Which of the following Medicare parts will allow an assignment payment method?
Part B
Part C
Part D
All Medicare Parts - ANSWER Part B
Assignment is an agreement by the insured's doctor, provider, or supplier to be paid directly
by Medicare, to accept the payment amount Medicare approves for the service, and not to
bill the insured for any more than the Medicare deductible and coinsurance. Assignments
are applicable to Medicare Part B, but not to Parts C or D.
Which of the following would be covered under Medicare home health care?
Durable medical equipment
24-hour a day care at home
Prescription drugs
Meals delivered to a home - ANSWER Durable medical equipment
Medicare home health care pays 80% of the cost of durable medical equipment.
Which of the following is EXCLUDED from coverage under Medicare hospice care?
Respite care
1
,Short-term inpatient care
Ambulance transportation
Nursing care - ANSWER Ambulance transportation
Generally ambulance transportation is excluded (except for when arranged by the hospice
medical team). All the other examples are covered services.
Which of the following define a loss ratio? - ANSWER Premiums collected vs. Claims paid.
A 65-year-old man joined a Private Fee-For-Service Plan. He is worried that his next doctor's
visit will not be covered by the plan. What can he do?
Call the service provider to see if his plan will cover the services
Get a written advance coverage determination for the service
Sue the plan for coverage if the plan refuses coverage
The patient has no options at this point. - ANSWER Get a written advance coverage
determination for the service
If the patient has any questions whether the PFFS plan will pay for a service, including
inpatient hospital services, the patient has the right under the law to have a written/binding
advance coverage determination made for the service. The service provider would not be
able to determine whether or not the PFFS plan will cover a service.
A patient has a 110-day stay in a skilled nursing facility. All Medicare requirements have been
satisfied. For how many days will Medicare participate in the cost of the patient's care?
20
80
100
110 - ANSWER 100
2
, Medicare does not participate in the cost of skilled nursing care after 100 days.
What does first-dollar coverage mean?
No deductible
No coinsurance or any other forms or copay
Patient pays first, then Medicare covers the rest
First come, first served - ANSWER No deductible
First-dollar coverage means there is no deductible. Medicare pays all cost for home health
care visits.
A woman has a Medigap policy. She purchased the policy at age 65. Her premium does not
increase automatically as she gets older. This premium calculation method is known as
No age.
Issue age.
COLI.
Attained age. - ANSWER Issue age.
Issue age policy premium calculations are based on age at the time of issue and do not
Automatically increase as the insured gets older.
If an agent receives $1,000 in commissions upon the first renewal of a Medigap policy, what
is the maximum compensation that the agent may receive on the fourth renewal?
$1,000
$2,000
3
Part B
Part C
Part D
All Medicare Parts - ANSWER Part B
Assignment is an agreement by the insured's doctor, provider, or supplier to be paid directly
by Medicare, to accept the payment amount Medicare approves for the service, and not to
bill the insured for any more than the Medicare deductible and coinsurance. Assignments
are applicable to Medicare Part B, but not to Parts C or D.
Which of the following would be covered under Medicare home health care?
Durable medical equipment
24-hour a day care at home
Prescription drugs
Meals delivered to a home - ANSWER Durable medical equipment
Medicare home health care pays 80% of the cost of durable medical equipment.
Which of the following is EXCLUDED from coverage under Medicare hospice care?
Respite care
1
,Short-term inpatient care
Ambulance transportation
Nursing care - ANSWER Ambulance transportation
Generally ambulance transportation is excluded (except for when arranged by the hospice
medical team). All the other examples are covered services.
Which of the following define a loss ratio? - ANSWER Premiums collected vs. Claims paid.
A 65-year-old man joined a Private Fee-For-Service Plan. He is worried that his next doctor's
visit will not be covered by the plan. What can he do?
Call the service provider to see if his plan will cover the services
Get a written advance coverage determination for the service
Sue the plan for coverage if the plan refuses coverage
The patient has no options at this point. - ANSWER Get a written advance coverage
determination for the service
If the patient has any questions whether the PFFS plan will pay for a service, including
inpatient hospital services, the patient has the right under the law to have a written/binding
advance coverage determination made for the service. The service provider would not be
able to determine whether or not the PFFS plan will cover a service.
A patient has a 110-day stay in a skilled nursing facility. All Medicare requirements have been
satisfied. For how many days will Medicare participate in the cost of the patient's care?
20
80
100
110 - ANSWER 100
2
, Medicare does not participate in the cost of skilled nursing care after 100 days.
What does first-dollar coverage mean?
No deductible
No coinsurance or any other forms or copay
Patient pays first, then Medicare covers the rest
First come, first served - ANSWER No deductible
First-dollar coverage means there is no deductible. Medicare pays all cost for home health
care visits.
A woman has a Medigap policy. She purchased the policy at age 65. Her premium does not
increase automatically as she gets older. This premium calculation method is known as
No age.
Issue age.
COLI.
Attained age. - ANSWER Issue age.
Issue age policy premium calculations are based on age at the time of issue and do not
Automatically increase as the insured gets older.
If an agent receives $1,000 in commissions upon the first renewal of a Medigap policy, what
is the maximum compensation that the agent may receive on the fourth renewal?
$1,000
$2,000
3
