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Disability Insurance > Soecialized Insurance For Qualified Indivi > Flashcards

Soecialized Insurance For Qualified Indivi Flashcards

1
Q

What is Medicare ?

A

Federal Med Expense ins program for people age 65 even if they work

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2
Q

How to qualify for Medicare?

A

65+ years
Entitled to Social Security Coverage 2 years
End stage Renal Failure ESRD

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3
Q

What are the 4 parts of Medicare ?

A

Part A Hospital Insurance:
Part B Medical Insurance:
Part C Medicare Advantage
Part D Prescription Drugs

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4
Q

Part A Hospital Ins is financed how ?

A

Federal Govt
Portion of payroll tax FICA

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5
Q

Part B Medical Insurance is funded by?

A

Monthly premiums paid by insureds
Gen funds of federal govt

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6
Q

Part C financed through who?

A

Provider organizations

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7
Q

Part D is for ?

A

Prescription drugs

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8
Q

Original Medicare refers to ? Doesn’t require? Doesn’t cover ?

A

Part A & B
To have a PCP
Prescription drugs

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9
Q

Ambulatory Surgical Services

A

Surgical services don’t require inpatient sta, ambulatory center

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10
Q

Names of Part A v Part B

A

A: Hospital insurance
B: Medical insurance

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11
Q

Part A pays for ?

A

Inpatient hospital care
Inpatient care in skilled nurse facility
Home health care
Hospice care

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12
Q

Eligibility for Medicare Part A include ?

A

65+ and social security
Under 65 entitled to social security 24 months
Has End Stage Renal Disease
Has ALS

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13
Q

What’s mean by fully insured? Part A ?

A

40 quarters 10 years

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14
Q

Medicare Initial enrollment period ?

A

3 months before 65 , first eligible

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15
Q

When is general enrollment for part A?

A

Jan 1 - March 31

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16
Q

Part A Special enrollment period ?

A

Anytime if still employed

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17
Q

If fail to sign up for Part A when first eligible, what is the consequence?

A

Premium up 10%

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18
Q

Inpatient Hospital Care pays for how long ?

A

90 Days
First 60 100% after deduct
Next 30 daily copayment

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19
Q

Skilled Nursing Facility Care pays for how long ?

A

100 Days

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20
Q

Home Health Care is what ?

A

Care in the house by skilled nurse
Phys therapy
Speech therapy

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21
Q

Hospice Care includes ?

A

Doctor services
Nursing
Medical appliances
Supplies: outpatient drugs

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22
Q

Which part of Medicare covers Outpatient care ?

A

Outpatient hospital care
Part B does

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23
Q

Medicare Part B purpose

A

Pays for doctor services and med services not covered under A

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24
Q

How is Part B funded?

A

Monthly premiums
Gen rev of Fed

25
Q

After initially declining part B when can you apply ?

A

General enrollment period Jan 1 - March 31

26
Q

Part B will generally cover how much of costs?
Medical insurance

A

80%
No out of pocket max

27
Q

Outpatient Hospital Services includes what ?

A

Emergency room care outpatient clinic hospital

28
Q

Part C must cover what?

A

Same covered under original Medicare
Except hospice care

29
Q

Part C may have a lower what? And offer what extra coverages ?

A

Out of pocket costs than original Medicare
Vision, hearing, dental

30
Q

To be eligible for Medicare advantage?

A

Must be enrolled in Part A & B

31
Q

What organizations provide PART C ?

A

HMOs and PPOs

32
Q

How can you be eligible for Part D Medicare?

A

Eligibile for Part A
Or Part A & B

33
Q

Stand alone plans Part D offer are paid on what basis ?

A

Fee for service plans

34
Q

After initial benefit limit is reached Prescription Drug relief will pay how much ?

A

75%

35
Q

Catastrophic coverage will cover how much prescription costs?

A

95%

36
Q

Eligible for Medicare when ?

A

Turn 65

37
Q

What is Medigap?

A

Medicare supplement plans
Fill gaps of Medicare

38
Q

Medigap is administered through who ?

A

Private insurers not federal health

39
Q

Who administers Medicare?

A

The federal government

40
Q

OBRA is what ?

A

Require certain requirements
Eliminate questionable marketing practices
Standardize protection afforded

41
Q

Open enrollment period for Medigap after first Medicare part B sign up ?

A

6 months guarantees right to buy

42
Q

Prohibited from obtaining Medicare Supplement ?

A

Those enrolled in Medicaid

43
Q

Medical supplement policies cannot pay for ?

A

Part C Medicare Advantage

44
Q

Standard Medicare supplement plans are identified/ named what ?

A

A through N

45
Q

What found in plan A needs to be offered in all plans ?

A

Core benefits

46
Q

Is Medigap guaranteed renewable? Explain?

A

Yes
Can’t cancel or no renew coverage
Premiums could change on policy anniversary

47
Q

What is Medicaid?

A

Federal and state funded program
Those who can’t meet necessary costs of medical care

48
Q

Eligibility of Medicaid depends on ?

A

65+
Blindness
Income
Disability,
Pregnant

49
Q

List Some Medicaid services?

A

Physicians
Inpatient hospital
Outpatient hospital
Skilled nurse home
Laboratory and x ray
Home health care

50
Q

Long term care policies are provided for who ?

A

Individuals who can no longer live independently

51
Q

What locations qualify as long term care?

A

Home or nursing home facility

52
Q

LTC policies must provide coverage for atleast how long ?

A

12 months

53
Q

LTC policies elimination period is how long ?

A

0-365 Days

54
Q

LTC: longer the waiting period, what happens to premium?

A

Lower the premium

55
Q

LTC 3 levels of care ?

A

Skilled nursing care
Intermediate care
Custodial care

56
Q

Skilled Care is what?

A

Daily nursing, rehab under direction of physician
Institutions

57
Q

Care done by who isn’t considered skilled care ?

A

Nonprofessional

58
Q

Explain Intermediate Care

A

Occasional nursing or rehab
Daily med assistance

59
Q

Custodial Care is provided for ?
And by who ?

A

Meeting personal needs such as assistance eating dressing bathing
Provided by non medical personnel

Disability Insurance (9 decks)

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