Social Insurnace

Question 1

Medicare VS Medicaid VS Social Security (SSI)

Answer 1

Medicare- 65+ health insurance - payroll tax deductions federal insurance, end stage renal failure, ALS, dialysis - eligible for SSDI for 24 months

Medicaid- health insurance for the poor- state and federally funded ,

SSDI- benefits for disabled - income

Question 2

Medicare- (4)

Answer 2

Part A - Hospital Insurance-

• automatic and mandatory 65+
• no additional premium

Part B - Medical Insurance (Doctor)
- Optional for additional premium

A+B = Traditional Medicare - Reimbursement Plan

Part C - “Medicare Advantage”

• Managed Care Plan (Ex HMO, PPO) - Private insurance carrier
• Networks

Part D - Prescription Drugs Plans (PDP)

Opt out of part A and B go to —> Part C which automatically comes with Part D (AKA MAPD)

Question 3

Traditional Medicare

Answer 3

Part A (Hospital Insurance and Part B (Medical Insurance)

Question 4

Medicare Participating and Non Participating

Answer 4

Participating - doc has agreed to accept medicare approved charge as “FULL Payment”

Non Participating - doc has not

Medicare example - Bill is $125 / Approved is $100 payment
*Participating Doctor- Medicare pays $80 - Patient”Beneficiary” pays remanding $20 and “eats the rest” - Doctor cannot “Excess bill” beneficiary

*Non Participating- Medicare pays $80 - Patient pays $20 and the “Excess Bill”

Question 5

Medicare Supplement Plan

Answer 5

Is not medicare insurance- supplements the medicare policy to help pay some OR all of medicare expenses, deductibles, co-insurance, and co-pays

Question 6

How much does Medicare pay for self administered prescription drugs?

Answer 6

$0

Question 7

Part D of Medicare covers what?

Answer 7

Prescription Drug Plans

Question 8

Hospital Insurance Covers what?

Answer 8

Inpatient Hospital Bills, In-patient skilled nursing, Home health care, hospice care (plan of teatment not a place),

Question 9

What qualifies someone for Part A?

Answer 9

• Citizen or legal resident,
• 65+ entitled to monthly SS based on
• Under 65 and on SSDI for 24 months
• Under 65 and ALS or ESRD - dialysis

Question 10

Part A Benefits

Answer 10

-Starts upon admission to hospital - 1st 60days 100%
- Next 30 days - CoPayment
- Next 60 (lifetime reserve) days - larger copayment
-Does not pay tv, tele, private nurses
— Ends when discharged for 60 consecutive days
150 days total benefit period

Question 11

Benefit Period Deductible

Answer 11

Paid in first 60 days

Question 12

After Benefits period part A how much does medicare pay?

Answer 12

Benefits period is 150 days and paid is $0

Question 13

How long is Part A’s skilled nursing benefit covered for?

Answer 13

100 days per benefit period

• Days 1-20 paid at 100%
• Days 21-100 beneficiary pays portion per day
• Prereq- beneficiary had to be in hospital for at least 3 days in the last 30 days.

Question 14

True or False - There can only be ONE primary beneficiary?

Answer 14

False- it is just an order of how many funds may be distributed in what order (succession)

Question 15

What are owners rights?

Answer 15

Owner has all rights - name and change beneficiaries - if death benefit is part of contract - make any other changes without consent of the beneficiary

Question 16

What about SSDI benefits before the 40 (quarters)?

Answer 16

ages 31-42 credits needed is 20
each year after requires additional credit. 
 Age          Credits needed
31-42                   20
43                        21
44                        22
etc...

Question 17

What is PIA?

Answer 17

Primary Insurance Amount - SSDI amount

Question 18

To get SSDI benefits one must meet a strict definition. - what are the requirements?

Answer 18

Definition of Disability -

1. Fully Insured (40 quarters over a lifetime)
2. Disability Insured (20 of the last 40 quarters)
3. Unable to perform ANY job exists in the national economy
4. The disability must be in the type that will last at least 1 year or end in death
5. 5 month waiting period
6. Check in the 6th month and NOT retroactive

Question 19

How much does Medicare pay towards Long Term Care?

Answer 19

$0

Question 20

Medigap is what?

Answer 20

Medicare Supplement Policies - and only pays all or some of medicare deductibles, coinsurance, copays, provided from private insurance companies, standards are set by NAIC, NO medical requirements if beneficiary enrolls within 6 months of enrolling in Part B

Question 21

Total Disability- Own Occupation Definition

Answer 21

unable to perform any of the duties of ones own occupation based on education training or experience

Question 22

Total Disability - Any Occupation Definition

Answer 22

Unable to perform any of the duties of any occupation based on education training or experience

Question 23

Partial Disability

Answer 23

a

Question 24

Residual Disability

Answer 24

Not a type of disabiity but a method of dertermining

Question 25

Recurrent - relapse

Answer 25

a