NC STATE EXAM- Simulated practice
questions 1 with correct answers
If a person is a member of a private Fee-For-Service plan, where can he or she receive
emergency medical care? - Answer -Anywhere in the U.S.
**Members of a PFFS plan may receive emergency care anywhere in the U.S. when
needed.
Medicare Part B will cover services received from a doctor if performed - Answer -
Anywhere.
**Medicare Part B covers medically necessary services received from a doctor
regardless where performed: in the office, in a hospital, in a skilled nursing facility, in the
patient's home, or any other location.
All of the following statements are true about HMOs EXCEPT - Answer -A Medicare
HMO is not a Medicare Advantage Plan.
** IT IS **
**A Medicare HMO is a Medicare Advantage Plan.
All of the following statements are true about a Preferred Provider Organization (PPO)
EXCEPT - Answer -A PPO does not have to pay for covered services received out-of-
network.
**Every PPO plan must pay for all covered services received out-of-network, but every
plan is different in what the patient must pay.
An insured receives health care through both Medicare and Medicaid. She currently has
prescription drug coverage through Medicaid. Does the insured need to enroll in
Medicare Part D? - Answer -Yes, she must begin receiving her prescription drug
coverage through Part D.
**Anyone enrolled in both Medicare and Medicaid, and who receives prescription drug
coverage through Medicaid should enroll in Medicare Part D for prescription drug
coverage. Those with Medicaid who are not enrolled in Medicare can continue to
receive prescription drug coverage through Medicaid.
, When a patient is in a facility receiving care at the Medicaid rate and has limited
resources, the patient's income must be - Answer -Less than the cost of care at the
facility.
**Medicaid pays for medically necessary nursing home care for patients in skilled or
intermediate care nursing homes or in intermediate care facilities for the mentally
retarded. The patient's income must be less than the cost of care in the facility at the
Medicaid rate, and there is a limit on resources.
A long-term care insurance sales representative replaced a long-term care policy
belonging to an elderly insured. The premium and benefits were the same in the new
policy as in the old policy. The agent's first year commission is 60%, and the renewal
commission is 4%. What will be the commission on this sale? - Answer -4%
**Unless there is a substantial increase in benefits, agents cannot receive commission
on the sale of a replaced policy that is greater than the renewal commission. The
agent's commission is 4%.
Which of the following statements must be prominently displayed on the first page of a
Medicare Supplement policy? - Answer -"Notice to Buyer: This policy may not cover all
your medical expenses"
**Medicare Supplement insurers must prominently display on the first page of the policy
the following: "Notice to Buyer: This policy may not cover all your medical expenses."
A long-term care policy may limit coverage for which of the following? - Answer -
Services for which benefits are available under Medicare
**A long-term care policy may exclude or limit coverage for illness, treatment, or medical
conditions arising out of services for which benefits are available under Medicare. All
the other conditions will be covered.
The traditional pay-per-visit arrangement available nationwide is known as - Answer -
Original Medicare Plan.
**The traditional pay-per-visit (also called fee-for-service) arrangement available
nationwide is called the Original Medicare Plan.
Which of the following is EXCLUDED from coverage under a Medicare supplement
policy? - Answer -Dental copayments
**Medicare supplement policies do not cover dental care, long-term care, vision, hearing
aids, private-duty nursing, or "unlimited" outpatient prescription drugs. Dental and vision
care, along with eyeglasses and hearing aids, may be covered if treatment is a result of
an injury.
questions 1 with correct answers
If a person is a member of a private Fee-For-Service plan, where can he or she receive
emergency medical care? - Answer -Anywhere in the U.S.
**Members of a PFFS plan may receive emergency care anywhere in the U.S. when
needed.
Medicare Part B will cover services received from a doctor if performed - Answer -
Anywhere.
**Medicare Part B covers medically necessary services received from a doctor
regardless where performed: in the office, in a hospital, in a skilled nursing facility, in the
patient's home, or any other location.
All of the following statements are true about HMOs EXCEPT - Answer -A Medicare
HMO is not a Medicare Advantage Plan.
** IT IS **
**A Medicare HMO is a Medicare Advantage Plan.
All of the following statements are true about a Preferred Provider Organization (PPO)
EXCEPT - Answer -A PPO does not have to pay for covered services received out-of-
network.
**Every PPO plan must pay for all covered services received out-of-network, but every
plan is different in what the patient must pay.
An insured receives health care through both Medicare and Medicaid. She currently has
prescription drug coverage through Medicaid. Does the insured need to enroll in
Medicare Part D? - Answer -Yes, she must begin receiving her prescription drug
coverage through Part D.
**Anyone enrolled in both Medicare and Medicaid, and who receives prescription drug
coverage through Medicaid should enroll in Medicare Part D for prescription drug
coverage. Those with Medicaid who are not enrolled in Medicare can continue to
receive prescription drug coverage through Medicaid.
, When a patient is in a facility receiving care at the Medicaid rate and has limited
resources, the patient's income must be - Answer -Less than the cost of care at the
facility.
**Medicaid pays for medically necessary nursing home care for patients in skilled or
intermediate care nursing homes or in intermediate care facilities for the mentally
retarded. The patient's income must be less than the cost of care in the facility at the
Medicaid rate, and there is a limit on resources.
A long-term care insurance sales representative replaced a long-term care policy
belonging to an elderly insured. The premium and benefits were the same in the new
policy as in the old policy. The agent's first year commission is 60%, and the renewal
commission is 4%. What will be the commission on this sale? - Answer -4%
**Unless there is a substantial increase in benefits, agents cannot receive commission
on the sale of a replaced policy that is greater than the renewal commission. The
agent's commission is 4%.
Which of the following statements must be prominently displayed on the first page of a
Medicare Supplement policy? - Answer -"Notice to Buyer: This policy may not cover all
your medical expenses"
**Medicare Supplement insurers must prominently display on the first page of the policy
the following: "Notice to Buyer: This policy may not cover all your medical expenses."
A long-term care policy may limit coverage for which of the following? - Answer -
Services for which benefits are available under Medicare
**A long-term care policy may exclude or limit coverage for illness, treatment, or medical
conditions arising out of services for which benefits are available under Medicare. All
the other conditions will be covered.
The traditional pay-per-visit arrangement available nationwide is known as - Answer -
Original Medicare Plan.
**The traditional pay-per-visit (also called fee-for-service) arrangement available
nationwide is called the Original Medicare Plan.
Which of the following is EXCLUDED from coverage under a Medicare supplement
policy? - Answer -Dental copayments
**Medicare supplement policies do not cover dental care, long-term care, vision, hearing
aids, private-duty nursing, or "unlimited" outpatient prescription drugs. Dental and vision
care, along with eyeglasses and hearing aids, may be covered if treatment is a result of
an injury.
