Soecialized Insurance For Qualified Indivi

Question 1

What is Medicare ?

Answer 1

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

Question 2

How to qualify for Medicare?

Answer 2

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

Question 3

What are the 4 parts of Medicare ?

Answer 3

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

Question 4

Part A Hospital Ins is financed how ?

Answer 4

Federal Govt
Portion of payroll tax FICA

Question 5

Part B Medical Insurance is funded by?

Answer 5

Monthly premiums paid by insureds
Gen funds of federal govt

Question 6

Part C financed through who?

Answer 6

Provider organizations

Question 7

Part D is for ?

Answer 7

Prescription drugs

Question 8

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

Answer 8

Part A & B
To have a PCP
Prescription drugs

Question 9

Ambulatory Surgical Services

Answer 9

Surgical services don’t require inpatient sta, ambulatory center

Question 10

Names of Part A v Part B

Answer 10

A: Hospital insurance
B: Medical insurance

Question 11

Part A pays for ?

Answer 11

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

Question 12

Eligibility for Medicare Part A include ?

Answer 12

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

Question 13

What’s mean by fully insured? Part A ?

Answer 13

40 quarters 10 years

Question 14

Medicare Initial enrollment period ?

Answer 14

3 months before 65 , first eligible

Question 15

When is general enrollment for part A?

Answer 15

Jan 1 - March 31

Question 16

Part A Special enrollment period ?

Answer 16

Anytime if still employed

Question 17

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

Answer 17

Premium up 10%

Question 18

Inpatient Hospital Care pays for how long ?

Answer 18

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

Question 19

Skilled Nursing Facility Care pays for how long ?

Answer 19

100 Days

Question 20

Home Health Care is what ?

Answer 20

Care in the house by skilled nurse
Phys therapy
Speech therapy

Question 21

Hospice Care includes ?

Answer 21

Doctor services
Nursing
Medical appliances
Supplies: outpatient drugs

Question 22

Which part of Medicare covers Outpatient care ?

Answer 22

Outpatient hospital care
Part B does

Question 23

Medicare Part B purpose

Answer 23

Pays for doctor services and med services not covered under A

Question 24

How is Part B funded?

Answer 24

Monthly premiums
Gen rev of Fed

Question 25

After initially declining part B when can you apply ?

Answer 25

General enrollment period Jan 1 - March 31

Question 26

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

Answer 26

80% No out of pocket max

Question 27

Outpatient Hospital Services includes what ?

Answer 27

Emergency room care outpatient clinic hospital

Question 28

Part C must cover what?

Answer 28

Same covered under original Medicare Except hospice care

Question 29

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

Answer 29

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

Question 30

To be eligible for Medicare advantage?

Answer 30

Must be enrolled in Part A & B

Question 31

What organizations provide PART C ?

Answer 31

HMOs and PPOs

Question 32

How can you be eligible for Part D Medicare?

Answer 32

Eligibile for Part A Or Part A & B

Question 33

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

Answer 33

Fee for service plans

Question 34

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

Answer 34

75%

Question 35

Catastrophic coverage will cover how much prescription costs?

Answer 35

95%

Question 36

Eligible for Medicare when ?

Answer 36

Turn 65

Question 37

What is Medigap?

Answer 37

Medicare supplement plans Fill gaps of Medicare

Question 38

Medigap is administered through who ?

Answer 38

Private insurers not federal health

Question 39

Who administers Medicare?

Answer 39

The federal government

Question 40

OBRA is what ?

Answer 40

Require certain requirements Eliminate questionable marketing practices Standardize protection afforded

Question 41

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

Answer 41

6 months guarantees right to buy

Question 42

Prohibited from obtaining Medicare Supplement ?

Answer 42

Those enrolled in Medicaid

Question 43

Medical supplement policies cannot pay for ?

Answer 43

Part C Medicare Advantage

Question 44

Standard Medicare supplement plans are identified/ named what ?

Answer 44

A through N

Question 45

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

Answer 45

Core benefits

Question 46

Is Medigap guaranteed renewable? Explain?

Answer 46

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

Question 47

What is Medicaid?

Answer 47

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

Question 48

Eligibility of Medicaid depends on ?

Answer 48

65+ Blindness Income Disability, Pregnant

Question 49

List Some Medicaid services?

Answer 49

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

Question 50

Long term care policies are provided for who ?

Answer 50

Individuals who can no longer live independently

Question 51

What locations qualify as long term care?

Answer 51

Home or nursing home facility

Question 52

LTC policies must provide coverage for atleast how long ?

Answer 52

12 months

Question 53

LTC policies elimination period is how long ?

Answer 53

0-365 Days

Question 54

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

Answer 54

Lower the premium

Question 55

LTC 3 levels of care ?

Answer 55

Skilled nursing care Intermediate care Custodial care

Question 56

Skilled Care is what?

Answer 56

Daily nursing, rehab under direction of physician Institutions

Question 57

Care done by who isn’t considered skilled care ?

Answer 57

Nonprofessional

Question 58

Explain Intermediate Care

Answer 58

Occasional nursing or rehab Daily med assistance

Question 59

Custodial Care is provided for ? And by who ?

Answer 59

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