2025 Well care ACT Mastery Exam Tele-agent
Assessment Questions & Answers
deductible - Answer - Amount you must pay before you begin
receiving any benefits from your insurance company
Medicare - Answer - A national health insurance program in the
United States, begun in 1965 under the Social Security
Administration and now administered by the Centers for
Medicare and Medicaid Services.
Medicare Advantage - Answer - Medicare plans other than the
Original Medicare Plan
Medicaid - Answer - A federal and state assistance program that
pays for health care services for people who cannot afford them.
Medicare requirements - Answer - -must be 65 or older, disabled,
or have end-stage renal disease
-have to be under a licensed physician
-home care recipients must also be homebound and in need of
skilled nursing or therapy services on an intermittent basis
Medigap - Answer - a private insurance policy that pays the
difference between the medical charge and the amount that
Medicare pays
Medigap Eligibility and Enrollment - Answer - Unlike Part C which
'disenrolls' an individual from Parts A and Part B, a Medigap plan
works with Part A and Part B, requiring recipients to first enroll
into the Original Medicare program and then supplement it with a
Medigap plan. Individuals who are enrolled in Part C cannot also
receive coverage from a Medigap plan and must re-enroll into
Parts A and B in order to purchased a Medigap plan. All Medigap
insurers are required to offer a one-time, 6- month enrollment
Page 1 of 19
,period after turning age 65 for individuals who have already
enrolled in Medicare Part B that guarantees an enrollee the right
to purchase any part of a Medicare supplement insurance policy,
regardless of his or her health status. Beyond the initial
enrollment period, an insurer can require a paramedical exam or
an attending physician's statement if needed to ensure the
health of the enrollee.
End-stage renal disease - Answer - the final stage of chronic
kidney disease
Medicare Coverage - Answer - Hospital services, some
home health, hospice, religiously-associated facilities
If a beneficiary requests to discuss other products not originally
documented on the SOA, must youdocument a second SOA for
the additional product type before the appointment may
continue? - Answer -
Page 2 of 19
, Part A coverage - Answer - Inpatient hospital care, skilled nursing
facility care, home health care and hospice care
Medicare Part B - Answer - The part of the Medicare program
that pays for physician services, outpatient hospital services,
durable medical equipment, and other services and supplies.
Part C coverage - Answer - (medicare advantage) managed care
alternative to original medicare. provided through commercial
insurers
Part D of Medicare - Answer - Prescription drug coverage
Original Medicare - Answer - Medicare Parts A and B providing
only hospital and medical coverage.
Employer Group Health Coverage - Answer - Employer Group
Health Coverage
AHIP, MUnder Original Medicare, the inpatient hospital co-payment
is a flat per-day amount that remains the same throughout the
first 60 days of a beneficiary's stay. After day 60 the amount
gradually increases until day 90. After 90 days he would pay the
full amount of all costs. - Answer -
c. - Answer -
Under Original Medicare, if the inpatient hospital service is
provided by a participating Medicare provider, the co-payment
is waived. Co-payments are only charged when a beneficiary
opts to receive care from a non-participating provider. - Answer
-
Incorrect: Beneficiaries are responsible for a single deductible
amount for each benefit period, followed by a per day coinsurance
amount through day 90. For day 91 and beyond, there is a charge
for each "lifetime reserve day" up to 60 days over a beneficiary's
Page 3 of 19
Assessment Questions & Answers
deductible - Answer - Amount you must pay before you begin
receiving any benefits from your insurance company
Medicare - Answer - A national health insurance program in the
United States, begun in 1965 under the Social Security
Administration and now administered by the Centers for
Medicare and Medicaid Services.
Medicare Advantage - Answer - Medicare plans other than the
Original Medicare Plan
Medicaid - Answer - A federal and state assistance program that
pays for health care services for people who cannot afford them.
Medicare requirements - Answer - -must be 65 or older, disabled,
or have end-stage renal disease
-have to be under a licensed physician
-home care recipients must also be homebound and in need of
skilled nursing or therapy services on an intermittent basis
Medigap - Answer - a private insurance policy that pays the
difference between the medical charge and the amount that
Medicare pays
Medigap Eligibility and Enrollment - Answer - Unlike Part C which
'disenrolls' an individual from Parts A and Part B, a Medigap plan
works with Part A and Part B, requiring recipients to first enroll
into the Original Medicare program and then supplement it with a
Medigap plan. Individuals who are enrolled in Part C cannot also
receive coverage from a Medigap plan and must re-enroll into
Parts A and B in order to purchased a Medigap plan. All Medigap
insurers are required to offer a one-time, 6- month enrollment
Page 1 of 19
,period after turning age 65 for individuals who have already
enrolled in Medicare Part B that guarantees an enrollee the right
to purchase any part of a Medicare supplement insurance policy,
regardless of his or her health status. Beyond the initial
enrollment period, an insurer can require a paramedical exam or
an attending physician's statement if needed to ensure the
health of the enrollee.
End-stage renal disease - Answer - the final stage of chronic
kidney disease
Medicare Coverage - Answer - Hospital services, some
home health, hospice, religiously-associated facilities
If a beneficiary requests to discuss other products not originally
documented on the SOA, must youdocument a second SOA for
the additional product type before the appointment may
continue? - Answer -
Page 2 of 19
, Part A coverage - Answer - Inpatient hospital care, skilled nursing
facility care, home health care and hospice care
Medicare Part B - Answer - The part of the Medicare program
that pays for physician services, outpatient hospital services,
durable medical equipment, and other services and supplies.
Part C coverage - Answer - (medicare advantage) managed care
alternative to original medicare. provided through commercial
insurers
Part D of Medicare - Answer - Prescription drug coverage
Original Medicare - Answer - Medicare Parts A and B providing
only hospital and medical coverage.
Employer Group Health Coverage - Answer - Employer Group
Health Coverage
AHIP, MUnder Original Medicare, the inpatient hospital co-payment
is a flat per-day amount that remains the same throughout the
first 60 days of a beneficiary's stay. After day 60 the amount
gradually increases until day 90. After 90 days he would pay the
full amount of all costs. - Answer -
c. - Answer -
Under Original Medicare, if the inpatient hospital service is
provided by a participating Medicare provider, the co-payment
is waived. Co-payments are only charged when a beneficiary
opts to receive care from a non-participating provider. - Answer
-
Incorrect: Beneficiaries are responsible for a single deductible
amount for each benefit period, followed by a per day coinsurance
amount through day 90. For day 91 and beyond, there is a charge
for each "lifetime reserve day" up to 60 days over a beneficiary's
Page 3 of 19
