Healthcare Systems Midterm II

which group of individuals would automatically receive their medicare card in the mail a few months before turning age 65?

individuals who are already receiving social security retirement benefits

which statement is true for an individual turning 65 but who is still working and covered by an employer group health plan (EGHP) with creditable prescription drug coverage?

they can enroll in Part A while still covered by their EGHP but are allowed to defer Part B until they retire

Under which condition would continuing with an employer group health plan (EGHP) not allow a person to defer Part B without penality?

if the employee retires, even if the employer continues the EGHP despite no active work

An individual who is 40 years old develops a serious medical condition and is unable to continue their current employment. Which of the following is the best advice for this situation?

should apply for disability benefits from social security and if approved, they will be automatically enrolled in medicare after 2 years

Which group of individuals might qualify for premium-free medicare Part B?

low income individuals who qualify for financial assistance through their state’s medicaid program

A person with medicare part A and B but no additional insurance would pay…

20% co-insurance for an office visit with a specialist

 A person with Medicare Part A and B but no additional insurance would pay…

no cost share for an antibiotic administered during a hospital stay

A person with medicare Part A and B but no additional insurance would pay…

no copayment for an annual flu shot administered at a pharmacy

An individual with Medicare Part A and Part B plus a supplement (medigap) plan G would be responsible for which cost sharing?

the annual Part B deductible for outpatient services

A patient, who is currently 70, enrolled in Medicare part A and part B plus a supplement (medigap) Plan F at age 65. Which of the following correctly applies to this situation?

they have no deductible for hospitalizations

An individual has a medicare advantage plan with an out of pocket maximum of $4,000. THis means that..

once the individual pays the $4,000 for medical services, the individual no longer has cost sharing for medical services

An individual enrolled in a medicare advantage plan that is a health maintenance organization model (HMO). Which of the following is generally true?

there is a cost-sharing for inpatient and outpatient services

which of the following is true for standalone Part D plans?

most Part D plans have cost sharing for prescription purchases, although some plans offer Tier 1 drugs without cost sharing

which of the following correctly describes the coverage gap for medicare prescription drug plans? 

once an individual enters the coverage gap “donut hole”, they may have to pay up to 25% coinsurance for this prescription drug

An individual qualifies for a limited income subsidy (LIS/extra help). This means…

their income is low enough that medicare will pay their monthly drug plan premium (up to a threshold) and any drug plan deductible