Medicare and Medicaid Chapter 20

Question 1

Monica is covered under Medicare part A. She spends 9 days in the hospital for back surgery and is released on August 22nd. It was the first time she ever had to stay overnight in the hospital. When the bill arrives, she pays her deductible, and medicare pays the balance. She is admitted to the hospital again on November 14th of that same year for additional surgery. Which of the following statements is correct?

A. she will not have to pay the part A deductible again

B. she need not pay the part A deductible, but she must make a daily co-payment

C. it will be considered the start of a new benefit period

D. she will have to pay the part A deductible agian only if the second surgery is unrelated to the first surgery

Answer 1

C

Question 2

Lynn is insured under medicare part A and enters the hospital for surgery. Assuming that Lynn has not yet tapped into her lifetime reserve, what is the maximum number of days that medicare will pay for her hospital bills?

A. 90 days

B. 60 days

C. 120 days

D. 150 days

Answer 2

D

Question 3

Which of the following statements regarding medicare supplement insurance is incorrect?

A. it is illegal to sell a medicare supplement policy to a person who is in a medicare advantage plan

B. all standard medigap plans must include 100% of the part A hospital coinsurance

C. medicare supplement policies cover co-payments, coinsurance and deductibles

D. the number of standard medigap plans changes every year

Answer 3

D

Question 4

An individual who requires 24 hour a day supervision by skilled medical professionals in a nursing home receives what kind of care?

A. custodial care

B. intermediate nursing care

C. skilled nursing care

D. respite care

Answer 4

C

Question 5

Individuals claiming a need for medicaid must prove that they cannot pay for their own nursing home care. In addition, the potential recipient must

A. be receiving social security

B. be a long-term care insurance policyowner

C. be at least 70 years old

D. need the type of care that is provided only in a nursing home

Answer 5

D

Question 6

Medicare supplement insurance is designed for persons who have reached age of

A. 50 to 65

B. 65 or older

C. 70 to 80

D. 60 or older

Answer 6

B

Question 7

All of the following benefits are available under Medicare except

A. home health care visits for a speech therapist

B. hospital expenses

C. skilled nursing care following a hospital stay of at least 3 days

D. custodial care

Answer 7

D

Question 8

In addition to the Buyers guide, what must be delivered to an applicant or insured either with or before the delivery of a life insurance policy?

A. a copy of the signed application

B. a copy of the company annual report

C. the outline of coverage

D. a statement regarding dividends

Answer 8

C

Question 9

What is the maximum number of days of skilled facility care for which Medicare will pay benefits?

A. 75 days

B. 25 days

C. 60 days

D. 100 days

Answer 9

D

Question 10

A 65 year old employee of a company with 90 employees suffers a heart attack and as a result, becomes totally disabled. Which of the following statements describes how his health benefits will be paid?

A. medicare pays most of the benefits. After that, his employer sponsored health insurance pays the remainder

B. because he is over 65, medicare is responsible for paying all benefits

C. his employer is the primary payer and medicare pays the remaining eligible expenses

D. as an active employee, his employer sponsored health insurance will pay all benefits

Answer 10

C

Question 11

Charles signs up for Medicare Part B on March 21, during the open enrollment period. His coverage will become effective

A. July 1

B. June 30

C. March 21

D. April 1

Answer 11

A

Question 12

To be eligible for Medicare’s skilled nursing facility care benefit, the claimant must do all of the following except

A. meet acceptable income limits

B. enter a medicare-certified skilled nursing care facility

C. have a physician certify that skilled care is required

D. meet acceptable income limits

Answer 12

A

Question 13

Which of the following statements regarding Medicare is correct?

A. medicare recipients are billed for their medicare part a premiums on a semiannual basis

B. medicare part A carries no deductible

C. under medicare part B, payments for physician’s services are unlimited

D. medicare part B is voluntary

Answer 13

D

Question 14

Medicare plans K and L are characterized by which of the following features?

A. no annual limit on annual out of pocket expenditures

B. lower co-payments

C. higher coinsurance contributions

D. no annual deductible

Answer 14

C

Question 15

A medicare supplement policy that contains restricted network provisions is known as

A. an HMO

B. a long term care policy

C. an individual health policy

D. a medicare select policy

Answer 15

D

Question 16

Medicare is an example of

A. social insurance

B. commercial insurance

C. debt insurance

D. casualty insurance

Answer 16

A

Question 17

Which of the following is not covered by Medicare Part A?

A. a skilled nursing facility

B. hospice care

C. home health care

D. an outpatient medical facility

Answer 17

D

Question 18

Under Medicare Part B, the participant must pay

A. 80% of covered charges above the deductible

B. a per benefit deductible

C. 20% of covered charges above the deductible

D. have a physician certify that skilled care is required

Answer 18

C

Question 19

All Medicare supplement policies must cover 100% of the Part A hospital coinsurance amount for each day used from

A. the 45th through the 90th day in any medicare benefit period

B. the 61st through the 90th day in any Medicare benefit period

C. the 30th through the 90th day in any medicare benefit period

D. the 1st through the 60th day in any medicare benefit period

Answer 19

B

Question 20

Which of the following statements pertaining to Medicare is correct?

A. Elena is covered under medicare part she submitted a total of $1,100 of approved medical charges to medicare after paying the required deductible. Of that total, Elena must pay $880

B. each individual covered by medicare part A is allowed one 90 day benefit period per year

C. for the first 90 days of hospitalization, medicare part A pays 100% of all covered services, except for an initial deductible

D. medicare part A is automatically provided when a qualified individual applies for social security benefits

Answer 20

D

Question 21

Which of the following individuals would be eligible for Medicare?

A. Marla, who is 59 and has received social security disability benefits for the last 36 months

B. Nick, a single person who is 45 and has never worked

C. Bernadette, who retired at 55 and is now 60 and living on her company pension

D. Simon, who is 62 and just started receiving his social security monthly retirement checks

Answer 21

A

Question 22

With regard to medical benefits available through the federal government, Medicaid provides

A. funds to states to assist their medical public assistance programs

B. medical benefits for the disabled, regardless of income

C. medical benefits to all who have contributed to its funding through payroll taxes

D. medical benefits exclusively for the aged

Answer 22

A

Question 23

A contract designed primarily to supplement reimbursement under Medicare for hospital, medical or surgical expenses is known as

A. an alternative benefits plan

B. an alternative health care plan

C. a home health care plan

D. a medicare supplement plan

Answer 23

D

Question 24

Medicare part A covers

A. custodial care

B. private duty nursing

C. 80% of the cost of durable medical equipment

D. the first three pints of blood

Answer 24

C

Question 25

An individual who chooses not to enroll in Part B when first applying for Medicare may do so

A. at any time after enrolling in part A

B. on the anniversary of his part A enrollment date

C. between July and September of each year

D. during an annual open enrollment period

Answer 25

D

Question 26

Which of the following is a federal and state program designed to help provide needy persons, regardless of age, with medical coverage?

A. medicare

B. medicaid

C. medigap

D. workers compensation

Answer 26

B

Question 27

Skilled nursing care differs from intermediate care in which of the following ways?

A. skilled nursing care must be available 24 hours a day, whereas intermediate care is daily, but not 24 hour care

B. skilled nursing care is typically given in a nursing home, whereas intermediate care is usually given at home

C. skilled nursing care encompasses rehabilitation, whereas intermediate care is for meeting daily person needs, such as bathing and dressing

D. skilled nursing care must be performed by skilled medical professionals, whereas intermediate care does not require medical training

Answer 27

A

Question 28

Medicaid provides

A. funds to states for the provision of medical care to the aged

B. funds to charitable organizations for providing medical benefits to poor people

C. medical benefits to those who have contributed to its funding through payroll taxes

D. funds to states to assist their medical public assistance programs

Answer 28

D

Question 29

The purpose of Medicare supplement insurance is to provide

A. an alternative insurance plan for people who do not want to use medicare

B. coverage to elderly people who are not covered under a corporate plan for retired employees

C. coverage for certain expenses not fully covered by medicare

D. coverage for certain medical expenses before the insured becomes eligible for medicare

Answer 29

C

Question 30

Which of the following statements regarding the lifetime reserve of hospital coverage for Medicare patients is correct?

A. the reserve may be replenished if the patient reenters a hospital after a benefit period ends and pays a new deductible

B. tapping into the reserve results in a lower daily co-payment

C. if a patient exhausts the reserve, she must pay a higher co-payment

D. the reserve does not renew with a new benefit period

Answer 30

D

Question 31

The purpose of Medicare supplement insurance is to provide

A. coverage for certain expenses not fully covered by medicare

B. coverage to elderly people who are not covered under a corporate plan for retired employees

C. coverage for certain medical expenses before the insured becomes eligible for medicare

D. an alternative insurance plan for people who do not want to use medicare

Answer 31

A

Question 32

The first page of a Medicare supplement policy must contain all of the following except

A. the policy’s renewal provision, including a description of any premium increases that may be involved

B. highly visible notice of the 30 day free look period

C. the producer’s commission and the policy’s premium

D. the notice to buyer-this policy may not cover all of your medical expenses

Answer 32

C

Question 33

A Medicare supplement policy must offer coverage of Medicare Part A-eligible expenses for hospitalization

A. from days 61 through 90

B. for the first year

C. from days 1 through 90

D. for the length of the illness

Answer 33

A

Question 34

The abbreviation PDP refers to which part of Medicare?

A. Part B

B. Part D

C. Part C

D. Part A

Answer 34

B

Question 35

The core policy (Plan A) developed by NAIC as a standard Medicare supplement policy includes all of the following except

A. coverage for the Medicare Part A deductible

B. coverage for the first 3 pints of blood each year

C. coverage for the part A coinsurance amounts

D. coverage for the 20% part B coinsurance amounts for medicare approved services

Answer 35

A

Question 36

Which of the following statements regarding Medicare part B is not true?

A. it provides glaucoma testing once every 12 months

B. it pays for skilled care provided in the home like speech, physical, or occupational therapy

C. it provides for annual mammograms for those over 40, pap tests, pelvic exams, and clinical breast exams

D. it covers a routine physical exam within 6 months of enrollment

Answer 36

B

Question 37

Victoria currently as a Medicare Advantage Plan. Should her agent sell her a Medicare supplement policy?

A. no, it is illegal for anyone to sell a medicare supplement policy to someone who is already in a medicare advantage plan (medicare c).

B. yes, if her agent does not offer to sell her a medicare supplement policy, the agent could be sued under her errors and ommissions policy

C. no, her agent already provides her with all the insurance she requires

D. yes, it is her agents responsibility to make sure she has the coverages she needs

Answer 37

A

Question 38

People age 65 or older who enroll in Medicare Part B may also select Medigap coverage during

A. a grace period

B. an open enrollment period

C. a free enrollment period

D. a free look period

Answer 38

B

Question 39

In the standardized Medicare supplement policy, Plan A is characterized by

A. availability only to medicare recipients younger than age 75

B. offering the widest coverage

C. providing the least comprehensive coverage

D. duplicating medicare benefits for maximum security

Answer 39

C

Question 40

Tom is covered under Medicare Part A. He spends 1 week in the hospital for some minor surgery and return home on July 10. It was his first hospital stay in years. Which of the following statements regarding his Medicare coverage is correct?

A. after Tom pays the deductible, medicare part A will pay 100% of all covered charges

B. medicare part A will not cover Tom’s hospital expenses because he was not hospitalized for 10 consecutive days

C. after Tom pays the deductible, medicare part A will pay 80% of all covered charges

D. medicare part A will pay benefits, but Tom must make a daily co-payment

Answer 40

A

Question 41

Which of the following statements about Medicare D is correct?

A. it is available to anyone enrolled in medicare part A and part B

B. benefits are available only through medicare advantage plans

C. some plans offer basic drug coverage

D. it helps cover the costs of hospitalization

Answer 41

A

Question 42

Medicare is designed to pay for

A. old age benefits

B. a large portion of the health care bill for eligible persons

C. death benefits

D. disability benefits

Answer 42

B

Question 43

A contract that is designed primarily to augment reimbursement under Medicare for hospital, medical, or surgical expenses is known as

A. an alternative health care plan

B. an alternative benefits plan

C. a medicare supplement plan

D. a home health care plan

Answer 43

C

Question 44

Which of the following coverages must be included in all Medicare supplement policies?

A. emergency care in a foreign country

B. at home recovery services

C. cost of the first 3 pints of blood

D. daily coinsurance amount for skilled nursing facility care

Answer 44

C

Question 45

Medicare supplement (Medigap) policies do not

A. supplement medicare benefits

B. pay for some health care services not covered by medicare

C. pay for most or all medicare deductibles and co payments

D. pay for extended nursing home care

Answer 45

D

Question 46

Which of the following required provisions is incorrect?

A. medicare supplement policies must have a 10 day free look period

B. medigap policies must be at least guaranteed renewable

C. medigap policies may not duplicate benefits provided by medicare

D. pre-existing conditions limitations may not last longer than six months from the date of issue

Answer 46

A

Question 47

Paul age 66, works for American Accounting Inc, a firm with 500 employees. He is covered by its health insurance plan. He is also covered by Medicare. Which of the following statements is correct?

A. american accountings plan is the primary payor, and medicare is the secondary payor

B. medicare is the primary payor, and american accountings plan is the secondary

C. medicare will pay only the deductibles that are not covered by american accountings plan

D. medicare is not required to provide coverage for Paul

Answer 47

A

Question 48

Under Medicare Part A, the participant must pay his deductible

A. once per benefit period

B. monthly

C. annually

D. twice per benefit period

Answer 48

A

Question 49

Which of the following statements about Medicare supplement policies is correct?

A. there are 3 basic supplement policies that are considered core plans

B. each standardized medicare supplement policy must cover the basic benefits

C. medicare plan B provides coverage for skilled nursing facility care and at home recovery care

D. medicare plan A provides coverage for skilled nursing facility care

Answer 49

B

Question 50

Which of the following is a mandatory minimum benefit for Medicare supplement policies?

A. supplemental coverage for 80% of all eligible hospital expenses not covered by medicare

B. coverage of the 30% coinsurance amount under medicare part B, subject to a calendar year deductible of $100

C. a $1,000 death benefit

D. coverage of medicare part A-eligible hospital expenses to the extent not covered by Medicare from the 61st through the 90th day in any medicare benefit period

Answer 50

D

Question 51

To be eligible for Medicare, you must be fully insured according to social security. This involves accumulating a minimum of how may credits?

A. 40 credits

B. 100 credits

C. 80 credits

D. 60 credits

Answer 51

A

Question 52

Medicare supplement (or Medigap) policies pay

A. benefits to those who cannot afford medicare part B coverage

B. benefits provided under medicare part A

C. all or most of medicare’s deductibles

D. medical costs arising from extended custodial (nursing home) care

Answer 52

C

Question 53

According to the National Association of Insurance Commissioners standardized model Medicare supplement, insurers must offer coverage for all of the following core benefits except

A. the coinsurance amount of medicare part B-eligible expenses, regardless of hospital confinement, subject to the medicare part B deductible

B. the medicare part A deductible

C. coverage under medicare parts A and B for the first 3 pints of blood or equivalent (unless replaced according to federal regulations)

D. medicare part A-eligible hospital expenses not covered by medicare from the 61st day through the 90th day in any medicare benefit period

Answer 53

B

Question 54

The core policy (Plan A) developed by the NAIC as a standard Medicare supplement policy includes all of the following except

A. the first 3 pints of blood each year

B. the 20% part B coinsurance amounts for medicare approved services

C. coverage for part A co-payment amounts

D. long-term care insurance deductibles

Answer 54

D

Question 55

Sally age 66, has accumulated 50 credits from working during the past 15 years. For social security purposes, this means that Sally is

A. ineligible for medicare

B. fully insured

C. ineligible for full retirement and survivor benefits

D. partially insured

Answer 55

B