ILHI - Indiana Life and Health Insurance Exam

Question 21: An employee leaves her job after three years. She wants to know how much of the money in her employer-sponsored qualified plan account she actually owns and may carry away with her. Which statement about plan ownership is correct here?

She owns nothing until age fifty-nine

She owns only the employer contributions

She always owns her own contributions

She owns nothing before six years

Question 22: A homebound Medicare beneficiary gets part-time visits from a home health aide for nursing and physical therapy, and also asks the plan to pay someone to do her weekly shopping and laundry. Which statement about Medicare payment is correct here?

Both services are fully covered

Neither service is covered at all

Only the homemaker services are covered

Only the skilled visits are covered

Question 23: A Medicare patient leaves the hospital after an inpatient stay and pays the Part A deductible for it. Forty-five days later she is admitted again for a new condition. Which statement about the second admission is correct under Part A?

No new deductible is owed

A new deductible applies immediately

A calendar-year deductible now applies

Lifetime reserve days begin at once

Question 24: A disabled worker qualifies for Social Security. His spouse cares for their young child, and both spouse and child are eligible for payments based on his record. Which statement BEST describes the limit on what this household will actually receive?

Each dependent receives the worker's full amount

Dependents receive nothing while the worker lives

A maximum family benefit caps the total

The worker's benefit alone is capped

Question 25: A man became eligible for Medicare four years ago, declined prescription drug coverage at that time, and had no other drug coverage since. He now wants to join a prescription drug plan. Which consequence follows from his delay?

He is barred from Part D permanently

He must satisfy a two-year waiting period

His deductible doubles for one year

A late enrollment penalty raises his premium

Question 26: A private insurer offers a Medicare Advantage product designed specifically for beneficiaries who qualify for both Medicare and Medicaid, and another built around patients with kidney failure. Which one of the four Medicare Advantage categories describes these two products?

Medicare specialty plans

Medicare managed care plans

Medicare preferred provider organization plans

Medicare private fee-for-service plans

Question 27: One Medicare Advantage option gives members a contracted provider network but requires no referral to see a specialist, and members who go outside the network simply pay a larger share of the cost. Which plan type matches this description?

Medicare managed care plan

Medicare specialty plan

Medicare preferred provider organization plan

Medicare private fee-for-service plan

Question 28: A fully insured worker dies leaving a widower who is caring for their eight-year-old son. The widower asks whether Social Security will pay anything to the household while the boy is still young. Which statement describes what the program provides?

Survivor benefits go to widower and child

Only the child receives a survivor benefit

Nothing is payable until he turns sixty

Survivor benefits require currently insured status only

Question 29: A client asks who pays for and who runs the government program that covers health care for people of all ages whose income and resources are insufficient to pay for it themselves. Which description of Medicaid funding and administration is accurate?

Funded and administered entirely federally

Funded by states, administered by Medicare

Jointly funded, administered by the state

Funded federally, administered by private insurers

Question 30: A terminally ill Medicare beneficiary receives counseling, pain relief and symptom management at home, and her usual caregivers occasionally get a short break while she stays in an approved facility. Which Part A benefit covers the care she is receiving?

Skilled nursing facility care

Custodial care

Inpatient hospital care

Hospice care

Question 31: A widow covered by Medicare enters a nursing home, pays privately for two years until her remaining assets fall to her state's threshold, and only then qualifies for Medicaid. Which statement best describes her coverage position once Medicaid eligibility begins?

Medicaid eligibility ends her Medicare coverage

She must choose one program only

Both cover her; Medicaid pays cost sharing

Medicare pays her Medicaid premiums

Question 32: A Medicare Advantage enrollee must select a primary care physician from the plan network, cannot see a specialist without that doctor's referral, and pays a small co-payment rather than Medicare deductibles. Which type of Medicare Advantage plan is described?

A Medicare private fee-for-service plan

A Medicare preferred provider organization plan

A Medicare specialty plan

A Medicare managed care plan

Question 33: A claimant who can no longer do his old job applies for Social Security disability income. His private policy would pay him under its own-occupation wording, yet the federal program denies him. Which definition does Social Security apply to disability claims?

Any occupation, lasting twelve months or death

Own occupation for the first two years

Any occupation, expected to last six months

Modified own occupation with residual benefits

Question 34: A new Medicare beneficiary asks his producer what the optional medical portion of the program actually pays for, and how the cost of that portion is collected from him each month. Which statement correctly describes Medicare Part B coverage?

It is free to all beneficiaries

It covers physician services for a premium

It covers inpatient hospital room charges

It replaces Part A hospital benefits

Question 35: An agent is explaining a Medicare private fee-for-service plan to a client who has used original Medicare for several years. The client asks what actually differs between the two arrangements. Which of the following statements gives the accurate distinction?

A gatekeeper physician controls specialist access

Care is prepaid through capitation payments

A private company negotiates the provider fees

Benefits are limited to hospital services

Question 36: A Medicare beneficiary is discharged from a four-day hospital stay and moves directly into a Medicare-approved skilled nursing facility. Her daughter asks how the first twenty days of that stay will be paid. Which statement about that period is accurate?

Medicare pays those days in full

She pays a daily co-pay throughout

Medicare pays nothing for skilled nursing

Coverage requires a thirty-day prior hospitalization

Question 37: After a wage earner dies, Social Security survivor payments to the surviving spouse stop once the youngest child reaches a stated age and do not resume until that spouse turns sixty. Which name is given to the interval in between?

The family dependency period

The probationary period

The blackout period

The elimination period

Question 38: An insurer monitors a member's hospital stay while she is still an inpatient, checking that her treatment is proceeding on schedule and that she will be released on the expected date. Which stage of utilization management does this describe?

Concurrent review

Prospective review

Retrospective review

Alternative review

Question 39: An insured injures his shoulder and returns to work able to handle some but not all of the essential duties of his job. His policy pays him half his total disability benefit for a few months. Which disability benefit is he receiving?

Residual disability benefit

Partial disability benefit

Presumptive disability benefit

Recurrent disability benefit

Question 40: A husband and wife are each covered as a dependent under the other's employer group health plan. Without a provision addressing double coverage, either could collect more than the actual expense. Which group health provision prevents that outcome?

The time limit on defenses

The pro rata liability provision

The change of occupation provision

The coordination of benefits provision

ILHI Indiana Life and Health Insurance Exam - Set 5 - Part 2