Eligible for medicare - Study guides, Class notes & Summaries

Steps used to control costs of managed care include: - ANSWER-Bundled codes Capitation Payer and Provider to agree on reasonable payment DRG is used to classify - ANSWER-Inpatient admissions for the purpose of reimbursing hospitals for each case in a given category w/a negotiated fixed fee, regardless of the actual costs incurred Identify the various types of private health plan coverage - ANSWER-HMO Conventional PPO and POS HDHP/SO plans - high-deductible health plans with a savings...

Edward IP suffered from serious kidney disease. As a result. Edward became eligible for Medicare coverage due to end-stage renal disease (ESRD). A close relative donated their kidney and Edward successfully underwent transplant surgery 12 months ago. Edward is now age 50 and asks you if his Medicare coverage will continue, what should you say? - ANSWER Individuals eligible for Medicare based on ESRD generally lose eligibility 36 months after the month in which the individual receives a kidney tr...

Virginia life and Health Final Exam Questions and Answers 100% Pass Insurable inter in one's own life is legally considered as Generally unlimited Where dose the primary funding for medical part A come from? Federal payroll and self employment taxes What would be a valid reason for naming a trust as the beneficiary of a life insurance policy as opposed to naming an individual? Management of proceeds would be provided Virginia requires that an agent must complete___ hours of conti...

North Carolina Medicare Supplement and Long-Term Care Exam Questions With Correct Answers.

What type of insurance allows treatment virtually anywhere with a high deductible that policy holders are willing to pay? a. COBRA b. EPO c. PPO d. HMO - C Veterans with service related disabilities are eligible for case under which of the following programs: a. CHAMPUS b. Medicare c. CHAMPVA d. TRICARE - C _______________________ is usually sponsored and partially paid by an employer. a. TRICARE b. Private Insurance c. Group Health Insurance d. Worker's Aide - C _______________...

Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him?correct answersHe may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of15 emplo...

Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? - Medicare is a program for people 65 or older and those under the age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig's disease so she will be eligible for Medicare. Mr. Schmidt would like to pla...

Idaho Life and Health Final Exam Questions and Answers Already Passed What are the benefits that must be provided by an individual health insurance policy for prenatal, maternity, and delivery expenses? Prenatal, maternity, and delivery expenses are required to be covered under all health plans subject to the same deductible and coinsurance as other medical and surgical expenses. Which situation would qualify an individual for receiving benefits from a qualified long-term care policy?...

Exam Simulator FL-LH - FL Health and Life and Annuity 100% Pass A non-contributory plan requires _________ participation of all eligible employees 100% A characteristic of preferred provider organizations (PPOS) would be: Discounted fees for the patient Which of the following areas of state regulation is NOT protected by the saving clause in ERISA? Commerce Additional coverage can be added to a whole Life policy by adding a(n): decreasing term rider What benefit does the payor clause on a Ju...

Missouri Life and Health Exam Questions and Answers 100% Pass In a Life insurance contract, an insurance company's promise to pay stated benefits is called the: a) insuring clause b) consideration clause c) entire contract d) owner's rights insuring clause under which circumstance MUST a health insurer have an expedited grievance review procedure? when the enrollee's life or health is jeapordized The Consideration clause in a life insurance contract contains what pertinent information? ...