Hard 1s
In addition to the Buyer's Guide, what must be delivered to an applicant or insured either with or before the delivery of a life insurance policy?
The outline of coverage
Medicaid or Medicare? This one is based on income.
What is Medicaid?
Medicare is run by this federal agency.
What is CMS (Centers for Medicare & Medicaid Services)?
This is the late enrollment penalty for Part B — it’s added to your premium for each 12-month delay.
What is 10% per 12-month period?
The ACA prohibits insurers from denying coverage based on this.
What is a pre-existing condition?
Which of the following is NOT covered by Medicare Part A?
An outpatient medical facility
This program helps cover the cost of care in nursing homes for low-income seniors.
What is Medicaid?
You usually don’t pay a premium for this part of Medicare.
What is Part A?
You generally don’t need to enroll in Medicare at 65 if you’re still working and covered under this kind of group health plan.
What is a large employer group health plan (20+ employees)?
This ACA provision requires most individuals to have health insurance or pay a tax penalty — until it was set to $0.
that is the individual mandate?
The purpose of Medicare supplement insurance is to provide
coverage for certain expenses not fully covered by Medicare
You can have both Medicare and this if you qualify.
What is Medicaid?
This must happen during your Initial Enrollment Period to avoid late penalties.
What is signing up for Part B and/or D?
This is the maximum number of lifetime inpatient psychiatric care days Medicare will cover.
What is 190 days?
These income-based discounts help reduce out-of-pocket costs like copays and deductibles — but only with silver plans.
What are cost-sharing reductions (CSRs)?
Charles signs up for Medicare Part B on March 21, during the open enrollment period. His coverage will become effective
July 1
True or False: Medicare covers long-term custodial care.
What is False?
This happens if your doctor “doesn’t accept assignment.”
What is you pay more out-of-pocket?
These types of services are covered only under specific circumstances — like a homebound patient needing intermittent skilled care.
What are home health services?
The ACA expanded Medicaid to this percentage of the federal poverty level.
What is 138%?
This is the name for the gap in Part D drug coverage, once notorious for high costs.
What is the donut hole?
This program lets private plans offer Medicare benefits
What is Medicare Advantage (Part C)
Once a year, this period lets you switch or drop Medicare Advantage plans.
What is the Medicare Advantage Open Enrollment Period (Jan 1–Mar 31)?
This is the formal name of the Medicare program that combines Part A, Part B, and usually Part D in a single plan.
What is Medicare Advantage (Part C)?
This benchmark plan is used to calculate premium subsidies in the Marketplace.
What is the second-lowest cost Silver plan?