Medical Insurance

Question 1

Name two types of military insurance?

Answer 1

Tricare and Champus

Question 2

Who has access to TriCare?

Answer 2

active members, retirees, and their family members, some former spouses and survivors of the deceased.

Question 3

Which branch is eligible?

Answer 3

Army, Navy, Air Force, Marine, Coast Guard, Public Health Service, and NOAA.

Question 4

Who determines the eligibility?

Answer 4

Branches of the military

Question 5

What is the benefit period?

Answer 5

The measure of time for Medicare patients that have used a hospital or nursing facility services.

Question 6

When does the benefit period begin?

Answer 6

Once the patient is admitted as an inpatient and ends when the patient hasn’t received care within 60 days in a row.

Question 7

What is the Benefits Coordination and Recovery Center (BCRC)?

Answer 7

A company that acts on Medicare’s behalf to collect and manage information. They determine whether the coverage pays before or after.

Question 8

True or False: providers have to become certified to treat Medicare patients?

Answer 8

True.

Question 9

What is CHAMPVA?

Answer 9

A health care benefit for dependents of qualifying veterans.

Question 10

What is coinsurance?

Answer 10

The amount the patient is required to pay as their share of the cost for services after they pay the deductible.

Question 11

True or False: Comprehensive outpatient rehab only deals with physical therapy?

Answer 11

False; They provided social and psychological services, rehabilitation, and physicians’ services.

Question 12

What is Medicare Part D?

Answer 12

Drug benefits

Question 13

What is the turnaround time for Part D decisions for payment?

Answer 13

72 hours for standard and 24 hours for expedited. If the patients disagree with the decision they can appeal.

Question 14

What is the coverage gap?

Answer 14

A period of time in which the patient pays a higher cost share for prescription drugs until the patient spends enough to qualify for catastrophic coverage.

Question 15

True or False: Medigap is used for pre-existing conditions?

Answer 15

True; Previous health insurance coverage that can be used to shorten a pre-existing condition waiting period under a Medigap policy.

Question 16

What is creditable prescription drug coverage?

Answer 16

Prescription drug coverage that’s expected to pay on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can generally keep that coverage without paying a penalty.

Question 17

Where are critical access hospitals (CAH) known for?

Answer 17

small rural hospitals that provide 24/7 ER care.

Question 18

What is the ABN?

Answer 18

In Original Medicare, a notice that a doctor, supplier, or provider gives a person with Medicare before furnishing an item or service if the doctor, supplier, or provider believes that Medicare may deny payment. In this situation, if you aren’t given an ABN before you get the item or service, and Medicare denies payment, then you may not have to pay for it. If you are given an ABN, and you sign it, you’ll probably have to pay for the item or service if Medicare denies payment.