Special Needs And Elderly Flashcards
If an individual is covered by Medicare, and is also covered by his employers health plan, which is considered primary?
The employer plan
What is another name for Medicare supplement plans?
Medigap
What is the purpose of Medicare supplement plans?
Fill in gaps in Medicare coverage
What type of Medicare policy requires insureds to use specific healthcare providers and hospitals (in other words has restricted network provisions)
Medicare SELECT
What Medicare part helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care?
Part A
What part of Medicare is known as medical insurance?
Part B
What are the activities of daily living?
Mobility, bathing, dressing, eating, toileting and continence
What is the required free look period for Medicare supplement policies?
30 days
Who is eligible for Medicare part B?
Part B is optional and is offered to everyone who enrolls in Part A
At what age do individuals qualify for Medicare?
65
Who qualifies for Medicare coverage?
People age 65 and older, anyone who has been entitled to SS disability income benefits for 2 years, or who has chronic kidney disease.
What is another name for Medicare advantage points?
Part C
How many parts does Medicare have?
4, A-D
Medicare part A pays for what type of services?
Inpatient hospital care, skilled nursing facility care, home health and hospice
How is Part B funded?
By monthly premiums and from general revenues from the federal government
What part of Medicare is known as hospital insurance?
Part A
Can Alzheimer’s disease be excluded from coverage under a long term care policy?
No organic cognitive disorders like Alzheimer’s or Parkinson’s must be covered
An insured with Medicare part D has reached the initial benefit limit and must now pay a portion of prescription drug costs. What is the term for the gap in coverage?
The donut hole
What Medicare part will cover lab services or diagnostic tests?
Part B
When is the initial enrollment period for part A?
When an individual first becomes eligible for Medicare, starting 3 mos before turning age 65 and ending 3 months after 65th birthday
What is the purpose of respite care in long term care insurance?
To provide relief for a major caregiver usually a family member
How many pints of blood will be paid for by Medicare Supplement core benefits?
First 3
When must the outline of coverage be provided to the insured?
No later than policy delivery
Who issues medigap policies?
Private insurers
What Medicare part provides a prescription drugs benefit?
Part D think D for drugs
What benefits are provided by Medicare part C?
Expanded benefits for a fee through private insurance programs such as HMOs or PPOs
In which Medicare supplemental policies are the core benefits found?
All plans (A-N)
Part A covers hospitals and Part B covers what
Doctors
In Medicare, the diff between what the doctor bills and what Medicare pays is called
The excess charge
What Medicare part is hospital insurance?
Part A
How many days of psychiatric care does part A cover
190 days
How many days of skilled nursing per coverage period does part A cover
100 days
Under part A, do you have to go to the hospital before you go to skilled nursing?
Yes, a 3 day minimum stay, part A doesn’t cover custodial care
What is the coinsurance proportion under part B (physicians services)?
80/20 also has a deductible
How do you calculate Medicare part B coinsurance?
Percentage of Medicare’s approved amount not the amount the doctor charges
What is Part C Called?
Medicare Advantage
What does part C provide?
Managed Care
What is Part D Called?
Prescription Drug Insurance
What else must you enroll in to be enrolled in Part D
Part A or in Parts A and B
Who sells medicare supplements?
Private insurance cos and their agents
How long is open enrollment for buying a medigap policy?
6 months
Are medicare supplement plans required to be approved by Medicare?
No
How many medigap policies can you sell someone?
1
Maximum probationary period on medicare supplement policy
6 months
Can you replace one medicare supplement with another?
Yes as long as its not detrimental to the insured
When someone needs care, but not 24 hour care provided by a doctor, what is this called?
Long Term Care
Minimum free look period on a LTC policy?
10 Days
Activities of Daily Living
Mobility Dressing Bathing Toileting Continence Eating
Inability to perform how many ADLs triggers benefits?
2
Does LTC insurance cover acute care?
No
LTC home health care services include
physical therapy, nursing care, home health aides and homemaker services
The period of time that a long term care policy will provide custodial care in a nursing home is called
The benefit period
LTC policies usually pay a fixed amount per day
While an insured is confined to a custodial nursing home
LTC policies may exclude
pre existing illness, acute care, mental disorders, alcohol drug addiction, war related illness and self inflicted injuries
LTC policies may not exclude
Alzheimers disease
LTC return of premium rider will
refund some or all of the insureds premiums to the insureds estate or benny if the insured dies before age 65
