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Insurance for Senior Citizens & Special needs Individuals
Terms in this set (106)
Long term care policies must cover?
Medicaid provides all of the following benefits, except?
Income assistance for work related injuries
The Omnibus Budget Reconciliation Act of 1990 requires that large group health plans must provide primary coverage for disabled individuals under:
Age 65 and not retired
Primary eligibility requirement for medicaid is based upon:
What is correct of medicaid?
The program is divided into 4 parts (a-d)
Concerning medicaid part B, what is not correct?
It is full funded by social security taxes (FICA)
What is true of Medicaid, Part A?
Automatically provided when an individual qualifies for social security benefits at age 65
What must the patient pay under medicare, part B?
20% of covered charges above the deductible
Employer health plans must provide primary coverage for individuals with end stage renal disease before medicare becomes the primary insurance for how many months?
What is true of additional benefits with long term care policies?
They are available for an additional premium
If a new individual long term care policyholder is not happy with the policy, how many days does he have to return for a full premium refund?
According to OBRA how many employees is considered a "large group"?
What is not covered by medicare?
In reference to standard medicare supplement benefit plans, what does 'standard' mean?
All providers have the same options and conditions for each plan
What is not an enrollment period for medicare part A applicants?
When does medicare cover nursing home care?
Only if it is part of the treatment for a covered illness or injury
What is not an activity of daily life?
A medicare select policy does NOT...
Prohibit payment for regularly covered services if provided by a non-network provider
When must the medicare supplement buyer's guide be presented?
At the time of application
When a person applies for medicare, who is supposed to make sure they don't already have accident and sickness insurance in force?
What is not true?
Medicare advantage must be provided through HMO's
What is the duration of the medicare free look?
What is true of medicare part B?
It pays for physician services, diagnostic tests, and physical therapy
Medicare part D covers:
Prescription drug benefit
What kind of services may not be covered by a long term assisted care policy?
Visits by a registered nurse
An applicant is 65 years old and enrolled in medicare parts A&B. What is the insurance company obligated to do?
Offer the policy on a guaranteed basis
What is not true of Medicaid?
it is made of 3 parts (it only has 2- A&C)
under a long term care policy, what is not considered to be an activity of daily living?
What provision allows a person to return the medicare policy within 30 days for a full premium refund?
In order to receive care in a skilled nursing facility under medicare part A, what condition must be met?
Hospitalized for 3 consecutive days
What type of care is respite care?
Relief for a major care giver
If one takes SS retirement benefits at age 62, what had to be done at age 65to qualify for medicare?
What is not an acceptable reason to renewal refusal of a long term care policy?
There is no acceptable reason
What must be present in all medicare supplement policies?
Medicare Part A
If an insurer does not have a right to change any provision of the premium rate, the policy is:
Guarantee of insurability option in a long term care policy allows the insured to:
Increase benefit levels without providing evidence of insurability
What type of long term care is not provided in an institutional setting?
Home health care
An insurer offers a product similar to medicare and calls it medicare. What is. true?
This practice is illegal
How long is the medicare open enrollment period for supplement policies?
What is true of every long term care policy?
it must offer a nonforfeiture benefit to the applicant
What is not correct of medicaid?
It is solely a federally administered program
An insured has medicare part D. He has used initial benefits and has to pay 50% of the prescription drug costs. What is the term for the gap in coverage?
Occasional visits by ____________ will not be covered under long term care home health care?
An individual purchased a medicare supplement policy, but replaces it 2 months later. His history of coronary artery disease is considered a pre-existing condition. What is true?
The pre existing condition waiting period is fulfilled in the old policy and will pick up where it left off
What medicare supplement plan is available to a reasonable healthy 91 year old woman?
If an insurance company offers medicare, it must offer what plan?
What type of medicare policy required insured's to use specific health care providers and hospitals (except for emergency situations)?
What is true of medicare supplement policies?
they must be guaranteed renewable
Medicare advantage is also known as what?
Medicare Part C
An insured LTC policy offers to cover $120/day. The facility charges $100/day. What will the insurance company pay?
What program expands individual public assistance programs for people in need?
What is not covered under a LTC policy?
Acute care in a hospital
Hospice care is intended for:
The terminally ill
To sign up for the medicare prescription drug plan, one must first be enrolled in:
Medicare part A
In which medicare plans are the core benefits found?
What is not required to be stated in the outline of coverage provided by a LTC policy?
Basic information about all supplementary policies
An insurer is not allowed to amend or refuse to renew what type of policy?
What is not a goal of the medicare supplement application?
Presuming the applicant is eligible for medicaid based on the nature of the policy
The part of medicare that helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health and hospice, is known as:
The medicare renewal commission rate for 3rd year must be as high as what year?
An individual wants to replace his LTC policy with a new one from the same company. How long is the waiting period?
There is no waiting period
Regarding return of premium, what happens if a policy lapses?
If a policy lapses, the insurer will not return the premium paid into the policy
How long is the pre existing condition period under CHIP?
What provision must be included on the 1st page of medicare policies that states the right to change premium amounts?
How many pints of blood are paid for by medicare supplement core benefits?
the first 3
What is correct?
HMO;s may pay for services not provided by medicare
Which program is made of 4 parts, 1st part paid by FICA, 2nd part is financed by premiums and payroll taxes?
An agent is completing an application for a LTC policy. an Agent is not required to:
Warn the applicant of the 10 day free look period
What would not fall under the duration medical equipment definition?
What is necessary in order to be eligible to receive benefits from a LTC policy?
The insured must be able to perform some activities of daily living
OBRA requires what disease to be covered by an employer for 30 months before medicare becomes the primary mode of coverage?
end stage renal disease
A man is employee at 65 years old and wants to know what coverage he is able to receive. What is available to him?
Both group health care and medicare
If an insurance company offers medicare supplement policies, it must offer what plan?
How long must an insurer retain an advertisement for it's LTC policies?
What LTC benefit would provide coverage for care less than 24 hours basis for functionally impaired adults?
Adult day care
What is not correct of medicare supplement insurance policies?
The cover the cost of extended nursing home care
Who may not qualify for medicare health insurance benefits?
A 50 year old retired person
What is true of HMOs and medicare?
HMO's may pay for services not covered by medicare
What is true of medicare part A?
Part A is automatically provided when an individual qualifies for SSDI benefits at age 65
Prior to purchasing a medigap policy, a person must be enrolled in what?
Parts A & B of medicare
Who would not qualify for medicare?
just anyone willing to pay the premium
Medicare part A services do not include what?
Outpatient hospital treatment
For how many days of skilled nursing facility care will medicare pay benefits?
What is not covered by part A of medicare?
Physician's and surgeon's services
What care coverage would not let an insured receive care at home
In LTC, what type of care is provided with immediate care?
Occasional nursing or rehabilitative care
What program expands individual public assistance programs for people with insufficient income and resources?
What is the amount a physician or supplier bills for a particular service/ supply?
What is not an advantage of an HMO or PPO for a medicare recipient?
Elective cosmetic procedures covered
What type of care is not provided by medicare?
Long term care
Issue age policy premiums increase in response to what factor?
Most long term care plans include what feature?
In long term care policies, as the benefit period lengthens, the premiums
In what location would skilled care most likely be completed/provided?
In an institutional setting
What is the difference between the medicare approved amount for a service or supply and the actual charge?
What statement is not correct of medicare part B coverage?
Part be is provided for free for people who are 65 years old
Shortly after a replacement transaction on a medicare supplement policy, the insured decided to cancel the policy. He could see if the free look period applies. Where can he find this information?
Notice regarding replacement
Regarding long term care, as the elimination period gets shorter, the premium responds in what way?
What is not covered under medicare part b?
Routine dental care
A long term care insurance shopper's guide must be provided in what format?
What is not covered under plan AN in medigap insurance?
Medicare Part A deductible
Who can provide skilled nursing care?
When an employee is still employed at 65 and eligible for medicare, what is his or her option?
Remain on group health insurance plan and defer medicare until the retire
What is not true of medicare part B?
It is a compulsory program
What do LTC policies offer to policy holders to account for inflation?
Option of purchasing coverage that increases benefit levels accordingly
When must an insurance company present an outline of coverage to an applicant for a medicare supplement policy?
At the time of application
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