?

Answer 44

Whether the applicant has a spouse who needs support

Question 45

Both the federal govt and the state govt fund Medicaid. Only one “administers” it..Which is it?

Answer 45

ONLY the states ADMINISTER medicaid

Question 46

Modern long term care policies can no longer require what?

Answer 46

That the insured be hospitalized before benefits are triggered.

Question 47

What is the difference of service days and calendar days for LTC plans and benefits?

Answer 47

Calendars days are the specific number of days that must pass before benefits are payable.
Service days are the accumulative amount of days that care was received. (30 days of care in total, not in a row)

Question 48

Which policy cost less? Shorter elimination period or longer elimination period?

Answer 48

Longer elimination period

Question 49

Policy payments begin after the insured has passed the ?

Answer 49

Elimination period aka waiting period

Question 50

What are the three basic levels of long term care?

Answer 50

Custodial, intermediate, and skilled nursing care.

Question 51

Out of the 3 levels of LTC, which is usually the most expensive?

Answer 51

skilled nursing care- b/c needs 24hr coverage

Question 52

Which type of LTC policy pays a daily benefit amount NO MATTER what the actual cost is?

Answer 52

LTC indemnity policy

Question 53

When are LTC policy benefits triggered?

Answer 53

When the insured has the inability to perform two or more activities of daily living (ADL), or the loss of cognitive ability, or medical necessity.

Question 54

What is automatically included in a LTC policy unless the buyer rejects it in writing?

Answer 54

Inflation protection.

Question 55

What is a common benefit period in a long-term care policy?

Answer 55

2-5 years

Question 56

What Medicare supplement plans are only available to those who were 65y/o before year 2020?

Answer 56

C, F, standard deductible and F high deductible

Question 57

what is the name of the level of care in a LTC policy that: is continuous 24 hour care delivered by licensed medical professionals, under direct supervision of a doctor and usually in a nursing home?

Answer 57

Skilled nursing care.

Question 58

what is the name of the level of care in a LTC policy that: is ongoing care for a person’s condition but not needed all day.

Answer 58

Intermediate care

Question 59

what is the name of the level of care in a LTC policy that: helps a person with daily living activities. Does not have to be administered by skilled professionals and usually provided by nurses aids.

Answer 59

Custodial care

Question 60

All LTC policies must be issued as ___?

Answer 60

guaranteed renewable