Medicare Part B Flashcards
Part B annual deductible
$147.00
Part B Annual blood deductible
3 pints
Part B coinsurance
20%
Under Part B, how much can “nonparticipating” physicians charge?
115% of the approved Medicare Part B amount
What is the name of the document that must be supplied to the beneficiary if the provider believes a certain requested service will not be covered by Medicare?
Advanced Beneficiary Notice (ABN)
Medicare Part B 2014 premiums for people making $85,000 or less
$104.90
Failure to enroll in Medicare Part B during their initial Enrollment Period will result in a permanent additional __% premium for EACH full ____ delayed enrollment from the end of the individual’s Initial Enrollment Period
10% for each 12 months
Hoqw long do physicians have to file a claim with Medicare without incurring a reduction in payment?
1 year
What is the name of the document that must be sent to the beneficiary by the MAC when a claim is filed?
Medicare Summary Notice
Medicare will provide coverage for bone mass measurements at lease every ___ for treatment of osteoporosis
24 months
Medicare will provide coverage for cardiovascular screenings every ___ years
5
Medicare will provide coverage for a colonoscopy once every ___ for high-risk patients
24 months
Medicare will provide coverage for mammograms, pap smear/pelvic exams, prostate cancer screenings once every ___
12 months
Part B requires a ___% deductible for outpatient mental health services. The initial diagnosis will have ___% coinsurance.
40%; 20%
The “Welcome to Medicare” [hysical exam will be free if conducted within ___ of the enrollment
12 months
By law, what type of plan cannot be sold to enrollees in Part C
Medicare Supplement
T/F: Medicare supplement plans cover hospice
False- Hospice will be covered by Part A
Part C Open Enrollment
October 15th to December 7th
Part C plan benefits for those who enroll during the general enrollment period will begin on what date?
Jan. 1
T/F: Medicare Beneficiaries cannot be solicited to join a Medicare Advantage Plan
True
What medical condition will make someone ineligible for Part C?
End Stage Renal Disease, or require kidney dialysis or require a kidney transplant
T/F: A beneficiary can enroll in Part C if they aren’t enrolled in Part B
False- Beneficiary must be enrolled in both Parts A & B in order to enroll in Part C.
Open enrollment period for Part D
October 15th-December 7th
Late enrollment penalty for Part D
1% for each month after end of initial enrollment period
Expected average premium for Part D in 2014
$32.42- rates vary depending on coverage
Part D “donut hole” boundaries
$2,850-$4,550 (these totals included beneficiary payments PLUS insurer payments)
During the Part D “gap,” how much coinsurance does the beneficiary have to pay? (for basic PDP)
47.5% for brand name
79% for generic
During the “catastrophic coverage” phase of Part D, how much coinsurance will the beneficiary have to pay? (for basic PDP)
5% or a copayment of:
$2.65 for generic
$6.60 for others
How often can an insurer change its Prescription Drug Plan (PDP)
annually
T/F: Medicare beneficiaries enrolled in a Medicare-approved PDP can receive extra help if they are also enrolled in Medicaid AND a Medicare Savings Plan.
True
Part D Basic plan deductible
$310
Medicare Supplement (Medigap) policies cannot be sold to people who have coverage under which part of Medicare?
Part C
T/F: Medicare Supplement policies provide coverage for Part D
False- Medigap is only for Parts A & B
T/F: Medicare Supplement policies can be sold to beneficiaries who have at least Part A coverage
False- Beneficiaries must be covered by both Parts A & B in order to purchase Medigap
Are Medigap policies sold as individual policies, family policies, or both?
Individual policies only
How many Medigap policies are available?
10
What Medigap policies no longer sold?
E,H,I,J
What percentage does a Medigap Plan K pay?
50%
What percentage does a Medigap Plan L pay?
75%
Which Medigap Plan(s) offer a high deductible?
Plan F
What is the out-of-pocket Maximum for Medigap Plan K?
$4,800
What is the out-of-pocket Maximum for Medigap Plan K
$2,400
Medigap Plans available to people who have Medicare Coverage due to a disability or end stage renal disease?
Plans A,C,F
Open enrollment period for Medicare Supplement Policies
6 months after enrollment in Part B- after this coverage is not guaranteed and one can be denied a policy
What is the mandatory loss ratio for Medicare Supplement Policies for individuals?
65%
What is the mandatory loss ratio for Medicare Supplement Policies for groups?
75%
T/F: Medigap policies can contain limitations or exclusions from coverage that are more restrictive than those of original Medicare
False
T/F: Medigap policies are guaranteed renewable?
True
Insureds must be notified how many days before changes in the Medicare Program take effect?
30 days
If a Medicare Supplement insured begins receiving Medicaid benefits, he or she may within ____ request a suspension of premiums and benefits under the policy for up to ____
90 days; 2 years
Medicare Supplement coverage my be automatically reinstated (without conditions) if the insured loses Medicaid eligibility and notifies the insurer within ____ of the lost Medicaid eligibility
90 days
Insureds may only have ____ Medigap policy(ies)
One
An agent may not earn more than ___% in first year commissions relative to the second year’s renewal commissions
200%
The renewal commission must be the same in years ___ through ___
2-6
How long does a Medicare beneficiary who has switched from Original Medicare to Medicare Advantage or who has enrolled directly into Medicare Advantage have to switch back and be guaranteed reinstatement of a Medigap policy if they want it
12 months
Maximum aggregate coverage that can be provided by Medigap for foreign travel emergencies
$50,000
Medigap annual deductible for foreign travel emergencies
$250
Medigap Coinsurance for foreign travel emergencies
80/20
T/F: A person must be certified, in writing, by a physician of the necessity for admission to a nursing home and level of care required in order to be eligible for Medicaid
True
A community spouse may keep up to how much of their spouse who is insured through Medicaid
Up to the minimum monthly maintenance needs allowance. If the community spouse has some income, but less than the MMMNA, they will be allowed to keep their spouse’s income up to the difference between their own income and the MMMNA
A community spouse may keep all of their own assets as well as what percent of co-owned assets between them and their spouse?
50%, subjecy to a minimum and maximum, both of which are established annually
The cash surrender value of life insurance policies are not counted by Medicaid in the “spend down” if they have a combined face value of less than what amount?
$1,500
T/F: The residence of an insured under Medicaid is counted in the “spend down”
False
Penalty period for asset transfers under the Medicaid Policy
60 months prior to application for Medicaid (Before the Deficit Reduction Act of 2005 it was 36 months)
Long-Term Care Insurance (LTCI) provides coverage for not less than how many months?
12 months
What are the six Activities of Daily Living (ADLs)?
Bathing Eating Transferring Dressing Toileting Continence
T/F: LTCI policies don’t have elimination periods
False, most LTCI policies have elimination periods, though it is at the insurer’s discretion
T/F: NC LTCI regulations require companies to offer applicants a method of increasing the daily benefit amount to offsety the effect of inflation
True
Under automatic inflaion protection, benefit amounts increase at a minimum of what percent compounded annually?
5%
T/F: NC LTCI insurers don’t have to offer non-forfeitures to applicants
False
T/F: NC LTCI policies MUST have a provision for having the applicant list a third party to be notified before cancellation or lapse of policy
True, though the applicant can sign a waiver opting out
Notice of premium nonpayment cannot be given until how long after the missed due date?
30 days
Notice of non-payment of premium for a LTCI policy shall be deemed to have been given as of ___ days after the date of mailing
5 days
No LTCI policy can be lapsed or be terminated for nonpayment of premim how many days after the missed due date?
65 days
LTCI policy reinstatement must be provided to anyone who furnishes proof of cognitive impairment within how long after policy lapse or termination?
5 months
T/F: All NC LTCI policies must be guaranteed renewable
True
NC regulations require LTCI policies to provide ___ levels of care for a period of at least ___ consecutive months
3 levels; 12 months
LTCI policy-holders must be given ___ days notice before there is a premium increase
45 days
All NC LTCI policies must have a free-look period of how many days?
30 days
T/F: The six and six rule applies to LTCI
True
LTCI policies have a period of incontestibility of how long?
2 years
Policies to be issued to anyone age ___ or older must be accompanied by a physical examination of the proposed insured, and assessment of the functional ability of the proposed insured and an attending physician’s statement or medical records provided about the insured to the insurance company
80
T/F: LTCI is a Medicare Supplement
False
In the Outline of Coverage on an LTCI policy must have a font size no smaller than ___ point type
10
LTCI Outlines of Coverage on an LTCI policy must provide a comparison covering at least a ___ year period
20 year
LTCI Outlines of Coverage must provide premiums charged for what two ages?
75 and 85
T/F: An outline of coverage and Shopper’s Guide must be provided at the time of application for an LTCI policy
True
Individual LTCI policies must have a loss ratio of ___%
60%
Group LTCI policies must have a loss ratio of ___%
75%
How long does the replacing LTCI insurer have to give notice to the existing insurer after the replacing insurer has received the application for replacement
5 business days
In LTCI policies, if home health care benefits are offered, the amount of payment can be no less than how much?
$25 per day
How big must a group be to qualify for group LTCI?
100
How long must a group have been in existence to qualify for group LTCI?
1 year
