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Licensing Class 2024 > Medicare & Medicaid > Flashcards

Medicare & Medicaid Flashcards

1
Q

What does Medicare Part A cover?

A

Inpatient care in hospitals, skilled nursing facility care, hospice care and home health care.

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2
Q

What is part of Medicare coverage is considered Hospital insurance ?

A

Medicare Part A

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3
Q

What does Medicare Part B cover?

A

Services from Doctors and other health care providers, outpatient care, home health care, durable medical equipment, Preventative services.

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4
Q

What does Medicare Part D cover?

A

Prescription Drugs, including many recommended shots or vaccines.

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5
Q

What is considered the original Medicare ?

A

Part A & Part B

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6
Q

What is Medicare Advantage known as?

A

Part C

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7
Q

What does Medicare Advantage cover?

A

In Network only providers and Doctors. It also covers vision, hearing, and dental services.

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8
Q

What is Medigap?

A

It is a Medicare Supplement Insurance that covers / or fills in the gaps in areas that the original Medicare doesn’t pay for such as copayments, coinsurance, and deductibles.

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9
Q

If you have Medicare Advantage, is it possible to purchase Medigap?

A

No

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10
Q

When is open enrollment for Medicare Part A & Part B coverage?

A

This is 3 months before you turn age 65 and 3 months after the month you turn 65. (7 month period)

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11
Q

Does Medicare Part A and Part B come automatically?

A

Only if you are already receiving benefits from social security or the Railroad retirement Board will you automatically get Part A and Part B starting the first day of the month you turn 65.

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12
Q

If I am not receiving Social Security or Railroad Retirement Board benefits when do I contact Medicare to sign up for Part A and Part B?

A

3 months before you turn 65.

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13
Q

What happens if you don’t sign up for Medicare Part B when you’re first eligible ?

A

You may have a late enrollment penalty of 10% for each full 12 months in the period that you could’ve had Part B. ** If there is a special enrollment period, you usually don’t have to pay a late enrollment penalty.

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14
Q

If you turn 65 on June 1st, the 7 month period would begin and end when?

A

It would begin in February and end in August.

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15
Q

If you sign up for Medicare Part A &/ or Part B during the first 3 months of the initial enrollment Period when would the coverage start ?

A

Coverage would begin the first day of the month of your birthday month.

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16
Q

What is Consolidated Omnibus Budget Reconciliation Act (COBRA)?

A

This covers retiree health plans, VA coverage, and individual health insurance through the insurance Marketplace after they have left the employment of their companies/line of duties.

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17
Q

Do you have to pay premiums for Medicare Part B?

A

Yes

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18
Q

When is General Enrollment Period for Part A & B?

A

January 1- March 31st each year.

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19
Q

If you sign up during the General Enrollment period when does your coverage start?

A

The first day of the month after you sign up.

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20
Q

Who is covered under TRICARE?

A

Active duty and retired service members and their families.

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21
Q

True or False: Are Medigap policies sold by private insurances companies ?

A

True

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22
Q

Does Medicare Part A cover the first 3 pints of blood?

A

No

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23
Q

What Medicare Supplement plan under Medigap covers the most?

A

Plan F

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24
Q

Which of the Medicare Supplement plans under Medigap cover the least?

A

Plan A

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25
Q

True or False: Before you can buy ad Medicare Supplement Insurance ( Medigap) you must have Part A & Part B ?

A

True

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26
Q

Is it illegal for someone to sell a Medigap policy if you already have a Medicare Advantage plan?

A

Yes, UNLESS you are switching back to Original Medicare.

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27
Q

If you have retiree health coverage who who pays first?

A

Medicare pays first

28
Q

If you’re 65 or older, have group health plan coverage based on you or your spouse’s current employer that has 20 or more employees who is the first to pay ?

A

Your group health plan pays first.

29
Q

If you’re 65 or older , have a group health plan coverage based on you or your spouse’s current employer that has fewer than 20 employees who is the first to pay ?

A

Medicare pays first.

30
Q

If you’re under 65 and have disability with group health coverage based on you or a family members current employer and the employer has 100 or more employees, who is the first to pay?

A

Your group health plan pays first.

31
Q

If you’re under 65 and have disability with group health coverage based on you or a family members current employer and the employer who has fewer than 100, who is the first to pay?

A

Medicare pays first.

32
Q

If you have TRICARE who pays first ?

A

Medicare pays first, unless you’re on active duty.

33
Q

If you have Medicaid who pays first?

A

Medicare pays first.

34
Q

Under what circumstance is Medicare Part A premium- free?

A

When a individual is considered fully insured by working 40 credits while paying Social Security FICA taxes.

35
Q

How many days are under the lifetime reserve days ?

A

60 Days

36
Q

True or False: Medicare covers only medically necessary services?

A

True

37
Q

What does it mean if a provider accepts an assignment?

A

It means that the provider has agreed to be paid directly from Medicare, to accept the payment amount that Medicare approves for the service.

38
Q

Do you have to pay a deductible for a new benefit period?

A

Yes

39
Q

If a doctor accepts the assignment, who submits the claim to Medicare ?

A

The Doctor/ their office

40
Q

Providers who haven’t accepted an assignment for all services are called ________

A

Non-participating

41
Q

If a provider does not accept an assignment is it possible that you will have to pay more for the service?

A

Yes

42
Q

What are some of the different types of Medicare Advantage plans ?

A

Health Maintenance Organization (HMO)

Preferred Provider Organization (PPO)

Private Fee-for-Service (PFFS)

43
Q

To join a Medicare Advantage Plan you must have what (hint: 3 specific things)

A
  • You must be a citizen
  • You must have Part A & Part B
  • You must live in the plan’s service area.
44
Q

Under the Medicare Advantage Plans: With Health Maintenance Organization plans (HMO) are you able to pick any provider/ Doctor?

A

No, the provider/doctor must be in network. (Except for emergency care)

45
Q

Under the Medicare Advantage Plans: With Health Maintenance Organization plans (HMO) do you need a referral to see a specialist?

A

Yes, in most cases.

46
Q

Under the Medicare Advantage Plans: Can you choose any provider/Doctor with a Preferred Provider Organization (PPO) ?

A

Yes, you can use in network and out of network providers for covered services, usually for a higher cost.

47
Q

Under the Medicare Advantage Plans: Do you need a referral to see a specialist if you have a Preferred Provider Organization (PPO) ?

A

No, but if you use in network specialist, your cost for covered services will usually be lower than the out of network specialist.

48
Q

Under the Medicare Advantage Plans: Are you able to select any provider/ doctor while having a Private Fee - for - service (PFFS) plan?

A

Yes

49
Q

How is Medicare funded ?

A

By the Centers for Medicare and Medicaid services (CMS) which is a branch of the Dept of Health and Human resources.

50
Q

If the provider does not accept a Medicare assignment who is the bill sent to?

A

The patient

51
Q

If the provider does not accept a Medicare assignment who is responsible to fill out the claim form with the itemized bill?

A

The patient

52
Q

When should the buyers guide that was developed by the NAIC be given to a person ?

A

At the time of the application delivery.

53
Q

Under the Medicare Supplement policies: Applicants must be given a Outline of Coverage that describes what ?

A

The policy’s coverage, the premium and renewal provisions.

54
Q

Under the Medicare Supplement policies: Applicants first page if the policy must contain what?

A
  • Notice to Buyer ( it may not cover all medical expenses)
  • 30 day free look
  • The policy’s renewal provision including a description of any premium increases that may be involved
55
Q

True or False: With Medigap, pre-existing conditions may not last longer than 6 months from the date of issue?

A

True

56
Q

What are the eligibility requirements for Medicare coverage?

A

Age 65 or older
Kidney failure (end stage renal disease)
Received SS disability for at least 24 months

57
Q

For Medicare Part A, how many days of the hospital stay are covered ?

A

90 days

58
Q

For Medicare Part A, how many days in a Skilled nursing facility is paid at 100% by Medicare ?

A

Days 1-20

59
Q

After 100 days in a Medicare qualified skilled nursing facility who is responsible to pay for the expenses?

A

The patient, Medicare stops paying for the facility after 100 days

60
Q

True or False: Medicare Part B is required ?

A

False

61
Q

Who funds Medicaid ?

A

By the State and Federal government

62
Q

How do you qualify for Medicaid?

A

Low income/ the needy, U.S citizens and disabilities.

They must qualify for Temporary assistance for the needy families (TANF) or Supplemental Security Income (SSI) 65 or older, blind, or disabled.

63
Q

What is the largest payor of health care cost?

A

Medicaid

64
Q

What is Program of all-inclusive care for the elderly (PACE)?

A

It is a Medicare and Medicaid program offered to people who otherwise need a nursing home level of care to remain in the community like home/ or apartment.

65
Q

True or False: Medicare covers custodial care ?

A

False

66
Q
A

Licensing Class 2024 (4 decks)

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