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Medicare, Medicaide, LTC NC Insurance Exam Questions and Answers
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Medicare, Medicaide, LTC NC Insurance Exam Questions and Answers
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Medicare, Medicaide, LTC NC InsuranceExam Questions and Answers
Federal Program - Answer -Medicare is a federal health insurance program. Part of the
Social Security program, Medicare is run by the Centers for Medicare & Medicaid
Services of the Department of Health and Human Services. Private firms contract with
the federal government to handle the paperwork, review claims, and disburse claim
payments.
Medicare Part A - Answer -Designed primarily to provide hospital insurance and to pay
for certain other types of institutional care.
Medicare Part B - Answer -Designed primarily to provide medical insurance for
physician visits and other out-patient care.
Medicare Part C - Answer -Provides expanded coverage through managed care plans
such as Health Maintenance Organizations (HMOs) and Preferred Provider
Organizations (PPOs).
Medicare Part D - Answer -Provides coverage for prescription drugs.
What is the "original medicare"? - Answer -Parts A and B because those two parts were
enacted together in the original amendment to Social Security that created the Medicare
program in 1965. Parts C and D were added later (in 1997 and 2003, respectively) to
keep the Medicare program up to date with changes in the health care delivery system.
If someone has Original Medicare, in which part or parts of Medicare is he or she
enrolled?
A Parts A, B, and C
B Parts A, B, C, and D
C Part C
D Parts A and B - Answer -D Parts A and B
*Parts A and B are referred to as Original Medicare because they were enacted
together when the So-cial Security law was originally amended to create Medicare.
Parts C and D were added later.
Qualified Medicare Beneficiary (QMB) - Answer -Program is for persons whose monthly
income is no more than the Federal Poverty Level (FPL) plus $20. Some states
disregard more than an additional $20 of monthly income. In addition to helping pay the
,Part B premium, the QMB program may also help pay a beneficiary's Part A premium (if
any) and Medicare cost-sharing amounts such as deductibles, coinsurance, and
copayments.
Specified Low-Income Medicare Beneficiary (SLMB) - Answer -For persons whose
monthly income is no more than 120% of the FPL plus $20. As with the QMB program,
some states disregard more than an additional $20 of monthly income. The SLMB
program helps pay for only the Part B premium, not other Medicare costs.
Qualifying Individual (QI) - Answer -For persons whose monthly income is no more than
135% of the FPL plus $20. Some states disregard more than an additional $20 of
monthly income. The QI program helps pay for only the Part B premium.
An individual has been working for 8 years while the Hospital Insurance tax has been
getting deducted from her paycheck. How many more years must she work before she
can get Medicare Part A coverage premium-free?
A 12
B4
C7
D 2 - Answer -D 2
*Part A coverage is premium-free for workers who have paid the Hospital Tax for 10
years. The individual has paid for 8 years, so she has 2 more years to go.
Suppose a worker's income is between 120% and 135% of the federal poverty level.
What is the name of the Medicare Savings Program for which she is eligible?
A Specified Low-Income Medicare Beneficiary
B Medicare Advantage
C Qualified Medicare Beneficiary
D Qualifying Individual - Answer -D Qualifying Individual
*The Qualifying Individual program pays the Part B premium for persons whose income
is less than 135% of the federal poverty level but higher than the requirements for other
Medicare savings pro-grams.
Medicare Advantage is another name for what part of Medicare?
A Parts A and B
B Part C
C Part D
D Part A - Answer -B Part C
*Medicare Part C is also called Medicare Advantage.
To be eligible to enroll in Medicare, individuals must fall into one of three groups. They
must be: - Answer --Age 65 or Older
-Social Security disability beneficiaries (generally after 2 years)
-Suffering from ESRD (end-stage renal disease—that is, kidney failure)
, This is the largest group of Medicare beneficiaries. Most people become eligible for
Medicare by reason of age - Answer -Age 65 or older group
Description of group 2 Social Security disability beneficiaries (generally after 2 years) -
Answer -Individuals who have been receiving Social Security benefits because they are
disabled and cannot work can become eligible for Medicare even if they have not yet
turned age 65. Usually, such individuals become eligible for Medicare only after they
have received Social Security disability benefits for a period of 24 continuous months (2
years).
Individuals who are eligible for medicare immediately - Answer -Individuals who qualify
for Social Security disability benefits because they have ALS (amyotrophic lateral
sclerosis, also called Lou Gehrig's disease)
Description of group 3 who qualifies for Medicare Suffering from ESRD (end-stage renal
disease—that is, kidney failure) - Answer -Individuals under age 65 can also become
eligible for Medicare if they have had a kidney transplant or need regular dialysis
because their kidneys no longer work.
Enrollment in Medicare Part A and Part B is automatic for people who are already
receiving Social Security benefits when they become eligible for Medicare. So,
enrollment would be automatic for individuals: - Answer --At age 65 if they are receiving
Social Security retirement benefits at that time; or
-After receiving Social Security disability benefits for 2 years (immediately for those with
ALS) even if they are not yet 65 at that time
For people covered by Social Security, which part is premium free? - Answer -Part A is
premium free, Part B is not
Individuals who are automatically enrolled in Part B have what option if they do not want
to pay the premiun? - Answer -Drop Medicare part B, However, people who do not
enroll in Medicare Part B when they are first eligible generally have to pay a penalty in
the form of a higher premium if they wish to sign up for it later.==
What is the late enrollment penalty designed to do? - Answer -Prevent against adverse
selection or —a disproportionately high number of above-average risks in the insurance
pool.
Finish the sentence:
By encouraging everyone to purchase Part B coverage when they are first eligible, ------
----------------- - Answer -the late enrollment penalty maintains the expected balance of
average and above-average risks in the insurance pool.
What is the additional enrollment penalty for Medicare part B? - Answer -An additional
charge of 10% of the amount of the individual's Part B premium for every 12-month
period that has elapsed since the individual became eligible for Medicare.
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