2/17/25, 4:08 PM NC Medicare Supplement & Long Term Care Insurance Licensing 2025 Real Exam Questions And Answers ( 100% ACCURAT…
NC Medicare Supplement & Long Term Care
Insurance Licensing 2025 Real Exam Questions
And Answers ( 100% ACCURATE) GET IT RIGHT!!
Save
Terms in this set (79)
Health insurance for those over age 65, people
under 65 with certain disabilities & those with ESRD
Medicare
(end stage renal disease - permanent kidney failure
requiring dialysis or kidney transplant)
Centers for Medicare and Medicaid Services
administers the Medicare program. Social Security
CMS
Administration handles most of the enrollment &
plays a role in claims appeal process.
Medicare Administrative Contractor - company
MAC
contracted to administer Part A & Part B claims.
-hospital coverage
-no premium requirements for those with 40 "work
Medicare Part A credits" of FICA or Self Employment tax credits.
-Those who don't qualify can voluntarily participate
by paying a monthly premium
The part of the Medicare program that pays for
physician services, outpatient hospital services,
durable medical equipment, and other services and
supplies.
Medicare Part B
-Has a monthly premium of $135.50 in 2019 which is
deducted from SS check.
-Part B enrollment is optional. You can reject Part B
by signing a rejection form.
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 1/16
,2/17/25, 4:08 PM NC Medicare Supplement & Long Term Care Insurance Licensing 2025 Real Exam Questions And Answers ( 100% ACCURAT…
Medicare Advantage Plans that are offered through
private insurance companies that provide both
Medicare Part C hospital and physician coverage and possible
prescriptions - financed by Social Security and
monthly premiums
-Over age 65 who have earned 40 "work credits" in
order to receive premium free part A benefits
-Permanently disabled prior to age 65 for at least 24
Medicare Eligibility
months
-ESRD or kidney disease requiring dialysis or kidney
transplant
Part A & B are automatically conducted by SSA
Medicare enrollment
when individual age 65+ enrolls for their Social
requirements
Security retirement benefits
7 month period straddling 3 months before and
ends 3 months after the individual turns 65,
including the birthday month.
-If enrollment is during the 3 mos prior to 65th
Initial Enrollment Period birthday, coverage begins on 1st day of 65th
birthday month
-If enrollment is during or after 65th birthday month,
coverage begins on 1st day of month after
enrollment
Medicare enrollment period - January 1st through
March 31st annually.
General Enrollment -Coverage begins July 1st of that year
Period -Monthly premium for part B may go up 10% for
each full 12 month period that you're eligible but
didn't sign up.
Individual can enroll at 8 months beginning with the
Special Enrollment month employment ends or when group coverage
Period ends whichever is earlier without subject to late
enrollment surcharge
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 2/16
, 2/17/25, 4:08 PM NC Medicare Supplement & Long Term Care Insurance Licensing 2025 Real Exam Questions And Answers ( 100% ACCURAT…
-Medicare is the secondary payer for the 'working
aged' who has a group health plan if the group has
20+ enrollees
-For single employer with <20 employees with a
group health plan, Medicare is the primary payer.
Medicare as a secondary
-If individual retains coverage thru the group plan,
or primary payer
the group contract is the primary unless person is
retired & still covered under the group plan. In that
case, Medicare is the primary.
-If individual rejects the employer plan, Medicare is
the primary payer
-In cases of Workers' Comp when it applies to an
Medicare as a secondary injury or illness
payer - In cases where no-fault insurance or liability
insurance is available as primary payer.
Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are
Medicare & the VA rendered in a VA facility but will pay if outside of VA.
There is NO coordination between Federal
agencies.
-Purely custodial care/ chronic care
-Services that are not reasonable or medically
Expenses NOT paid by necessary under Medicare standards
Medicare -Services performed by relatives/ member of
beneficiary's household
-Services paid for by another gov't agency
-acute inpatient hospital care
-inpatient skilled nursing care
Medicare Part A covers
-medically necessary home health care & hospice
services
-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
Medicare Deductible
-Deductible is $1364 plus need to pay/ replace first
3 pts of blood per calendar year.
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 3/16
NC Medicare Supplement & Long Term Care
Insurance Licensing 2025 Real Exam Questions
And Answers ( 100% ACCURATE) GET IT RIGHT!!
Save
Terms in this set (79)
Health insurance for those over age 65, people
under 65 with certain disabilities & those with ESRD
Medicare
(end stage renal disease - permanent kidney failure
requiring dialysis or kidney transplant)
Centers for Medicare and Medicaid Services
administers the Medicare program. Social Security
CMS
Administration handles most of the enrollment &
plays a role in claims appeal process.
Medicare Administrative Contractor - company
MAC
contracted to administer Part A & Part B claims.
-hospital coverage
-no premium requirements for those with 40 "work
Medicare Part A credits" of FICA or Self Employment tax credits.
-Those who don't qualify can voluntarily participate
by paying a monthly premium
The part of the Medicare program that pays for
physician services, outpatient hospital services,
durable medical equipment, and other services and
supplies.
Medicare Part B
-Has a monthly premium of $135.50 in 2019 which is
deducted from SS check.
-Part B enrollment is optional. You can reject Part B
by signing a rejection form.
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 1/16
,2/17/25, 4:08 PM NC Medicare Supplement & Long Term Care Insurance Licensing 2025 Real Exam Questions And Answers ( 100% ACCURAT…
Medicare Advantage Plans that are offered through
private insurance companies that provide both
Medicare Part C hospital and physician coverage and possible
prescriptions - financed by Social Security and
monthly premiums
-Over age 65 who have earned 40 "work credits" in
order to receive premium free part A benefits
-Permanently disabled prior to age 65 for at least 24
Medicare Eligibility
months
-ESRD or kidney disease requiring dialysis or kidney
transplant
Part A & B are automatically conducted by SSA
Medicare enrollment
when individual age 65+ enrolls for their Social
requirements
Security retirement benefits
7 month period straddling 3 months before and
ends 3 months after the individual turns 65,
including the birthday month.
-If enrollment is during the 3 mos prior to 65th
Initial Enrollment Period birthday, coverage begins on 1st day of 65th
birthday month
-If enrollment is during or after 65th birthday month,
coverage begins on 1st day of month after
enrollment
Medicare enrollment period - January 1st through
March 31st annually.
General Enrollment -Coverage begins July 1st of that year
Period -Monthly premium for part B may go up 10% for
each full 12 month period that you're eligible but
didn't sign up.
Individual can enroll at 8 months beginning with the
Special Enrollment month employment ends or when group coverage
Period ends whichever is earlier without subject to late
enrollment surcharge
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 2/16
, 2/17/25, 4:08 PM NC Medicare Supplement & Long Term Care Insurance Licensing 2025 Real Exam Questions And Answers ( 100% ACCURAT…
-Medicare is the secondary payer for the 'working
aged' who has a group health plan if the group has
20+ enrollees
-For single employer with <20 employees with a
group health plan, Medicare is the primary payer.
Medicare as a secondary
-If individual retains coverage thru the group plan,
or primary payer
the group contract is the primary unless person is
retired & still covered under the group plan. In that
case, Medicare is the primary.
-If individual rejects the employer plan, Medicare is
the primary payer
-In cases of Workers' Comp when it applies to an
Medicare as a secondary injury or illness
payer - In cases where no-fault insurance or liability
insurance is available as primary payer.
Can choose to get treatment under either plan.
Medicare usually will not pay benefits if services are
Medicare & the VA rendered in a VA facility but will pay if outside of VA.
There is NO coordination between Federal
agencies.
-Purely custodial care/ chronic care
-Services that are not reasonable or medically
Expenses NOT paid by necessary under Medicare standards
Medicare -Services performed by relatives/ member of
beneficiary's household
-Services paid for by another gov't agency
-acute inpatient hospital care
-inpatient skilled nursing care
Medicare Part A covers
-medically necessary home health care & hospice
services
-Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
Medicare Deductible
-Deductible is $1364 plus need to pay/ replace first
3 pts of blood per calendar year.
https://quizlet.com/1006878963/nc-medicare-supplement-long-term-care-insurance-licensing-2025-real-exam-questions-and-answers-100-accur… 3/16
