Entitlement
HI for an uninsured individual is also known as what?
Premium HI. HI 00801.126
Skilled nursing facility services are not cover under Part A of Medicare. True or False
False HI 00601.001
Which combination of forms are submitted for enrollment in SMI under the Special Enrollment Period (SMI)?
CMS-40B and CMS-L564
A beneficiary can submit the following form for Medicare Part D extra help?
SSA-1020-OCR
The person who fails to enroll during the IEP, or refuses automatic (deemed) enrollment, may enroll only during the ______ unless the individual meets the requirements for an SEP.
General Enrollment Period HI 00805.025
Under the automatic provision, an individual is deemed to have enrolled in SMI upon becoming entitled to HI. True or False
True HI 00805.035
A program which provides unbiased help to Medicare beneficiaries, their families, and caregivers is called what?
State Health Insurance Assistance Program (SHIP)
: Individuals who are age 65 or over can enroll in SMI in any of the 7 consecutive months following the last month, during any part of which, the individual was enrolled in the GHP based on current employment status. True or False
False HI 00805.275
Can beneficiaries receiving RIB with Medicare Part A based on age withdrawal from Medicare Part A and continue to receive RIB?
No HI 00801.001
This program pays a substantial part of enrollees' expenses for physicians' services, home health services, hospital outpatient services, and medical and other health services not covered by Medicare's Hospital Insurance (HI - Part A).
Supplementary Medical Insurance (SMI) (Part B) HI 00805.001
Under the rules on conditional Premium-Part A enrollment, if the state does not approve the QMB application, the beneficiary will not get Part A coverage. True or False
True HI 00801.140
What BIC code is assigned to a Medicare Qualified Government Employee (MQGE) primary beneficiary?
Bic TA SM 00550.010
According to the 2023 FPL table, what is the 140% dollar amount threshold for a beneficiary applying for the Part D subsidy having a family size of 5?
$49,196.00 HI 03001.020
Under the rules of SEP for exceptional conditions, can an individual apply for SMI in the event they experienced a medical emergency which prevented timely filing?
Yes HI 00805.387 and HI 00805.382
Would government employees be insured for HI under the regular insured, disability or end-stage renal disease provisions if their government employment was social security cover employment?
Yes HI 00801.001
An initial delinquent notice marked "Second Notice" will be sent approximately ______ after the initial billing notice for quarterly billed enrollees whose premiums have not been paid by that time.
60 days HI 01001.100
According to QMB legislation, the claimant must still enroll in Premium HI based on IEP or GEP rules where the state reserves the right to make the “buy-in” determination. This is known as a Group Payer State. Is NJ one of these?
Yes
Can a beneficiary participate in both Medicare Part A and a Health Savings Account (HSA)?
No
Beneficiaries who are already entitled to SSI, eligible for full Medicaid coverage or covered under one of the Medicare Savings Programs as a QMB and should not complete an application for Extra Help are known as?
Automatically deemed subsidy-eligible HI 03001.005
When the beneficiary's benefit payments are suspended for a period of time, which will not permit collection of all premiums due from benefits for the current year, the beneficiary will be billed and expected to pay the premiums by direct remittance. True or False.
True HI 01001.045
If a beneficiary requests the use of a more recent tax year for a new initial IRMAA determination because a one-time event such as lottery winnings caused an increase in income for the tax year we are using to impose IRMAA, it would qualify as what?
A non-qualifying event (LCE) HI 01120.005
______ result is a redetermination of the Extra Help amount and may affect the beneficiary’s eligibility.
Subsidy-Changing Events HI 03050.025
Find the penalty percentage and monthly premium amount. Beneficiary born 11/15/1953, filed for SMI in March 2023.
40%, $230.90
When suspended benefit payments are scheduled to be resumed (e.g., a deferred case) for the current year with payments beginning in or before the following January, any premiums owed when benefits are resumed will be deducted from the first benefit(s) payable. True or False
True HI 01001.045
What are the 8 life changing events (LCEs) a beneficiary can choose when applying for IRMAA relief?
Death of a Spouse, Marriage, Divorce or Annulment, Work Reduction, Work Stoppage, Loss of Income Producing Property, Loss of Employer Pension, Receipt of Settlement Payment from a Current or Former Employer HI 01120.005