Chapter 8 Health Insurance For Senior Citizens and Special Needs Individuals

An elimination period is the period of time that must pass after a claim is made on a long-term care policy before benefits are paid out. The options provided include various numbers of days, and the correct answer is 30, 60, 90, or 180 days. This means that after making a claim, the policyholder must wait for a minimum of 30 days and up to 180 days before receiving any benefits from the policy.

Being poverty stricken is not a qualifying event for Medicare. Medicare eligibility is primarily based on age (65 and older) or disability status (receiving Social Security disability benefits for 2 years or more). Additionally, individuals with chronic kidney failure may also qualify for Medicare. However, poverty status alone does not determine eligibility for Medicare.

Medicare Health Insurance benefits are generally available to individuals who are age 65 or older, or individuals under age 65 who have certain disabilities and are receiving Social Security Disability benefits. Therefore, the only individual who would not qualify for Medicare Health Insurance benefits in this list is a person age 50.

Under Medicare Part B, the patient is responsible for paying 20% of covered charges above the deductible. This means that after the deductible is met, Medicare will cover 80% of the approved charges, and the patient will be responsible for paying the remaining 20%.

After the deductible of Medicare Part D pays 75% of the prescription drug costs up to $2,830, and this limit is reached, a gap in coverage is put into place called the "Doughnut Hole". This refers to the period where the beneficiary is responsible for a larger share of the prescription drug costs until they reach the catastrophic coverage threshold. During this gap, the beneficiary may have to pay a higher percentage of the drug costs out-of-pocket.

Prescription Drugs are not provided under Part A of Medicare. Part A of Medicare mainly covers hospital insurance and inpatient care, including skilled nursing facility care, hospice care, and home health care. However, prescription drugs are typically covered under Part D of Medicare, which is a separate prescription drug coverage plan.

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Medicare is generally not the primary payor for employer group health plan coverage. In most cases, employer group health plans are the primary payor and Medicare is secondary. This means that the employer group health plan pays first and Medicare pays second. However, there are some exceptions to this rule, such as for small employers with fewer than 20 employees. In these cases, Medicare may be the primary payor.

The question asks for an exception to those who qualify for Medicare A. The answer states that anyone who is willing to pay a premium does not qualify for Medicare A. This means that simply being willing to pay a premium is not enough to qualify for Medicare A, suggesting that there are additional requirements or criteria that need to be met in order to qualify for this program.

The initial Enrollment Period for Medicare starts on the 1st day of the 3rd month before eligibility starts and ends on the last day of the 3rd month after the month of eligibility. This means that individuals have a total of 7 months to enroll in Medicare, starting before their eligibility begins and ending after their eligibility has started. This allows individuals to have ample time to sign up for Medicare and ensure that they have coverage when they become eligible.

The Medicare Supplement Right of Return provision, also known as the Free Look Period, allows the buyer in this state to return a policy and receive a full refund within a period of 30 days. This means that if the buyer is not satisfied with the policy or changes their mind within this timeframe, they have the option to cancel the policy and get their money back.

Producers are permitted to earn commissions on the sale of Medigap policies, but the commission they receive cannot surpass 200% of the renewal commission they earn for servicing the policy in the second year. This means that the maximum commission a producer can receive for selling a Medigap policy is twice the amount they earn for renewing and servicing the policy in the second year.

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Medical Supplement plans K and L have modified basic benefits.

The correct answer is A-L. Medicare Supplement plans, also known as Medigap plans, are available to individuals who are 65 years old or older. These plans provide additional coverage to help pay for healthcare costs that are not covered by Original Medicare. Plan A is the most basic Medigap plan, while Plan L provides more comprehensive coverage. Therefore, a reasonably healthy 91-year old female would be eligible for and could benefit from enrolling in a Medigap plan that offers more coverage, such as Plan A-L.