Study Guide for North Carolina Medicare
Supplement-Long Term
What is Medicare? - Answer - Government health insurance program for people over 65
or younger people who may qualify.
Who under 65 may qualify for Medicare? - Answer - Individuals who have disabilities
such as permanent kidney failure or ALS
Medicare part A covers what? - Answer - Hospital
Which part of Medicare covers medical insurance? - Answer - Part B
Which part of Medicare is known as Medicare Advantage? - Answer - Part C
What criteria must be met to qualify for enrollment in Medicare Advantage - Answer -
Must be enrolled in Part A & B
Which part expands Original Medicare Benefits through Private Health Insurance
Programs? - Answer - Part C
Which part of Medicare covers prescription Drugs? - Answer - Part D
Medicare parts A and B are administered only by whom - Answer - The Federal
Government
How many Medicare savings programs are there - Answer - 4
How are persons who are age 65 or older who do not participate in Social Security
eligible for Medicare? - Answer - If premium is paid
Is Medicare Part B a voluntary health insurance program? - Answer - Yes
What does the limited Medicare savings program MQB-B Pay for? - Answer - (Part B
Premium Only)
To participate in Medicare a person must be what? - Answer - A US citizen or a
permanent legal resident)
When does the initial enrollment period for Medicare Part B begin? - Answer - 3 months
before the month that the enrollee turns 65
For employers with 20 or more employees who offer group converge, would Medicare
be considered the primary or secondary coverage? - Answer - Secondary
, What does the acronym PPS stand for? - Answer - Prospective Payment System
What is the primary function of the MAC? - Answer - Medical reviews to ensure that
services covered are reasonable and necessary)
Under which review can a physician submit claim information prior to providing
treatment to know in advance if the procedure is covered under the insured's plan? -
Answer - (Prospective Review)
Medicare Part A allows how many reserve days per lifetime? - Answer - (60)
Under Medicare part A how many days can patients get coverage in a Skilled Nursing
Facility Coverage in a benefit period? - Answer - Up to 100 Days
Are only the first 20 days (about 3 weeks) in a Skilled Nursing Facility covered in full,
True or False - Answer - True
Skilled nursing care and certain other health care services that a patient receives at
home for an illness or injury is defined as what? - Answer - (Home health Care)
What does First Dollar Coverage Mean? - Answer - No Deductible
Special care for people who are terminally ill is what? - Answer - Hospice
Care given to a hospice patient by another caregiver so that the usual caregiver may
get a rest is what? - Answer - Respite care
How is hospice care administered? - Answer - Two 90 days (about 3 months) periods
followed by unlimited 60-day periods)
For Medicare to cover skilled nursing, who must recommend the patient needs daily
care? - Answer - The Doctor
What percentage of the cost of durable medical equipment does Medicare pay? -
Answer - (80 %)
Under Medicare Part A, who pays for the first 3 pints of Blood? - Answer - The patient
What is the Medicare Summary Notice known as? - Answer - EOMB or the EOB
How much is the Hospice drug benefit copayment for Pain relief drugs. - Answer - ($5)
What is the maximum number of days that Medicare will pay for inpatient mental health
care? - Answer - 190 Days
Supplement-Long Term
What is Medicare? - Answer - Government health insurance program for people over 65
or younger people who may qualify.
Who under 65 may qualify for Medicare? - Answer - Individuals who have disabilities
such as permanent kidney failure or ALS
Medicare part A covers what? - Answer - Hospital
Which part of Medicare covers medical insurance? - Answer - Part B
Which part of Medicare is known as Medicare Advantage? - Answer - Part C
What criteria must be met to qualify for enrollment in Medicare Advantage - Answer -
Must be enrolled in Part A & B
Which part expands Original Medicare Benefits through Private Health Insurance
Programs? - Answer - Part C
Which part of Medicare covers prescription Drugs? - Answer - Part D
Medicare parts A and B are administered only by whom - Answer - The Federal
Government
How many Medicare savings programs are there - Answer - 4
How are persons who are age 65 or older who do not participate in Social Security
eligible for Medicare? - Answer - If premium is paid
Is Medicare Part B a voluntary health insurance program? - Answer - Yes
What does the limited Medicare savings program MQB-B Pay for? - Answer - (Part B
Premium Only)
To participate in Medicare a person must be what? - Answer - A US citizen or a
permanent legal resident)
When does the initial enrollment period for Medicare Part B begin? - Answer - 3 months
before the month that the enrollee turns 65
For employers with 20 or more employees who offer group converge, would Medicare
be considered the primary or secondary coverage? - Answer - Secondary
, What does the acronym PPS stand for? - Answer - Prospective Payment System
What is the primary function of the MAC? - Answer - Medical reviews to ensure that
services covered are reasonable and necessary)
Under which review can a physician submit claim information prior to providing
treatment to know in advance if the procedure is covered under the insured's plan? -
Answer - (Prospective Review)
Medicare Part A allows how many reserve days per lifetime? - Answer - (60)
Under Medicare part A how many days can patients get coverage in a Skilled Nursing
Facility Coverage in a benefit period? - Answer - Up to 100 Days
Are only the first 20 days (about 3 weeks) in a Skilled Nursing Facility covered in full,
True or False - Answer - True
Skilled nursing care and certain other health care services that a patient receives at
home for an illness or injury is defined as what? - Answer - (Home health Care)
What does First Dollar Coverage Mean? - Answer - No Deductible
Special care for people who are terminally ill is what? - Answer - Hospice
Care given to a hospice patient by another caregiver so that the usual caregiver may
get a rest is what? - Answer - Respite care
How is hospice care administered? - Answer - Two 90 days (about 3 months) periods
followed by unlimited 60-day periods)
For Medicare to cover skilled nursing, who must recommend the patient needs daily
care? - Answer - The Doctor
What percentage of the cost of durable medical equipment does Medicare pay? -
Answer - (80 %)
Under Medicare Part A, who pays for the first 3 pints of Blood? - Answer - The patient
What is the Medicare Summary Notice known as? - Answer - EOMB or the EOB
How much is the Hospice drug benefit copayment for Pain relief drugs. - Answer - ($5)
What is the maximum number of days that Medicare will pay for inpatient mental health
care? - Answer - 190 Days
