A Medicare Supplement Policies Outline Of Coverage Must Include

Question: All the following qualify for Medicare Part A, except:
a. Anyone who was a railroad or government employee.
b. Anyone who qualifies through Social Security.
c. Anyone who is willing to pay a premium.
d. Anyone over 65 not qualifying for hospital insurance and willing to pay premiums.
Answer: c. Anyone who is willing to pay a premium.

Medicare was not designed for a specific class of society but primarily for citizens age 65 and over.
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Question: All of the following statements are true regarding Medicare Supplement Insurance, except:
a. Medicare Supplements are private plans following the same guidelines as Medicare.
b. The number of Medicare Supplement policies that may be sold in this state is limited to 6 standard benefit packages.
c. Anyone who is 65 or older may purchase a Medicare Supplement by paying the premium, if application is made within six months of Medicare Part B enrollment.
d. An HMO could be an adequate substitute for Medicare Supplement Insurance if the HMO contracts with Medicare.
Answer: b. The number of Medicare Supplement policies that may be sold in this state is limited to 6 standard benefit packages.

Medicare Supplement regulations limit the number of policies to no more than 10 standard benefit packages.
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Question: Every LTC Policy that provides benefits of homecare or community-based services shall provide all of the following except:
a. Hospice services
b. Respite care
c. Acute care
d. Adult day care
Answer: c. Acute Care
Acute Care is an excluded coverage.
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Question: Which of the following is incorrect regarding how Medicare works?
a. Part B covers routine physical exams and dialysis for those with kidney failure.
b. Part B is optional and offered to applicants when they become entitled to Part A.
c. Part B - outpatient service benefits are determined by consulting a national fee schedule.
d. Part A is premium free to those who qualify through Social Security or railroad retirement or government employment.
Answer: a. Part B covers routine physical exams and dialysis for those with kidney failure.

Medicare Part B does not cover routine physical exams, but would cover kidney dialysis treatments.
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Question: Medicare Supplement Insurance must meet certain minimum benefit standards in order to be offered to the general public. Those standards include all of the following, except:.
a. The policy must pay both accident and sickness expenses on the same basis.
b. The policy may limit coverage to a single disease or affliction.
c. Will not include exclusions for any preexisting conditions if the condition occurred more than six months prior to the effective date of coverage.
d. If a group policy is replaced, the insurer must offer the same coverage to all of those persons covered by the original group plan.
Answer: b. The policy may limit coverage to a single disease or affliction.

The policy cannot limit coverage to a single disease or affliction.
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Question: Any policy designed to provide coverage for not less than 12 consecutive months for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that is provided in a setting other than an acute care unit of a hospital is the definition of:
a. Home Convalescent Care
b. Residential Care
c. Long-Term Care
d. Custodial Care
Answer: c. Long-Term Care
The question is giving the definition of Long-Term Care.
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Question: Long-Term Care benefits may be triggered by the insured's inability to perform at least ______ Activities of Daily Living (ADL's).
a. One
b. Three
c. Five
d. Two
Answer: d. Two
The insured is considered to be fundamentally impaired if they are incapable of performing any two ADLs.
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Question: A program designed to provide increased assistance to those who are unable to pay for their medical needs is known as:
a. Medicare Part A
b. Medicaid (In California, Medi-Cal)
c. Supplemental Security Income
Answer: b. Medicaid (In California, Medi-Cal)
Medicaid (in California, Medi-Cal) is the federal and state administered program that provides increased assistance to those who are unable to pay for their own medical needs.
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Question: Which Long-Term Care definition does not match the coverage?
a. Residential Care - health care provided in one's home under a planned program established by his/her attending physician.
b. Skilled Nursing Facility - a licensed facility, operated in accordance with the laws of the state, providing skilled nursing care under the supervision of a physician.
c. Respite Care - provides relief to the caregiver not the long-term care patient.
d. Custodial Care Facility - a licensed facility, operated according to the laws of the state, under the supervision of an R.N.
Answer: a. Residential Care - health care provided in one's home under a planned program established by his/her attending physician.

This is the definition of Home Convalescent Care, not Residential Care, which occurs within a long-term care facility.
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Question: Which of the following is not a Medicare Part A benefit?
a. Outpatient hospital treatment
b. Hospitalization
c. Post hospital skilled nursing facility care
d. Hospice care
Answer: a. Outpatient hospital treatment

Remember, Part A is Hospital Insurance (Inpatient), not (Outpatient), which is covered under Part B.
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Question: Long-Term Care policies may not be written as which of the following?
a. Riders/Endorsements to life insurance policies
b. Individual policies
c. Medical coverage
d. Group policies
Answer: c. Medical coverage

Long-Term Care policies do not take the place of fundamental Medical Expense Insurance.
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a. Limiting benefits to services provided by Medicare-certified providers.
b. Requiring a need for care in a nursing home if care is not provided.
c. Requiring the existence of an acute condition.
d. All of the answers listed.
Answer: d. All of the answers listed.
Home Health Care benefits may not be limited or excluded under any of the other responses listed.
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Question: A Medicare Supplement Policy must contain which requirement?
a. Explain how the Medicare Supplement is paid for.
b. Explain the relationship of the coverage to Medicare.
c. Explain how the insurer will file their claims.
d. Guarantee premiums for the life of the contract.
Answer: b. Explain the relationship of the coverage to Medicare.

This is a Medicare Supplement Policy requirement.
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Question: Which of the following is not provided under Part A of Medicare?
a. Outpatient Hospital Treatment
b. Home Health Care
c. Hospice Care
d. Post-hospital Skilled Nursing Facility Care
Answer: a. Outpatient Hospital Treatment

Part A of Medicare is Hospital Insurance or (Inpatient); Part B of Medicare is Medical Insurance or (Outpatient).
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Question: Anna is seeking a Medicare Supplement Policy. An agent has explained that all supplements must contain some of the same items. Which of the following is false?
a. The policy must contain an Outline of Coverage.
b. The policy must contain a 30-day free look provision on the first page.
c. A question about replacement must appear on the application.
d. The insurer may provide a Buyer's Guide and an Outline of Coverage.
Answer: d. The insurer may provide a Buyer's Guide and an Outline of Coverage.
The insurer must provide a Buyer's Guide and Outline of Coverage at time of application.
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Question: Which statement is not true regarding Medicare?
a. Hospitals and other providers of health care wanting to participate in the Medicare program must be licensed by the state.
b. It is a federal health program for people 65 and older and others of any age, who have received Social Security Disability Benefits for at least two years.
c. The initial enrollment period lasts seven months and begins on the first day of the third month before one is eligible for Medicare.
d. Medicare may be the primary payor to any employer group health plan coverage.
Answer: d. Medicare may be the primary payor to any employer group health plan coverage.

Group health plans with 20 or more employees are primary to Medicare and pay first.
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Question: An insurance company's responsibilities under Medicare are all of the following, except:
a. Review Medicare claims.
b. Caution doctors about excessive fees.
c. Make sure Medicare does not pay all claims when Medicare is the secondary insurer.
d. Handle claim processing and payments.
Answer: b. Caution doctors about excessive fees.

The insurer would perform all the other choices
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Question: A type of Long-Term Care policy written to be renewable, may be convertible, and is more economical than an individual policy, is which of the following?
a. A Franchise Policy
b. A Policy Rider
c. An Employer-Employee Policy
d. A Group Policy
Answer: d. A Group Policy
Group policies cover the criteria specified in the question.
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Question: An insurer offering Medicare Supplements to the senior clients of this state must:
a. Offer Core Benefit Plan A if they sell any of the other plans.
b. Offer any plan from C to S.
c. Offer Core Benefit Plans only.
d. Offer the broader coverage plans only.
Answer: a. Offer Core Benefit Plan A if they sell any of the other plans.

If an insurer is going to offer Medicare Supplement insurance, they must make Plan A available if they offer any of the ten plans.
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Question: All are exclusions under the LTC policy except:
a. Nervous or mental disorders that have no demonstrable organic cause
b. Rest cures
c. Injury arising due to committing a felony
d. Chemical dependency on prescription drugs
Answer: d. Chemical dependency on prescription drugs

Chemical dependency would not be excluded if it results from the administration of drugs under a physician's prescription and direction.
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