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Insurance > Medicare Part B > Flashcards

Medicare Part B Flashcards

1
Q

Part B annual deductible

A

$147.00

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2
Q

Part B Annual blood deductible

A

3 pints

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3
Q

Part B coinsurance

A

20%

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4
Q

Under Part B, how much can “nonparticipating” physicians charge?

A

115% of the approved Medicare Part B amount

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5
Q

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?

A

Advanced Beneficiary Notice (ABN)

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6
Q

Medicare Part B 2014 premiums for people making $85,000 or less

A

$104.90

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7
Q

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

A

10% for each 12 months

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8
Q

Hoqw long do physicians have to file a claim with Medicare without incurring a reduction in payment?

A

1 year

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9
Q

What is the name of the document that must be sent to the beneficiary by the MAC when a claim is filed?

A

Medicare Summary Notice

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10
Q

Medicare will provide coverage for bone mass measurements at lease every ___ for treatment of osteoporosis

A

24 months

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11
Q

Medicare will provide coverage for cardiovascular screenings every ___ years

A

5

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12
Q

Medicare will provide coverage for a colonoscopy once every ___ for high-risk patients

A

24 months

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13
Q

Medicare will provide coverage for mammograms, pap smear/pelvic exams, prostate cancer screenings once every ___

A

12 months

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14
Q

Part B requires a ___% deductible for outpatient mental health services. The initial diagnosis will have ___% coinsurance.

A

40%; 20%

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15
Q

The “Welcome to Medicare” [hysical exam will be free if conducted within ___ of the enrollment

A

12 months

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16
Q

By law, what type of plan cannot be sold to enrollees in Part C

A

Medicare Supplement

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17
Q

T/F: Medicare supplement plans cover hospice

A

False- Hospice will be covered by Part A

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18
Q

Part C Open Enrollment

A

October 15th to December 7th

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19
Q

Part C plan benefits for those who enroll during the general enrollment period will begin on what date?

A

Jan. 1

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20
Q

T/F: Medicare Beneficiaries cannot be solicited to join a Medicare Advantage Plan

A

True

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21
Q

What medical condition will make someone ineligible for Part C?

A

End Stage Renal Disease, or require kidney dialysis or require a kidney transplant

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22
Q

T/F: A beneficiary can enroll in Part C if they aren’t enrolled in Part B

A

False- Beneficiary must be enrolled in both Parts A & B in order to enroll in Part C.

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23
Q

Open enrollment period for Part D

A

October 15th-December 7th

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24
Q

Late enrollment penalty for Part D

A

1% for each month after end of initial enrollment period

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25
Q

Expected average premium for Part D in 2014

A

$32.42- rates vary depending on coverage

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26
Q

Part D “donut hole” boundaries

A

$2,850-$4,550 (these totals included beneficiary payments PLUS insurer payments)

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27
Q

During the Part D “gap,” how much coinsurance does the beneficiary have to pay? (for basic PDP)

A

47.5% for brand name

79% for generic

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28
Q

During the “catastrophic coverage” phase of Part D, how much coinsurance will the beneficiary have to pay? (for basic PDP)

A

5% or a copayment of:
$2.65 for generic
$6.60 for others

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29
Q

How often can an insurer change its Prescription Drug Plan (PDP)

A

annually

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30
Q

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.

A

True

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31
Q

Part D Basic plan deductible

A

$310

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32
Q

Medicare Supplement (Medigap) policies cannot be sold to people who have coverage under which part of Medicare?

A

Part C

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33
Q

T/F: Medicare Supplement policies provide coverage for Part D

A

False- Medigap is only for Parts A & B

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34
Q

T/F: Medicare Supplement policies can be sold to beneficiaries who have at least Part A coverage

A

False- Beneficiaries must be covered by both Parts A & B in order to purchase Medigap

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35
Q

Are Medigap policies sold as individual policies, family policies, or both?

A

Individual policies only

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36
Q

How many Medigap policies are available?

A

10

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37
Q

What Medigap policies no longer sold?

A

E,H,I,J

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38
Q

What percentage does a Medigap Plan K pay?

A

50%

39
Q

What percentage does a Medigap Plan L pay?

A

75%

40
Q

Which Medigap Plan(s) offer a high deductible?

A

Plan F

41
Q

What is the out-of-pocket Maximum for Medigap Plan K?

A

$4,800

42
Q

What is the out-of-pocket Maximum for Medigap Plan K

A

$2,400

43
Q

Medigap Plans available to people who have Medicare Coverage due to a disability or end stage renal disease?

A

Plans A,C,F

44
Q

Open enrollment period for Medicare Supplement Policies

A

6 months after enrollment in Part B- after this coverage is not guaranteed and one can be denied a policy

45
Q

What is the mandatory loss ratio for Medicare Supplement Policies for individuals?

A

65%

46
Q

What is the mandatory loss ratio for Medicare Supplement Policies for groups?

A

75%

47
Q

T/F: Medigap policies can contain limitations or exclusions from coverage that are more restrictive than those of original Medicare

A

False

48
Q

T/F: Medigap policies are guaranteed renewable?

A

True

49
Q

Insureds must be notified how many days before changes in the Medicare Program take effect?

A

30 days

50
Q

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 ____

A

90 days; 2 years

51
Q

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

A

90 days

52
Q

Insureds may only have ____ Medigap policy(ies)

A

One

53
Q

An agent may not earn more than ___% in first year commissions relative to the second year’s renewal commissions

A

200%

54
Q

The renewal commission must be the same in years ___ through ___

A

2-6

55
Q

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

A

12 months

56
Q

Maximum aggregate coverage that can be provided by Medigap for foreign travel emergencies

A

$50,000

57
Q

Medigap annual deductible for foreign travel emergencies

A

$250

58
Q

Medigap Coinsurance for foreign travel emergencies

A

80/20

59
Q

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

A

True

60
Q

A community spouse may keep up to how much of their spouse who is insured through Medicaid

A

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

61
Q

A community spouse may keep all of their own assets as well as what percent of co-owned assets between them and their spouse?

A

50%, subjecy to a minimum and maximum, both of which are established annually

62
Q

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?

A

$1,500

63
Q

T/F: The residence of an insured under Medicaid is counted in the “spend down”

A

False

64
Q

Penalty period for asset transfers under the Medicaid Policy

A

60 months prior to application for Medicaid (Before the Deficit Reduction Act of 2005 it was 36 months)

65
Q

Long-Term Care Insurance (LTCI) provides coverage for not less than how many months?

A

12 months

66
Q

What are the six Activities of Daily Living (ADLs)?

A 
Bathing
Eating
Transferring
Dressing
Toileting
Continence
67
Q

T/F: LTCI policies don’t have elimination periods

A

False, most LTCI policies have elimination periods, though it is at the insurer’s discretion

68
Q

T/F: NC LTCI regulations require companies to offer applicants a method of increasing the daily benefit amount to offsety the effect of inflation

A

True

69
Q

Under automatic inflaion protection, benefit amounts increase at a minimum of what percent compounded annually?

A

5%

70
Q

T/F: NC LTCI insurers don’t have to offer non-forfeitures to applicants

A

False

71
Q

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

A

True, though the applicant can sign a waiver opting out

72
Q

Notice of premium nonpayment cannot be given until how long after the missed due date?

A

30 days

73
Q

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

A

5 days

74
Q

No LTCI policy can be lapsed or be terminated for nonpayment of premim how many days after the missed due date?

A

65 days

75
Q

LTCI policy reinstatement must be provided to anyone who furnishes proof of cognitive impairment within how long after policy lapse or termination?

A

5 months

76
Q

T/F: All NC LTCI policies must be guaranteed renewable

A

True

77
Q

NC regulations require LTCI policies to provide ___ levels of care for a period of at least ___ consecutive months

A

3 levels; 12 months

78
Q

LTCI policy-holders must be given ___ days notice before there is a premium increase

A

45 days

79
Q

All NC LTCI policies must have a free-look period of how many days?

A

30 days

80
Q

T/F: The six and six rule applies to LTCI

A

True

81
Q

LTCI policies have a period of incontestibility of how long?

A

2 years

82
Q

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

A

80

83
Q

T/F: LTCI is a Medicare Supplement

A

False

84
Q

In the Outline of Coverage on an LTCI policy must have a font size no smaller than ___ point type

A

10

85
Q

LTCI Outlines of Coverage on an LTCI policy must provide a comparison covering at least a ___ year period

A

20 year

86
Q

LTCI Outlines of Coverage must provide premiums charged for what two ages?

A

75 and 85

87
Q

T/F: An outline of coverage and Shopper’s Guide must be provided at the time of application for an LTCI policy

A

True

88
Q

Individual LTCI policies must have a loss ratio of ___%

A

60%

89
Q

Group LTCI policies must have a loss ratio of ___%

A

75%

90
Q

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

A

5 business days

91
Q

In LTCI policies, if home health care benefits are offered, the amount of payment can be no less than how much?

A

$25 per day

92
Q

How big must a group be to qualify for group LTCI?

A

100

93
Q

How long must a group have been in existence to qualify for group LTCI?

A

1 year

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