Health Insurance Providers Chapter 5

An individual can enroll in a Part C Medicare Advantage Plan at what time?

Which of these is NOT a qualifying event for Medicare?

How much does Medicare Part B pay for physician fees?

Small employers who are sponsored by an insurer to provide group benefits to its employees are called?

An accident and health policy that provides reimbursement benefits makes them payable to the?

Medicare Part A covers?

Which of these will typically authorize treatment from a specialist?

A medical provider that accepts Medicare Assignment must?

Donna and Mary were racing bicycles. Who would most likely be covered under Workers' Comp?

Part A Hospital expense coverage provided under Medicare is automatically made available to each of the following EXCEPT?

Medicare Part B covers?

A closed network plan offers a primary physician copay of $25. If a subscriber chooses a primary care physician out of the network, the subscriber will likely pay?

How is Medicare Part B funded?

What is Medicare Part B also known as?

An individual covered under a Blue Cross Blue Shield plan is called a(n)?

At what age will a person normally enroll with an insurance carrier under a Part C Medicare Advantage Plan?

Funding for Medicare Part B is partially provided by?

A 70-year old insured individual has suffered from kidney failure for the past 24 months. How will Medicare be utilized in this situation?

Medicare Enrollment and Coverage

Enrollment in a Part C Medicare Advantage Plan occurs when becoming eligible for Medicare.
Medicare does not qualify those who are falling below the federal poverty level.
Medicare Part B covers 80% of physician fees.

Health Insurance Structures

Small employers providing group benefits are known as Multiple Employer Welfare Arrangements (MEWA).
Accident and health policies reimburse payments to the insured.

Medicare Coverage Details

Medicare Part A primarily covers inpatient hospital stays.
Treatment from specialists is typically authorized by a gatekeeper system.
Providers accepting Medicare Assignment agree to receive payment in full based on the Medicare schedule.

Workers' Compensation

In a scenario of an accident involving employees, John, who was not at fault while doing his duties, is most likely covered under Workers' Comp.

Medicare Eligibility Criteria

Medicare Part A coverage is not automatically provided to a 70-year-old who is not eligible for Social Security.
Medicare Part B covers charges related to doctors' services but not long-term care or hospital room and board.

Insurance Plan Networks

Closed network plans impose higher costs, such as 100% of billed amounts for services outside the network.

Medicare Funding Sources

Medicare Part B is funded through general tax revenue as well as user premiums.
The term for Medicare Part B is also known as Supplementary Medical Insurance.

Insurance Participants

An individual under a Blue Cross Blue Shield plan is referred to as a subscriber.
Individuals typically enroll in a Part C Medicare Advantage Plan at age 65.

Coordination of Benefits

In cases where a 70-year-old with kidney failure has a spouse's large-group employer plan, Medicare acts as the secondary insurer for uncovered claims.