NC MEDICARE SUPPLEMENT & LONG
TERM CARE INSURANCE LICENSING.
EXAM 2025 QUESTIONS AND ANSWERS
Medicare - ANS Health insurance for those over age 65, people under 65 with certain
disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant)
CMS - ANS Centers for Medicare and Medicaid Services administers the Medicare program.
Social Security Administration handles most of the enrollment & plays a role in claims appeal
process.
MAC - ANS Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims.
Medicare Part A - ANS -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self Employment tax
credits.
-Those who don't qualify can voluntarily participate by paying a monthly premium
Medicare Part B - ANS The part of the Medicare program that pays for physician services,
outpatient hospital services, durable medical equipment, and other services and supplies.
-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.
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,Medicare Part C - ANS Medicare Advantage Plans that are offered through private insurance
companies that provide both hospital and physician coverage and possible prescriptions -
financed by Social Security and monthly premiums
Medicare Eligibility - ANS -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 months
-ESRD or kidney disease requiring dialysis or kidney transplant
Medicare enrollment requirements - ANS Part A & B are automatically conducted by SSA
when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - ANS 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 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
General Enrollment Period - ANS Medicare enrollment period - January 1st through March
31st annually.
-Coverage begins July 1st of that year
-Monthly premium for part B may go up 10% for each full 12 month period that you're eligible
but didn't sign up.
Special Enrollment Period - ANS Individual can enroll at 8 months beginning with the month
employment ends or when group coverage ends whichever is earlier without subject to late
enrollment surcharge
Medicare as a secondary or primary payer - ANS -Medicare is the secondary payer for the
'working aged' who has a group health plan if the group has 20+ enrollees
2 Copyright ©2025 THESTAR ALL RIGHTS RESERVED
, -For single employer with <20 employees with a group health plan, Medicare is the primary
payer.
-If individual retains coverage thru the group plan, 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
Medicare as a secondary payer - ANS -In cases of Workers' Comp when it applies to an injury
or illness
- In cases where no-fault insurance or liability insurance is available as primary payer.
Medicare & the VA - ANS Can choose to get treatment under either plan. Medicare usually
will not pay benefits if services are rendered in a VA facility but will pay if outside of VA. There
is NO coordination between Federal agencies.
Expenses NOT paid by Medicare - ANS -Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - ANS -acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - ANS -Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - ANS Non-Exhaustible Benefit
3 Copyright ©2025 THESTAR ALL RIGHTS RESERVED
TERM CARE INSURANCE LICENSING.
EXAM 2025 QUESTIONS AND ANSWERS
Medicare - ANS Health insurance for those over age 65, people under 65 with certain
disabilities & those with ESRD (end stage renal disease - permanent kidney failure requiring
dialysis or kidney transplant)
CMS - ANS Centers for Medicare and Medicaid Services administers the Medicare program.
Social Security Administration handles most of the enrollment & plays a role in claims appeal
process.
MAC - ANS Medicare Administrative Contractor - company contracted to administer Part A &
Part B claims.
Medicare Part A - ANS -hospital coverage
-no premium requirements for those with 40 "work credits" of FICA or Self Employment tax
credits.
-Those who don't qualify can voluntarily participate by paying a monthly premium
Medicare Part B - ANS The part of the Medicare program that pays for physician services,
outpatient hospital services, durable medical equipment, and other services and supplies.
-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.
1 Copyright ©2025 THESTAR ALL RIGHTS RESERVED
,Medicare Part C - ANS Medicare Advantage Plans that are offered through private insurance
companies that provide both hospital and physician coverage and possible prescriptions -
financed by Social Security and monthly premiums
Medicare Eligibility - ANS -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 months
-ESRD or kidney disease requiring dialysis or kidney transplant
Medicare enrollment requirements - ANS Part A & B are automatically conducted by SSA
when individual age 65+ enrolls for their Social Security retirement benefits
Initial Enrollment Period - ANS 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 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
General Enrollment Period - ANS Medicare enrollment period - January 1st through March
31st annually.
-Coverage begins July 1st of that year
-Monthly premium for part B may go up 10% for each full 12 month period that you're eligible
but didn't sign up.
Special Enrollment Period - ANS Individual can enroll at 8 months beginning with the month
employment ends or when group coverage ends whichever is earlier without subject to late
enrollment surcharge
Medicare as a secondary or primary payer - ANS -Medicare is the secondary payer for the
'working aged' who has a group health plan if the group has 20+ enrollees
2 Copyright ©2025 THESTAR ALL RIGHTS RESERVED
, -For single employer with <20 employees with a group health plan, Medicare is the primary
payer.
-If individual retains coverage thru the group plan, 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
Medicare as a secondary payer - ANS -In cases of Workers' Comp when it applies to an injury
or illness
- In cases where no-fault insurance or liability insurance is available as primary payer.
Medicare & the VA - ANS Can choose to get treatment under either plan. Medicare usually
will not pay benefits if services are rendered in a VA facility but will pay if outside of VA. There
is NO coordination between Federal agencies.
Expenses NOT paid by Medicare - ANS -Purely custodial care/ chronic care
-Services that are not reasonable or medically necessary under Medicare standards
-Services performed by relatives/ member of beneficiary's household
-Services paid for by another gov't agency
Medicare Part A covers - ANS -acute inpatient hospital care
-inpatient skilled nursing care
-medically necessary home health care & hospice services
Medicare Deductible - ANS -Deductible must be met for ea. benefit period
-Benefit period ends 60 days after discharge
-Deductible is $1364 plus need to pay/ replace first 3 pts of blood per calendar year.
Days 1 to 60 - ANS Non-Exhaustible Benefit
3 Copyright ©2025 THESTAR ALL RIGHTS RESERVED
