NC Medicare/LTC Exam Questions with Complete Solutions, Rated A+

Home health care covers occasional visits from who? - Registered nurses, licensed practical nurses, community-based professionals (like hospice). **Does NOT cover visits from attending physicians. Programs that are provided to people who are too poor to qualify for Medicaid. - State-only Medicaid programs LTC provision that provides a guarantee that certain policy benefits will remain available even if the insured stops paying premiums. (Offers option of a paid-up policy providing the same benefits for a shorter period, etc.) - Nonforfeiture When must the outline of coverage for a Medigap policy be provided to the insured? - At the time of application. Home health equipment such as dialysis equipment and supplies are covered under which part of Medicare? - Medicare Part B (Considered an outpatient service) What is the Medicare Part B enrollment period for an individual who is turning 65? - 3 months before the month in which the individual turns 65, as well as the 3 months following that month (7 months). What is the copayment of the Medicare approved amount? - 20% paid by the insured individual. Prospective review (Precertification provision) - Physician submits claim information prior to providing treatment to know in advance if the procedure is covered and what the rate will be. What options does an insured person have for prescription drug coverage if they are enrolled in a Medicare Advantage Plan? - 1) Receive prescription drug coverage through the Medicare Advantage Plan. 2) Sign up for separate prescription drug plan through Medicare Part D. Who facilitates processing Medicare applications, collects Medicare premiums, and provides general information about Medicare? - The Social Security Administration Who administers Medicare? - Centers for Medicare and Medicaid Services (CMS) How are LTC benefits triggered? - Insured must be unable to perform at least 2 ADLs without substantial assistance. (Cannot be triggered solely due to medical necessity) T/F. Relating to a tax qualified LTC policy, the premiums paid for the policy may be a deductible expense, and the benefits paid are also not considered taxable income. - True. Skilled nursing facility coinsurance is how much per day and starts after how many days of care? - $170.50 per day, beginning on after the first 20 days. (100 days of coverage)