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36 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Which of the following is true regarding commissions for Medicare supplement policies ? |
They are permitted up to a certain amount for each policy |
An agent or other repersentative that is involved in the sale of Medicare supplement policies may recieve commission as long the first year commission dose not exceed 200% of the commission paid for selling or servicing the policy in the 2nd year. Cimmission regulation rules appy to both monetary and non-monetary compensation. |
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Which of the following statements is NOT correct ? |
Medicare Advantage must be provided through HMO's |
Medicare Part A provides hospital care: Medicare Part B provides doctors and physicians services, and Medicare Advantage (previoulsy Medicare+Choice) offers expanded benefits for a fee through private health insurance programs such as hMO's and PPO's. |
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Which of the following statements is correct ? |
HMO's may pay for services not covered by Medicare |
The advantages of an HMO or PPO for a Medicare recipient may be that there are NO claims forms required, almost any medical problem is covered for a set fee so helth care cost can be budgeted and the HMO and PPO may pay for services not usually covered by Medicare or Medicare supplement policies such as prescriptions eye exams hearing aids or dental care. |
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What information is provided by the Explanation of Medical Benefits ? What information is provided by the Explanation of Medical Benefits ? |
Specified services covered and the amounts approved for each service. |
The explanation of Medical Benefits, or Medicare Summary notice is a monthly statement that list the insured's health insurance claims information, specific services covered, and the amount approved for each service. |
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When a client replaces an existing LTC or Medicare Supplement insurance policy with another from the same company, California Law requires that ? |
The agent must advise the client about HICAP and its services. |
A california Law Requirement. |
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HICAP offers services in the following areas EXCEPT ? |
Sales of LTC policies |
HICAP agencies do not sell or recommend products |
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Which of the following statements pertaining to Medicare Part A is correct? |
Medicare Part A is automatically provided when an individual qualifies for Social Security benefits at age 65. |
Workers that havepaid FICA taxes automatically qualify for Medicare Part A at age 65. Part A has been prepaid through FICA taxes. Workers who qualify for Part A are also eligible for Part B; however it requries that a monthly premium is withheald from Social Security benefits. |
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In reference to the standard Medicare Supplement benefit plans, what dose the term standard mean? |
All providers will have the same coverage options for each plan |
In reference to te standard Medicare Supplement benefits plan, the term "standard" implies that all providers will have the same coverage options and coditions for each plan. |
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Charges for services provided through a HICAP agency are ? |
Never made to the client |
HICAP services are provided free of charge to clients. |
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An applicant is disscussing his options for Medicare supplement coverage with his agent. Theapplicant is 65 years old and has just enrolled in Medicare Part A and B. What is the insurance company obligated to do ? |
Offer the suplement policy on a guaranteed issue basis. |
Once a person becomes eligible for Medicare supplement plans and during the open enrollment peroid, coverage must be offered on a guaranteed issue basis. |
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What i Medi-Cal ? |
Califirnia Medicaid health care program. |
Medicaid is a federal-stte partnership in which the federal government pays for the majority of the medical claims, while states are responsible for their own administrative expenses. In california the program is know asMedi-Cal |
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Shortly after a replacement transaction on a Medicare supplement policy, the insured decided to cancel the policy, but is unsure whether the free-look proviion applies. The insured could find that the information in the ? |
Notice Regarding Replacement. |
The Notice Regarding Replacement must inform the applicant of the 30 day-day free look provision of the replaceing policy. |
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Creditable coverage includes |
Coverage under a state health benefits risk pool |
Creditable coverage also includes but is not limited to. coverage provided under any individual or group policy; coverage ubder Medicare Parts A or B, abd Medicaid; or health plans under Federal Employees Health Benefits Program. |
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Which type of Medicare policy requires insured to use specific healthcare providers and hospitals (network providers) EXCEPT in emergency situations? |
SELECT |
Medical SELECT policies require insured to use specific healthcare providers and hospital, except in emergency situations. In return the insured pays lower premium amounts. |
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Which type of care is NOT covered by Medicare ? |
Long Term Care |
Hospice care, which includes respite care, and hospital care are included in Medicare Part A |
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Prior to purchasing a Medigap policy, aperson must be enroooed in which of the following ? |
Parts A and B Medicare. |
To buy a Medigap policy the applicant must generally have both Medicare Part A and Part B |
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Which of the following would automatically qualify for Medi-Cal bebefits ? |
A person recieving Supplementry Security Income assistance. |
California residents in a variety of situations may qualify for benefits from Medi-Cal; however individuals who recieve cash assistnce from one of the following programs are automatically eligible for Medi-Cal; SSI/SSP, CalWorks, Refugee Assistance and Foster care or Adoption Assistane Program. |
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If a person recieves benefits for long term care from Medi-Cal, when that recipient dies, the state may |
Pursue asset recovery against the estate of the recipient. |
Aset recovery will commence only if there is no surviving spouse. If there is a surviving spouse asset recovery may be postponed until after the surviving spouse die. The asset of heirs are not subject to recovery for Medi-Cal claims of others. |
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All of the following individuals may qualify for Medicare health insurance benefits EXCEPT ? |
A retired person over the age of 30 |
Under the current Federal Law, any of the described person could qualify for Medicare , except the individuals under 65 who have no special interest |
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How long dose the initial enrollment peroid for Medicare Part B last |
7 month |
Initial enrollmen peroid (IEP) is a 7 month peroid during which an individual may inroll into Medicare Part B program that usually begins 3 months before the month in which the individual turns age 65, and ends 3 months after that afer the birthday month. |
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Which of the following is NOT among the goals of a Medical supplement application ? |
Presuming the applicant is eligible for Medicaid, based on the nature of the policy. |
Medicare supplement policies must ask the applicant if they are eligible for medicaid |
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Who must sign the notice regarding replacement ? |
Both applicant and agent |
Before issuing replacement policy, the insurer must furnish the applicnt with a notice regarding replacement, which must be signed by both the applicant and the agent |
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Services provided by the Health Insurance Counseling and Advocasy Program are paid for |
By the state and local government |
Although the Department of Aging administerers the HICAP program, it is funded by stte and local governments |
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Following hospitilation because of an accident,, bill was confined in a skilled nursing facility. Medicare will pay full benefits in the facility for how many days |
20 |
Following hospitilization for at lrast 3 days if medically necessary .Medicare pays for all covered services during the first 20 days in a skilled nursing facility. Days 21 thru 100 require a daily copayent. |
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Medicare Advantage is also known as ? |
Medicare Part C |
Medicare consist of Hospital Insurance protection(PART A) Medical Insurance protedtion (PART B) and Medicare Advantge (PART C) formally know as medicare = Choice. Medicare Part D is a "stand aone" drug insurance policy for persons who need the coverage and are eligible for Medicare Part A and/ or Part B |
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The Health Insurance Counseling and Advocasy Program is administered by ? |
The California Deprtment of Aging |
The Department of Aging is responsible for overseeing the operations of each of the local HICAP agency in California. |
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What is the amount a physician or supplier bills flr a particular service or supply ? |
Actual charge |
Actual Charge is the amount a Physician or suppliers charges. |
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A medicare insured uses a particpating provider, pays the required deductable and recieves the necessary trement. Who is responsible for filing the claim for the rest of the bill ? |
The Health care provider. |
When a Medicare insured uses a participating health care provder. the provider wil file a medical claim. Medicare then pays its portion of the bill directly to the provider |
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Prior to purchasing a Medigap policy, a person must be enrolled in which of the following? |
Parts A and B of Medicare. |
Parts A and B of Medicare |
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How long is an open enrollment peroid for Medicare supplement policies ? |
6 months |
An open enrollment peroid for Medicare supplement policies is 6 months |
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Which of the following is NOT an enrollment peroid for Medicare Part A applicants ? |
Automic enrollment |
There are 4 types of enrollment periods for Medicare Part A: initial peroid; general enrollment peroid;special and special enrolment peroid for International volunteers |
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Which of the following statements is INCORRECT concerning Medicare Part B coverage ? |
Part B coverage is provided free of charge when the individual turns 65 |
Those who desire Part B coverage mustbeenroll and pay a monthly premium. |
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In order for an insured under Medicare Part A to recieve benefits for care in a skilled nursing facility, which of the following conditions must be met |
The insured must havefirst been hospitalized for 3 consecutive days |
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What is the difference between the Medicare approved amount of a service or supply and the actual charge? |
Excessive charge |
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An insured has Medicare Part D coverage. He has reached his initial benefit limit and must now pay 50% of his perscription drug cost. What is the term for this gap coverage? |
Donut hole |
Once the initial benefit limit is reached a gap called a " donut hole " occurs. in which the beneficiart is responsible for a portion of the prescription drug cost. |
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If If a Medicare insured uses a non- participating in medicare physician, he or she may be asked to sign a private contract. Which of the following conditions will NOT apply when the insured signs a private contract with the provideder ? |
Claims should be submitted to Medicare |
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