Combined Exam Questions with Correct

Medicare, M edicaide, LTC NC Insurance Combined Exam Questions with Correct Answers 2024/2025 Federal Program - Correct Answer Medicare is a federal health insurance program. Part of the Social Security program, Medicare is run by the Centers for Medicare & Medicaid Services of the Department of Health and Human Services. Private firms contract with the federal government to handle the paperwork, review claims, and disburse claim payments.Medicare Part A - Correct Answer Designed primarily to provide hospital insurance and to pay for certain other types of institutional care.Medicare Part B - Correct Answer Designed primarily to provide medical insurance for physician visits and other out-patient care.Medicare Part C - Correct Answer Provides expanded coverage through managed care plans such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).Medicare Part D - Correct Answer Provides coverage for prescription drugs.What is the "original medicare"? - Correct Answer Parts A and B because those two parts were enacted together in the original amendment to Social Security that created the Medicare program in 1965. Parts C and D were added later (in 1997 and 2003, respectively) to keep the Medicare program up to date with changes in the health care delivery system.If someone has Original Medicare, in which part or parts of Medicare is he or she enrolled?A Parts A, B, and C B Parts A, B, C, and D C Part C D Parts A and B - Correct Answer D Parts A and B *Parts A and B are referred to as Original Medicare because they were enacted together when the So- cial Security law was originally amended to create Medicare. Parts C and D were added later. 1 / 4

Qualified Medicare Beneficiary (QMB) - Correct Answer Program is for persons whose monthly income is no more than the Federal Poverty Level (FPL) plus $20. Some states disregard more than an additional $20 of monthly income. In addition to helping pay the Part B premium, the QMB program may also help pay a beneficiary's Part A premium (if any) and Medicare cost-sharing amounts such as deductibles, coinsurance, and copayments.Specified Low-Income Medicare Beneficiary (SLMB) - Correct Answer For persons whose monthly income is no more than 120% of the FPL plus $20. As with the QMB program, some states disregard more than an additional $20 of monthly income. The SLMB program helps pay for only the Part B premium, not other Medicare costs.Qualifying Individual (QI) - Correct Answer For persons whose monthly income is no more than 135% of the FPL plus $20. Some states disregard more than an additional $20 of monthly income. The QI program helps pay for only the Part B premium.An individual has been working for 8 years while the Hospital Insurance tax has been getting deducted from her paycheck. How many more years must she work before she can get Medicare Part A coverage premium-free?A 12 B 4 C 7 D 2 - Correct Answer D 2 *Part A coverage is premium-free for workers who have paid the Hospital Tax for 10 years. The individual has paid for 8 years, so she has 2 more years to go.Suppose a worker's income is between 120% and 135% of the federal poverty level. What is the name of the Medicare Savings Program for which she is eligible?A Specified Low-Income Medicare Beneficiary B Medicare Advantage C Qualified Medicare Beneficiary D Qualifying Individual - Correct Answer D Qualifying Individual *The Qualifying Individual program pays the Part B premium for persons whose income is less than 135% of the federal poverty level but higher than the requirements for other Medicare savings pro- grams. 2 / 4

Medicare Advantage is another name for what part of Medicare?A Parts A and B B Part C C Part D D Part A - Correct Answer B Part C *Medicare Part C is also called Medicare Advantage.To be eligible to enroll in Medicare, individuals must fall into one of three groups. They must be: - Correct Answer -Age 65 or Older -Social Security disability beneficiaries (generally after 2 years) -Suffering from ESRD (end-stage renal disease—that is, kidney failure) This is the largest group of Medicare beneficiaries. Most people become eligible for Medicare by reason of age - Correct Answer Age 65 or older group Description of group 2 Social Security disability beneficiaries (generally after 2 years) - Correct Answer Individuals who have been receiving Social Security benefits because they are disabled and cannot work can become eligible for Medicare even if they have not yet turned age 65. Usually, such individuals become eligible for Medicare only after they have received Social Security disability benefits for a period of 24 continuous months (2 years).Individuals who are eligible for medicare immediately - Correct Answer Individuals who qualify for Social Security disability benefits because they have ALS (amyotrophic lateral sclerosis, also called Lou Gehrig's disease) Description of group 3 who qualifies for Medicare Suffering from ESRD (end-stage renal disease—that is, kidney failure) - Correct Answer Individuals under age 65 can also become eligible for Medicare if they have had a kidney transplant or need regular dialysis because their kidneys no longer work.Enrollment in Medicare Part A and Part B is automatic for people who are already receiving Social Security benefits when they become eligible for Medicare. So, enrollment would be automatic for 3 / 4

individuals: - Correct Answer -At age 65 if they are receiving Social Security retirement benefits at that time; or -After receiving Social Security disability benefits for 2 years (immediately for those with ALS) even if they are not yet 65 at that time For people covered by Social Security, which part is premium free? - Correct Answer Part A is premium free, Part B is not Individuals who are automatically enrolled in Part B have what option if they do not want to pay the premiun? - Correct Answer Drop Medicare part B, However, people who do not enroll in Medicare Part B when they are first eligible generally have to pay a penalty in the form of a higher premium if they wish to sign up for it later.== What is the late enrollment penalty designed to do? - Correct Answer Prevent against adverse selection or —a disproportionately high number of above-average risks in the insurance pool.

Finish the sentence:

By encouraging everyone to purchase Part B coverage when they are first eligible, ----------------------- - Correct Answer the late enrollment penalty maintains the expected balance of average and above- average risks in the insurance pool.What is the additional enrollment penalty for Medicare part B? - Correct Answer An additional charge of 10% of the amount of the individual's Part B premium for every 12-month period that has elapsed since the individual became eligible for Medicare.Suppose Jack became eligible for Medicare in January of 2013 but did not sign up for Part B until July of

• The standard price for Part B is $104.90 in 2015. - Correct Answer Although Jack waited 18 months

after he first became eligible to sign up for Part B, only one period of 12 full months has elapsed, so his penalty would be an additional charge of 10% of his usual premium. The standard premium for Part B in 2015 was $104.90. Assuming that Jack, like most people, paid the standard premium, he would be charged an additional $10.49 (10% of the standard premium amount) for a total premium of $115.39 ($104.90 plus the $10.49 penalty). Jack would pay that additional 10% penalty for as long as he had Medicare Part B, not just for the first year. If the amount of the standard premium increased, the amount of the penalty would also increase to equal 10% of the higher premium.

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