IX. Insurance for Senior Citizens and Special Needs Individuals

Question 1

To whom is Medicare available?

Answer 1

People 65 or older even if they continue to work

Question 2

What does Medicare Part A cover

Answer 2

Inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care

Question 3

What is the initial enrollment period for Medicare Part A?

Answer 3

3 months before turning age 65 to 3 months after the month of birth.

Question 4

How is Part B of Medicare Funded?

Answer 4

monthly premiums and general revenues of the federal government

Question 5

Who is eligible for Part B of Medicare?

Answer 5

Part B is optional and offered to everyone who enrolls in Part A

Question 6

When is the general enrollment period for Medicare Part B?

Answer 6

January 1 to March 31st of every year

Question 7

What is excluded from coverage under Medicare Part B?

Answer 7

Private nursing
Skilled nursing home care cost over 100 days per benefit period
Intermediate nursing home care

Question 8

What are the advantages of an HMO or PPO for a Medicare recipient?

Answer 8

no claims forms required,
almost any medical problem is covered for a set fee so health care costs can be budgeted,
HMO or PPO may pay for services not usually covered by Medicare or Medicare supplement policies such as prescriptions, eye exams, hearing aids, or dental care.

Question 9

Who provides primary coverage if an individual who is eligible for medicare is still active under an employer plan?

Answer 9

Employer plan is primary.

Question 10

What is the purpose of Medicare Supplement Plans?

Answer 10

‘Medigap’ policies are issued by private insurance companies that are designed to fill in some of the gaps in medicare.

Question 11

Which Medicare supplement plan must be offered in all plans?

Answer 11

Part A. Part B and C are optional.

Question 12

What is the difference between Medicare SELECT and other Medicare policies?

Answer 12

Usually a lower premium with restricted network provisions.

Question 13

What must be included on the first page of a replacement policy?

Answer 13

“Notice to the Buyer: This policy may not cover all of your medical expenses”

Question 14

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

Answer 14

30 days

Question 15

What must be included in the renewal or continuation provision of a Medicare supplement policies?

Answer 15

Any reservation by the insurance company of the right to change premiums, and any automatic renewal premium increases based on the age of the policy holder.

Question 16

What is the maximum allowed first year commission for the sale of a Medicare Supplement Policy?

Answer 16

200% of the renewal commission.

Question 17

Describe the purpose for permitted compensation arrangements?

Answer 17

Permitted compensation arrangement detail the circumstances of the compensation made to agents for the sale of Medicare Supplement Policies. Agents may not receive compensation greater than the renewal compensation payable by the replacing insurance company unless the new policy are clearly and substantially greater than in policy being replaced.

Question 18

What is the purpose of Medicaid?

Answer 18

Federal and State funded program for those whose income and resources are insufficient to meet the cost of necessary medical care.

Question 19

What is included under the definition of Activities of Daily Living?

Answer 19

ADLs include mobility or transferring, bathing, dressing, toileting, continence, and eating.

Question 20

Where is skilled nursing care generally provided?

Answer 20

Institutional setting

Question 21

Describe an individual who would be a candidate for custodial care. who would provide it?

Answer 21

Custodial care is provided for meeting personal needs, and must be given under a doctor’s orders.

Question 22

Who would be eligible for adult day care? What services would be provided?

Answer 22

provided for functionally impaired adults on less than a 24-hour basis. Care includes transportation to and from the day care center, and a variety of health, social and related activities. Meals are usually included as part of the service.

Question 23

Regarding Medicare Supplement Plans, What is required of insurance companies during the open enrollment period for an eligible person?

Answer 23

Sell the patient a Medicare supplement plan (Coverage is offered on a guaranteed issue basis)
Cover all pre-existing conditions incurred more than 6 months from the effective date of the coverage
Not charge more for a supplement policy because of past or present health problems.

Question 24

The Omnibus Budget Reconciliation Act of 1990 requires the employer health plan to provide primary coverage for individuals with end-stage renal (kidney) disease before Medicare becomes primary for how many months?

Answer 24

The Omnibus Budget Reconciliation Act of 1990 as amended by the Balanced Budget Act of 1997 requires the employer health plan to provide primary coverage for 30 months for individuals with end-stage renal (kidney) disease before Medicare becomes primary.