NC Medicaide LTC NC Insurance Exam Questions & Answers Solved 100%

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 B 4 C 7 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. Suppose Jack became eligible for Medicare in January of 2013 but did not sign up for Part B until July of 2015. The standard price for Part B is $104.90 in 2015. - Answer Although Jack waited 18 months after he first became eligible to sign up for Part B, only one period of 12 full months has elapsed, so his penalty would be an additional charge of 10% of his usual premium. The standard premium for Part B in 2015 was $104.90. Assuming that Jack, like most people, paid the standard premium, he would be charged an additional $10.49 (10% of the standard premium amount) for a total premium of $115.39 ($104.90 plus the $10.49 penalty). Jack would pay that additional 10% penalty for as long as he had Medicare Part B, not just for the first year. If the amount of the standard premium increased, the amount of the penalty would also increase to equal 10% of the higher premium. What is the late enrollment penalty for Medicare Part A? - Answer A similar 10% late enrollment penalty also applies to Part A coverage for individuals who do not get their Part A coverage premium-free. For which of the following reasons do most people become eligible for Medicare? A Payment of the Hospital Insurance payroll tax for 10 years B Turning age 65 C Receipt of Social Security disability benefits for 2 years D Kidney failure - Answer B Turning age 65 *Medicare eligibility age is 65. Most people become eligible for Medicare by reason of age. If an individual waited for 30 months after he first became eligible to sign up for Medicare Part B, what percentage would his late enrollment penalty be? A 20% B 25% C 10% D 30% - Answer A 20% *The Part B late enrollment penalty is 10% for every 12-month period that the individual delayed signing up. 12 goes into 30 only 2.5 times, but only full 12-month periods count. So the penalty is 2 times 10%, or 20%. When did the Social Security program gradually raise the retirement age? - Answer 1980's What is the current Social Security retirement age? - Answer 66 The three types of Medicare enrollment periods - Answer -Initial Enrollment Period (IEP) -General Enrollment Period (GEP) -Special Enrollment Period (SEP) Initial Enrollment Period (IEP) - Answer A 7-month period that includes the month in which the individual's birthday occurs and the 3 months on either side. For example, if Lena turns age 65 in April of 2016, her Initial Enrollment Period begins January 1, 2016 and ends on July 31, 2016. When does coverage for individuals who sign up for Medicare in the first three months of IEP start? - Answer It starts on the first day of their birth month. For example, if Duane's birthday is May 18, and he signs up for Medicare in February, March, or April, his coverage becomes effective on May 1. The one exception of coverage for individuals who enroll in Medicare in the first 3 months of IEP - Answer If an individual's birthday is on the first day of the month, and the individual signs up during the first 3 months of the Initial Enrollment Period, coverage becomes effective on the first day of the month prior to his/her birthday month. For example, if Tamara's birthday is on May 1, and she signs up for Medicare in February, March, or April, her coverage becomes effective April 1. For individuals who sign up during their birthday month during IEP, when does coverage start? - Answer Coverage starts one month later For individuals who sign up the month after their birthday month during IEP, when does their coverage start? - Answer Coverage starts 2 months later. For individuals who sign up 2 or 3 months after their birthday month (that is, during the last 2 months of their Initial Enrollment Period), when does coverage start? - Answer Coverage starts 3 months later. How many times does The Initial Enrollment Period occur during an individuals lifetime? - Answer Only once in an individual's lifetime—it does not recur. When will people retiring today at Social Security's normal retirement age usually sign up for Medicare? A Before they retire B After they retire C At the same time they retire D Before they retire and again after they retire - Answer A Before they retire *For people retiring today, Social Security's normal retirement age is 66. The age of eligibility for Medicare is 65. If an individual turns age 65 in November, when does her Initial Enrollment Period for Medicare begin? A August 1 B November 1 C October 1 D September 1 - Answer A August 1 *An individual's Initial Enrollment Period for Medicare starts 3 months prior to the month in which the individual turns age 65. General Enrollment Period (GEP) for Medicare - Answer Extends from January 1 through March 31 each year. However, coverage for individuals who enroll during a General Enrollment Period does not become effective until July 1 of that year. Special Enrollment Period (SEP) - Answer Provides an exception to the late enrollment penalty for individuals who delay enrollment in Part B because they (or their spouse) are still working and they already have coverage through employer-sponsored group health insurance. What is the exception with SEP where Individuals can sign up for Medicare coverage without a late enrollment penalty - Answer All during the time they (or their spouse) remains employed and the employer-sponsored group health coverage is in effect. How many months does the SEP continue for? - Answer The Special Enrollment Period continues for eight months following the month that they lose their group health insurance, either by retiring or otherwise. In SEP when does Part B coverage start? - Answer In SEP, Part B coverage starts the month after the election is made.