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NC Medicare Supplement & Long Term Care Insurance Licensing
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NC Medicare Supplement & Long Term Care Insurance Licensing
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NC Medicare Supplement & Long TermCare Insurance Licensing
Medicare - ANS-Health insurance for those over age 65, people under 65 with certain
disabilities & those with ESRD (end stage renal disease - permanent kidney failure
requiring dialysis or kidney transplant)
CMS - ANS-Centers for Medicare and Medicaid Services administers the Medicare
program. Social Security Administration handles most of the enrollment & plays a role in
claims appeal process.
MAC - ANS-Medicare Administrative Contractor - company contracted to administer
Part A & Part B claims.
Medicare Part A - ANS--hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self Employment
tax credits.
-Those who don't qualify can voluntarily participate by paying a monthly premium
Medicare Part B - ANS-The part of the Medicare program that pays for physician
services, outpatient hospital services, durable medical equipment, and other services
and supplies.
-Has a monthly premium of $135.50 in 2019 which is deducted from SS check.
-Part B enrollment is optional. You can reject Part B by signing a rejection form.
Medicare Part C - ANS-Medicare Advantage Plans that are offered through private
insurance companies that provide both hospital and physician coverage and possible
prescriptions - financed by Social Security and monthly premiums
Medicare Eligibility - ANS--Over age 65 who have earned 40 "work credits" in order to
receive premium free part A benefits
-Permanently disabled prior to age 65 for at least 24 months
-ESRD or kidney disease requiring dialysis or kidney transplant
Medicare enrollment requirements - ANS-Part A & B are automatically conducted by
SSA when individual age 65+ enrolls for their Social Security retirement benefits
, Initial Enrollment Period - ANS-7 month period straddling 3 months before and ends 3
months after the individual turns 65, including the birthday month.
-If enrollment is during the 3 mos prior to 65th birthday, coverage begins on 1st day of
65th birthday month
-If enrollment is during or after 65th birthday month, coverage begins on 1st day of
month after enrollment
General Enrollment Period - ANS-Medicare enrollment period - January 1st through
March 31st annually.
-Coverage begins July 1st of that year
-Monthly premium for part B may go up 10% for each full 12 month period that you're
eligible but didn't sign up.
Special Enrollment Period - ANS-Individual can enroll at 8 months beginning with the
month employment ends or when group coverage ends whichever is earlier without
subject to late enrollment surcharge
Medicare as a secondary or primary payer - ANS--Medicare is the secondary payer for
the 'working aged' who has a group health plan if the group has 20+ enrollees
-For single employer with <20 employees with a group health plan, Medicare is the
primary payer.
-If individual retains coverage thru the group plan, the group contract is the primary
unless person is retired & still covered under the group plan. In that case, Medicare is
the primary.
-If individual rejects the employer plan, Medicare is the primary payer
Medicare as a secondary payer - ANS--In cases of Workers' Comp when it applies to an
injury or illness
- In cases where no-fault insurance or liability insurance is available as primary payer.
Medicare & the VA - ANS-Can choose to get treatment under either plan. Medicare
usually will not pay benefits if services are rendered in a VA facility but will pay if outside
of VA. There is NO coordination between Federal agencies.
Expenses NOT paid by Medicare - ANS--Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - ANS--acute inpatient hospital care
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