OBRA (Omnibus Budget Reconciliation Act) must provide primary coverage for disabled individuals under what age ?
age 65 who are NOT retired.
in long term care policy pre existing condition limitations must appear where?
in a separate paragraph and be clearly labeled
Medicare A services do not include ....
outpatient hospital treatment
Medicare part B includes
- outpatient services
- dialysis
- second opinions
- medical equiptment
- labs and diagnostic tests
- mammograms, flu shots, colonoscopy
*no meds, hearing, vision or dental
*must pay premiums monthly
after buying individual long term policy, how many days after will the insured be able to return the policy for a full premium refund
30 days
Most LTC plans have which of the following features?
guaranteed renew-ability
what is not among the goals of medicare supplement action
presuming the applicant is eligible for medicaid based on the nature of the policy ( polices must always ask, not assume. )
which medical supplemental policies are the core benefits found
ALL PLANS
medicaid does not include benefits for
income assistant for work related injury
During replacement of life insurance, a replacing insurer must do which of the following?
must list policies sold in the last 5 years
which program expands individual public asistance programs for people with insufficient income and resources
medicaid
medicare part D provides
prescription drug benefit
what type of care is not covered by medicare
long term care
excess charge
The difference between the Medicare approved amount for a service or supply and the actual charge.
OBRA what is the minimum number of employees required to constitute a group
100
Prior to purchasing a Medigap policy, a person must be enrolled in which of the following?
parts A and B of medicare
what provision allows a person to return a medicare supplement policy within 30 days for a full premium refund
RIGHT TO EXAMINE
Medicare
the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease
PART A (hospital insurance)
is financed through a portion of the payroll tax
PART B (medical insurance)
is financed from monthly premiums paid by insureds and from the general revenues of the federal government
Part C (Medicare Advantage)
allows people to receive all of their health care services through available provider organizations
PART D (prescription drug)
is for the prescription drug charge
original medicare refers to which part.
PART A AND B ONLY
Does original medicare require a referral for a specialst>
no as long as the specialist is enrolled in medicare.
Part A helps pay for
with inpatient hospital care, inpatient care in a nursing home, home health care, and hospice care
what are the three enrollment periods
initial, general, and special
Initial enrollment period
When an individual first becomes eligible for Medicare, starting 3 months before turning age 65 and ending 3 months after the 65th birthday
General Enrollment Period
between January 1st and March 31st each year
Special Enrollment Period
at any time during the year if the individual or his/her spouse is still employed and covered under a group health plan
if individuals do not sign up for PART A when they are first eligible what will happen
the monthly premium can go up 10 % unless the person becomes eligible for a special enrollment period
Inpatient Hospital Care
hospital insurance helps pay for up to 90 days in a participating hospital in any benefit period, subject to a deductible
Medicare plan B
-pays for necessary medical services and supplies
-most people pay a premium
-covers: outpatient care, doctor's services, physical or occupational therapies
actual charge
The amount a physician or supplier actually bills for a particular service or supply.
relationship between HMO and medicare.
HMOS pay for services not covered by medicare
what is not covered under plan B
routine dental care
how long is an open enrollment period for medicare supplement policies
6 months
Issue age policy premiums increase in response to which of the following factors?
increased benefits
what type of care is respite care?
Relief for a major care giver
chronically ILL
an individual is unable to perform at least two activities of daily living for just 90 days
how many pints of blood will be paid for by medicare supplement core benefits?
the first 3
ADL
activities of daily living
ADLs (activities of daily living)
bathing, toileting, transferring ( or mobility) , continence, and eating
Notice Regarding Replacement
must inform the applicant of the 30 day free look provision of the replacing policy.