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SS,Medicare etc
Social Insurance Programs
| Question | Answer |
|---|---|
| One reason for the social insurance programs is that certain types of losses are difficult to insure in the private market? | True |
| Social insurance programs are usually designed to be financed fully or at leas partially by the employers of covered persons? | True |
| Most soical insurance programs allow covered persons to select their own benefit levels within certain prescribed limits? | False. Under social insurance programs, benefit amounts are prescribed by law, and covered persons can neither increase nor decrease their prescribed level of benefits. |
| Social insurance benefits are subject to a needs test.? | False, Social insurance benefits are paid as a matter of right and are not subject to a needs test. |
| Social insurance benefits are based primarily on social adequacy rather than on individual equity? | True |
| All employees of the federal government are excluded from coverage under Social Security? | False. The only federal employees not covered under Social Security are civilian employees who are covered under the Civil Service Retirement System and were employed prior to 1984. They are however, covered by Medicare. |
| In order to establish an insured status under Social Security, a worker must have credit for a minimum amount of work under the program? | True |
| A worker who is full insured under Social Security is automatically diability insured? | False. A disability-insured status generally requires that an employee, in addition to being fully insured, must also have earned at least 20 credits during the last 40 calendar quarters. The credits are reduced for workers aged 31 or younger. |
| To receive retirement benefits under Social Security a retired worker must be both currently insured and fully insured.? | False. Retirement benefit s require fully insured status but not currently insured status. |
| A divorced woman may be eligible for Social Security retirement benefits based on her ex-husbands earnings record under SS as long as she was married to him for at least 10 years. | True. |
| All categories of survivors benefits under S.S. Require that a worker be fully insured at the time of death. | False. Some categories of survivors benefits are payable if a worker was currently insured, but not fully insured , at the time of death. |
| A parent of a deceased worker may be eligible for survivors benefits based on the worker's Social Security coverage? | True. |
| The definition of disability under S.S. is based on the inability of the disabled worker to perform all the duties of his or her regular occupation for at least 5 months? | False. The definition of disability under S.S. is based on the inability of a worker to engage in any substantial gainful employment. In addition, the disability must be expected to last (or must have)lasted at least 12 MONTHS, or end in death. |
| Disability benefits under S.S. are subject to a one-year waiting period? | False. disability benefits under S.S. are payable beginning w/the 6th FULL calendar month of disability. |
| Social security benefits for survivors are calculated as a percentage of the deceased worker's primary insurance amount? | True. |
| A worker's Social Security retirement benefit is reduced only if retirement takes place prior to age 62? | False. Benefits are reduced if taken prior to full retirement age. |
| the Social Security earnings test applies only to beneficiaries under full retirement age? | True. |
| Social Security benefits are subject to cost-of-living adjustments? | True. |
| A disabled worker's Social Security benefit may be reduced on the basis of benefits received under workers' compensation laws? | True. |
| Social Security retirement benefits begin automatically at a beneficiary's full retirement age? | False. Social Security benefits do not begin until an individual applies for benefits. |
| If an applicant wishes to appeal the denial for a claim for Social Security benefits, the issues must be settled by binding arbitration. | False. There is a multilevel appeals process that ultimately may lead to the applicant being able to file a lawsuit in federal district court. |
| Medicare is available to any person receiving benefits under Social Security? | False. Medicare is available only to persons 65 or older, certain disabled persons, and persons with end-stage renal disease. |
| Once a benefit period commences under Part A of Medicare, the period continues for one year. | False. The benefit period continues until a person has been out of a hospital or a skilled-nursing facility for 60 consecutive days. |
| To the extent that reserve days have been used, the lifetime reserve under Medicare Part A can be restored up to a maximum of 5 days for any calendar year in which a person is not hospitalized. | False. The lifetime reserve cannot be restored to the extent that reserve days have been used. |
| To receive benefits for skilled-nursing facilities under the hospital insurance portion of Medicare, a patient mustenter the facility within 30 days after being hospitalized and must have been hospitalized for at least 3 days. | True. |
| To receive home health care benefits under Medicare, a person must be treated under a home health plan set up by a physician | True. |
| Health Care Reform increases the Medicre Part A tax rate on wages by 0.9% on earning s over $200,000 for individual taxpayers and $250,000 for married couples filing jointly, effective January 1, 2012 | True |
| To qualify for hospice benfits, a Medicare recipient must be certified as being terminally ill with a life expectancy of 6 months or less | True. |
| Part B of Medicare pays for physician's services on both an inpatient and outpatient basis. | True |
| Medicare includes coverage for mammography and prostate cancer screening | True. |
| Subject to dollar maximums, Part B of Medicare provides benefits for eyeglasses, hearing aids, and orthopedic shoes | False. The Part B portion of Medicare does not provide benefits for eyeglasses, hearing aids or orthopedic shoes. |
| An annual deductible applies to certain benefits under Part B of Medicare | True. |
| A Medicare beneficiary who elects Medicare Advantage coverage is exempt from paying the Part B premium | False. The Part B premium must be paid even if a Medicare beneficiary elects Medicare Advantage. |
| by electing a Medicare Advantage plan, a Medicare beneficiary may have more comprehensive benefits than those provided under the original Medicare program? | True. |
| Beneficiaries under Medicare Advantage plans are able to switch plans or re-enroll in original Medicare at any time. | False. Changes can generally be made only between November 15 and December 31. |
| Medicare Advantage requires a Medicare beneficiary to be covered under an HMO? | False. Medicare Advantage allows many options for coverage other than HMOs. These include PPOs and private fee-for-service plans. |
| Medicare beneficiaries with incomes above a specified level are ineligible for Medicare prescription drug coverage? | False. No one can be denied Medicare prescription drug coverage because of income level. |
| Member's of Medicare Advantage plans must purchase stand-alone Medicare prescription drug plans? | False. If a Medicare Advantage plan has its own Medicare prescription drug plan,members must use that plan. |
| Under the standard benefit structure of a Medicare prescription drug plan, 95%of drug charges are paid after the satisfaction of the plan deductible. | False. After satisfaction of the deductible, the plan pays 75% of costs up to a specified limit. Then it pays nothing until a second threshold is reached. After that, the plan pays 95%. |
| Formularies for Medicare prescription drug plans must include at least two drugs in every therapeutic class. | True. |
| Medicare prescription drug plans can make fumulary deletions during the year, but persons taking the drug can continue to have refills until the end of the calendar year. | Ture. |
| Medicare prescription drug plans may require the use of mail-order pharmacies. | False. All plans must include walk-in pharmacies. However,plans can offer financial incentives to use mail order. |
| There is a penalty added to the premium for Medicare prescription drug coverage if an individual fails to enroll on time and has not had creditable coverage. | True |
| An individual may change Medicare precrition drug plans without evidence of insurability, during an annual election period | True. |
| Health Care Reform doubled the tax deduction fro employers who receive Medicare Part D retiree drug subsidy payments effective January 1, 2013. | False. Health Care Reform will eliminate the tax deduction for employers woh receive Medicare Part D retiree drug subsidy payments in 2013. |
| A $500 rebate ws given to Medicare beneficiaries who reached the Part D coverage gap in 2010? | False. The rebate was $250 in 2010/ |
| A senior with less-than-creditable perscription drug coverage from the retiree plan of an employer or union can keep the current plan and join a Medicare drug plan to obtain more complete coverage? | True. |
| Before selecting a Medicare prescription drug plan, it is important to determine whether drugs being taken are on plan's formulary? | True. |
| State Health Insurance Assistance Plans are alternatives to the original Medicare program. | False. Sate Health Insurance Assistance Plans are designed to give free health insurance counseling and assistance to persons with Medicare. |
| Enrollment in Medicare Part B is automatic for anyone reaching age 65 as long as he or she has been paying FICA taxes | False. Enrollment in Medicare Part B is automatic at age 65 only if an individual is already receiving retirement benefits from SS or the RR Retirement Board , but coverage can be rejected. Others must contact the SS Administration to enroll in Part B. |
| Medicare beneficiaries have the right to get information from Medicare that is clear and Understandable in order to make informed health care decisions | True. |
| The Social Security and Medicare programs are funded on a system of pay-as-you-go financing. | False. Social Security is financed on the basis of partial advance funding. There is some accumulation of assets for the payment of future benefits. |
| Social Security and Medicare trust funds are adequate to pay benefits for at least 100 years. | False. SS and Medicare trust funds will be unable to pay benefits in the foreseeable future unless changes are made to the system. |
| One possibility for increasing revenue of SS trust funds is to invest all or a portion of trust fund assets in higher-yielding investments than Treasury securities? | True |
| Medicare benefits are subject to federal income taxation if a beneficiary's income exceeds a specified amount | False. The only SS and Medicare benefits that may be subject to federal income taxation are benefits received in the form of monthly income under Social Security. |
| Unemployment insurance is financed primarily from payroll taxes on employers. | True. |
| Eligibility for unemployment insurance benefits is usually contingent on a 30-day waiting period. | |
| Quitting a job without good cause is grounds for denial of unemployment insurance benefits in many states | True. |
| A worker whose regular unemployment insurance benefits are exhausted is automatically eligible for extended benefits financed solely by the federal government. | False. |
| The usual definition of disability under temporary disability laws is the inability of an employee to perform his or her customary work because of a nonoccupational injury or illness, including pregnancy. | True. |
| Workers' compensation laws hold employers liable for occupational injuries or diseases without regard to fault | False. |
| In most states, employers must purchase workers' compensation coverage from monopolistic state funds | |
| the workers' compensation laws of most states cover occupational accidents only, not occupational illnesses. | |
| Most workers' compensation laws cover medical expenses in full without a time limit | False. |
| Higher-paid workers tend to have relatively better benefits under workers' compensation laws than do lower-paid workers. | |
| More litigation is one reason for increasing worker's compensation costs. | True. |
| One argument in favor of 24-hour coverage is the inability to determine whether some injuries or illnesses are work-related. | |
| Workers' compensation benefits are received free of federal income taxation.. | True. |
| Which is a condition that will result in the payment of unemploy. comp benes:1unemploy. due to a labor dispute 2. unemploy. due to voluntary leave job w/out good cause.3. unemploy. due to discharge for misconduct. 4.unemploy.due to bad econ.conditions | D.Reasons for disqualifications under uemploy.comp. programs include discharge for misconduct,involvement in a labor dispute,vol. leave of job w/out good cause |
| Which of stmts is concerning unemploy.insurance is correct? A) The majority of states pay regular unemploy insurance benes for a max of 52 weeks. b. Min. weekly benes typically fall between $20 to $100. c. You are elig for unemploy benes if you are fired | b. |
| Most unemployment programs have a 30-day waiting period before benefits commence. ? . | False |
| Which of the following statements concerning Medicare Part B benefits is (are) correct? I. Physician's fees are covered only while a beneficiary is hospitalized. II. There is coverage for eyeglasses, hearing aids, and orthopedic shoes. | D. |
| Social Security disability benefits commence one year after a disability begins?. | False. Benefts start the 6th full calendar month of disability |
| Benefits are reduced by a portion of any amounts received from individually owned disability income policies? | F. Benefits are reduced only if worker is eleigble for beneftis from other Fed. State or local program. Reduction occurs only if total benes exceed 80% of avg earnings at time of disability. |
| Under SS disability - Benefits are payable as long as a disabled worker is unable to perform his or her regular job? | F. Worker must be unable to engage in any kind of substantial gainful employment. |
| Social Security Disability Benefits cease at full retirement age but are replaced by comparable Social Security retirement benefits | True |
| Which of the following statements concerning Medicare prescription drug coverage (Part D) is (are) correct? I. It is a mandatory plan for all Medicare beneficiaries. II. It is financed by the FICA taxes paid by active workers. | D |
| Disability benefits under workers' compensation laws, the benefits are available for occupational diseases? | True |
| Concerning disability benefits under workers' compensation laws: Benefits are available for partial disabilities T/F? | True |
| concerning disability benefits under workers' Compensation laws: Benefits for permanent total disabilities usually continue for the life of disabled worker? | True |
| Concerning disability benefits under workers' compensation laws: Benefits are usually equal to 100 percent of a worker's predisability earnings | False |
| typical characteristics of social insurance EXCEPT (A) actuarial equivalency of contributions and benefits b. compulsory or broad participation c. compulsory or broad participation d.some degree of employer financing . | A. |
| Statement is T/F about the financing of SS and Medicare Parts A & B : Payroll taxes are deposited into trust funds from which benefits and administrative costs are paid. | True |
| Statement is T/F about the financing of SS and Medicare Parts A & B : The tax rate for self-employed persons is one-half of the combined tax rate for employees and employers | False |
| Statement is T/F about the financing of SS and Medicare Parts A & B : The earnings base on which taxes are paid increases annually based on changes in the national level of wages | True |
| Statement is T/F about the financing of SS and Medicare Parts A & B : The program uses a system of partial advance funding? | True |
| This statement about Medicare Part A is T/F? Inpatient hospital care is subject to an initial deductible for each benefit period. | True |
| This statement about Medicare Part A is T/F? Inpatient hospital care is paid in full after the 60th day of hospitalization. | False. Except for intial deduct. there is NO chg. for the 1st 60 days of confinement under Medicare. After 60 days there is an additional 30 days of covg. that is subj. to daily copay chg equal to 25% of intial deduc. |
| This statement about Medicare Part A is T/F? Inpatient care in a skilled-nursing facility requires a prior hospital stay of at least 3 days for the same medical condition? | True |
| This statement about Medicare Part A is T/F? (D) Hospice benefits may be elected in lieu of inpatient hospital benefits? | True |
| The following statement are common law defenses for employers in worker's compensation claims is T or F?contributory negligence doctrine? | True |
| The following statement are common law defenses for employers in worker's compensation claims is T or F? ) liability without fault | False. Liability w/out falult is the principle which makes the employer ABSOLUTELY liable for providing workers comp. benefits regardless of whether the employer would be considered legally liable in absense of these laws. |
| The following statement are common law defenses for employers in worker's compensation claims is T or F? fellow-servant doctrine | True |
| The following statement are common law defenses for employers in worker's compensation claims is T or F? ) assumption-of-risk doctrine . | True |
| Which of the following statements concerning Medicare prescription drug coverage (Part D) is (are) correct? I. It is a mandatory plan for all Medicare beneficiaries. II. It is financed by the FICA taxes paid by active workers | Neither I is incorrect because Medicare prescription drug coverage is voluntary. II is incorrect because the program is financed by participants who pay in aggregate about 26 percent of the cost of covg. The bal is pd by the fed govt from gen revenue |
| What is the requirement for a person to be disability insured? | The person must have credit for 20 of the 40 quarters earned from the labor force. |
| Susan F. age 37, had 28 quarters of cvg under SS. 24 of the quarters earned prior to her sons birth, 11 yrs ago. Four quarters have been earned since she returned to labor force 1 yr aqugo. Is Susan fully insured? | Yes, because she needs only ONE CREDIT FOR EACH AFTER she attains age 21 & prior to current yr. She would be fully insured with as few as 15 quarters. |
| Is Susan currently insured? | NO, she needs credit for at least 6 of the previous 13 quarters. |
| What is definition of Disability under SS? | Rigid, mental & physical impairment prevents worker from any gainful employ., Disability must have lasted or expected to last at least 12mos or result in death. |
| What category of workers may be eligible for disability benefits? | 1.Disabled worker under retirement age. 2.Certain family members who are disabled 3.Disabled widows/widowers who unable to engage in gainful employment. |
| What is PIA? | PIA is the monthly amount a worker receives if he/she retires at FULL RETIREMENT age or becomes disabled OR Dependents & Survivors benefits are a percentage of PIA |
| Describe Earnings Test as applicable to the SS program. | The Earnings tst applies to all under FULL retirement age. They are allowed yrly earnings up to $14,160 (2011) & figure subject to indexing in later yrs. If person earns more his/her SS benefit reduced by $1 for each $2 of excess earnings. |
| What is process to appeal denial of SS Claims? | 1.Make written appeal w/in 60 days of receiving denial, 1st level called RECONSIDERATION 2.If person disagrees w/RECONSIDERATION can ask for review from SS's Appeal Council. 3.IF disagrees w/Appeal Council decision may file Lawsuit in FEDERAL court. |
| Who is covered under Medicare? | Part A - any person 65 + as long as entitled to monthly retirement benes under SS.C Civilian employees of FED Govt age 65+, must be fully insured. 3. Persons 65+ who are spouses of full insured workers age 62/older. 4.Survivors 65+ for survivor benefits. |
| How is a benefit period determined for the inpatient hospital services portion of Medicare? | The benefit period begins the 1st time a Medicare recipient is hospitalized & ends ONLY AFTER the recipient is out of hospital/skilled nursing facility for 60 consecutive days. |
| Under Health Care Reform what is the fate of Medicare Advtg plans that DO NOT meet the medical loss ratio of 85%? | If a Medicare Advantage plan doesnt have a MLR of less than 85% for 2 consecutive yrs, plan is suspended for 3 yrs and if for 5 consecutive yrs plan terminated. |
| What are eligibility requirements for Medicare Part D? | Part D is available to ALL Medicare beneficiaries entitled to Part A & enrolled in Part B. Monthly premium involved. |
| How many plans are available under Part D? | Two basic types of Medicare prescription drug plans. 1 type of plan is for those enrolled in most Medicare Advtg plans. If plan available thru Med Advtg members must obtain drugs only thru that plan. Others referred to as Stand Alone. |
| What is benefit structure of Part D? | Annual deductible of $310 (in 2011) met, plan pays 75% of next $2840. Payments stop until OUT OF POCKET COSTS reach $6,447.50, then plan pays 95% of costs. |
| Describe enrollment process for Medicare prescription drug plans for INITIAL Enrollment | Initial enrollment for person who becomes eligible for Medicare is the 7 month period that includes the month of eligibility & 3 months BEFORE & AFTER that date. This is same as Medicare Part B. |
| What is the usual duration and amount of benefits under STATE unemployment programs? | The majority of states pay "regular" unemployment benes for a MAXIMUM of 26 weeks, the remaining states pay benes for slightly longer time. |
| What circumstances disqualify a worker from receiving benefits? | 1.Voluntarily leaving job. 2.Discharge for misconduct 3.Refusal to accept suitable work 4.Involvement in labor dispute 5.Receipt of disqualifying income. |
| Waht is the extended benefits program of unemployment insurance? | A permanent federal-state program provides extended benes for workers whose regular benes are exhausted during periods of HIGH UNEMPLOYMENT. The availability of these benes is triggered when states unemployment rate exceeds a specified level. |
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