Seniors

Question 1

Attained age

Answer 1

the insured’s age at the time the policy is issued or renewed

Question 2

Benefit period

Answer 2

a period of time during which benefits are paid under the policy

Question 3

Cost-sharing

Answer 3

sharing of expenses between the insured and the insurance company through
deductibles, copays and coinsurance

Question 4

Enrollee

Answer 4

a person enrolled in a health insurance plan, an insured (doesn’t include dependents of
the insured)

Question 5

HMO

Answer 5

Health Maintenance Organization: a prepaid medical service plan in which specified medical
service providers contract with the HMO and which focus on preventive care

Question 6

Network provider

Answer 6

a provider who enters into a contractual arrangement with other providers to
provide medical services to the network subscribers

Question 7

Nonforfeiture benefit

Answer 7

a cash or insurance benefit received by a policyholder who no longer
wishes to make payments after making premium payments for at least the minimum period

Question 8

Outline of coverage

Answer 8

a document required in all health insurance policies that provides a full
coverage disclosure to the applicant

Question 9

Medicare

Answer 9

Medicare is a federal medical expense insurance program for people age 65 and
older even if the individual continues to work. Medicare benefits are also available
to anyone, regardless of age, who has been entitled to Social Security disability
income benefits for 2 years or has a permanent kidney failure (End Stage Renal
Disease - ESRD)

Question 10

Who administers Medicare

Answer 10

Medicare is administered by The Center for Medicare and Medicaid Services
(CMS), which is a division of the United States Department of Health and Human
Services

Question 11

Medicare 4 parts

Answer 11

1. Part A (Hospital Insurance) is financed through a portion of the payroll tax (FICA);
2. Part B (Medical Insurance) is financed from monthly premiums paid by insureds
   and from the general revenues of the federal government;
3. Part C (Medicare Advantage) allows people to receive all of their health care
   services through available provider organizations; and
4. Part D (Prescription Drugs) is for prescription drug coverage.

Question 12

Original Medicare refers to

Answer 12

Note, however, that the term Original Medicare refers to Part A - Hospital
Insurance, and Part B - Medical Insurance only

Question 13

Does Original Medicare require a patient to choose a doctor?

Answer 13

No.

Question 14

Medicare Part A is.

Answer 14

• Hospital Insurance helps pay for inpatient hospital care, inpatient care in a skilled
  nursing facility, home health care, and hospice care.

Question 15

Qualification for Medicare Part A

Answer 15

A citizen or a legal resident of the United States age 65 or over and qualified for
Social Security or Railroad retirement benefits — Aged;
Is 65 years old or over and entitled to monthly Social Security benefits based
upon the spouse’s work record, and the spouse is at least 62;
Is younger than 65, but has been entitled to Social Security disability benefits for
24 months — Disabled;
Has End Stage Renal Disease (ESRD) — permanent kidney failure that requires
dialysis or a transplant; and/or
Has ALS (Amyotrophic Lateral Sclerosis, or Lou Gehrig’s disease) — automatically
qualifies for Part A the month disability benefits begin.

Question 16

Medicare Part A Enrollment

Answer 16

when an individual first becomes eligible for Medicare
(starting 3 months before turning age 65, ending 3 months after the 65th
birthday);

General enrollment period: between January 1st and March 31st each year;

Special enrollment period: at any time during the year if the individual or his/her
spouse is still employed and covered under a group health plan.

Question 17

Medicare Part A - Hospital Care Benefits are

Answer 17

Hospital insurance helps pay for up to 90 days in a
participating hospital in any benefit period, subject to a deductible. The first 60
days are covered at 100% of approved charges after the deductible is met. The
next 30 covered days are paid, but they are paid with a daily copayment.

Question 18

Medicare Part B

Answer 18

pays for doctor’s services and a variety of other medical services
and supplies that are not covered by hospital insurance