Medicare Essentials FINAL EXAM (OH 73122)

Americans who are eligible for Medicare must work in what type of employment?

The term “dual eligible” refers to an individual who is eligible for both Medicare and:

A _____ applies under certain circumstances, such as when people move or lose health insurance coverage.

Mr. Patel will turn 65 in April. The beginning and end dates of his initial enrollment period are:

When people enroll in Medicare during the annual open enrollment period between October 15 and December 7, when does their coverage begin?

Ahmed made two different requests for a plan change during the Medicare Advantage open enrollment period (1/1 to 3/31). His second request was denied because:

Unless individuals are eligible to enroll in Medicare during a special enrollment period, delaying enrollment beyond the initial enrollment period usually results in:

What type of drug coverage is deemed by Medicare to provide the same value as Medicare Part D does?

Medicare coverage always begins on _____.

When individuals FIRST enroll in Medicare, the plan they receive is:

Beneficiaries in Original Medicare may seek care and services from any physician, health care provider, or facility so long as which of the following conditions is met?

What type of Medicare plan must provide, at a minimum, the same coverages as Original Medicare does and are issued by private insurers?

Medicare Part A (Hospital Coverage) pays for some of the costs of ____ provided in certain hospitals and skilled nursing facilities.

All the following are types of Medicare Advantage plans, EXCEPT:

When a beneficiary’s Medicare card is issued, the Medicare number is:

When a beneficiary is insured by both Medicare and another health plan, the “primary payer” is the plan that:

Medicare will only pay for _____ care and services, meaning they are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms AND they meet accepted standards of medicine.

A provider accepts _____ when it agrees to accept the Medicare-approved amount as payment in full for covered services.

A doctor who accepts Medicare assignment will do all the following, EXCEPT:

Cedric’s physician does not accept assignment and can charge no more than 15% more than Medicare’s approved amount. For the services provided to Cedric. This figure is referred to as the:

_____ does not require beneficiaries to visit in-network physicians or obtain referrals to specialists, so long as their provides are Medicare-approved.

Which of the following BEST describes how Original Medicare imposes out-of-pocket expenses?

Which of the following statements is NOT true of Medicare Advantage plans?

Medicare Part B (Medical Coverage) pays some of the costs for all the following, EXCEPT:

In addition to paying for the costs of care while a beneficiary is an inpatient in a hospital, Part A pays for:

A _____ is the period of time during which Original Medicare provides benefits for covered care and services under Part A, Hospital Coverage.

Marco’s Part A benefit period ended once he had _____ for 60 consecutive days.

Tamar’s inpatient hospital stay lasted for five months. For how much of this time will Original Medicare pay for the costs of her inpatient care under Part A?

Which of the following services IS covered under Medicare Part A:

Medicare only pays for nursing home care that is defined as _____, which must be provided by, or under the direct supervision of, a licensed medical professional.

If Shuto’s nursing home stay was NOT covered by Medicare Part A, which of the following requirements was NOT met:

A beneficiary must meet all the following requirements to receive covered hospice care under Medicare Part A, EXCEPT:

Medicare _____ pays for the costs of medically necessary care such as physician services, outpatient care, durable medical equipment, and mental health services.

Which of the following is NOT covered by Medicare Part B, Medical Coverage?

Medicare Part D (Prescription Drug Coverage) pays for some of the costs of drug coverage, as well as recommended:

Medicare’s initial Welcome to Medicare Visit and Yearly Wellness Visit are covered under Part B as:

Medicare drug coverage can be obtained any of the following ways, EXCEPT:

Hendrik is reading through his Medicare drug plan’s ____, which is a list of prescription drugs for which it provides coverage.

What type of drug is sold by a single company, cannot be sold by other companies, and is generally more costly than other types of drugs?

What type of drug is required by the FDA to have the same active ingredients as its corresponding brand-name drug?

Under Medicare drug coverage, when the beneficiary and the drug plan pay a certain dollar amount in a calendar year for the cost of drugs, the beneficiary is automatically eligible for _____.

How does Supplemental Security Income differ from other Social Security programs?

To be eligible for the Extra Help program, which helps pay for the cost of prescription drugs, beneficiaries must have:

What must a Medicare beneficiary do first, before enrolling in a Medicare Advantage plan?

Oliver has enrolled in a _____, which is a Medicare Advantage Plan that only provides coverage to beneficiaries who have been diagnosed with a particular condition or disease.

At what age do Medicare benefits usually begin?

Which of the following is NOT a guideline or rule that applies to Medicare Advantage plans?

When enrolling in a Medicare Advantage plan, a beneficiary is automatically _____ Original Medicare.

During the Medicare Advantage Open Enrollment Period from January 1 through March 31, a beneficiary who is already enrolled in a MA plan may do all the following, EXCEPT:

_____ are not part of the Medicare program; however, they are subject to Medicare rules and guidelines.

All the following rules and guidelines apply to Medicare Supplement insurance/Medigap plans, EXCEPT:

If a beneficiary with Original Medicare cancels an existing _____ plan BEFORE enrolling in a replacement Medicare Advantage plan, a late enrollment penalty will be charged if the cancelled policy’s drug coverage was not creditable.

Medicare Supplement insurance/Medigap plans are no longer permitted to be sold if they include coverage for the costs of _____.

Enrique purchased a Medigap policy with a lower premium because he agreed to only obtain care from in-network providers. What type of Medigap policy did he buy?

Which of the following is NOT true of Medicare Select policies?

The only time enrollment in Medicare Supplement insurance is NOT subject to medical underwriting is during:

Which of the following individuals is NOT automatically enrolled in Medicare?

Mr. Hsieh enrolled in Original Medicare when he was first eligible. Two years later, he decided to purchase a Medicare Supplement insurance policy, and was charged a very high premium for the policy because:

Federal law does not require insurance companies to sell Medicare Supplement insurance to people who are:

A Medigap guaranteed issue right permits a beneficiary to purchase a Medicare Supplement insurance policy without:

Which of the following is not an illegal practice when selling Medicare Supplement insurance/Medigap plans?

In Medicare, beneficiaries must pay a _____ before their coverage begins paying covered costs each year.

The only Medicare beneficiaries who pay a monthly premium for Part A are those who:

Medicare Part A only provides coverage for the first _____ days a beneficiary receives care as an inpatient in a hospital, unless using any of the 60 lifetime reserve days.

Medicare beneficiaries receiving covered hospice care pay ____ for the cost of care.

Which of the following is NOT a cost related to Medicare Part B?

After beneficiaries pay the Part B deductible, a coinsurance percentage of ____ usually applies to covered services provided by a provider who accepts assignment.

______ exempts people from paying a late enrollment penalty if they enroll in Medicare after age 65 because they have existing health coverage based on current employment.

The Income-Related Monthly Adjustment Amounts (IRMAA) that apply to Part B do which of the following:

The Part B IRMAA surcharge is applied to which of the following Medicare beneficiaries?

Anna is eligible for a Medicare Savings Plan because she:

Which of the following is NOT a Medicare Savings Plan?

Medicare Advantage plan costs are determined by:

Medicare drug plan costs are determined by:

Drugs costs in Medicare are based on all the following, EXCEPT:

Medicare Part D works in phases, with the first phase requiring the beneficiary to pay _____.

Mr. Fischer is enrolled in Medicare Part D. He will not enter the Coverage Gap because he is enrolled in:

On an annual basis, CMS caps the out-of-pocket expenses beneficiaries can pay for drug coverage. Once a beneficiary has met this threshold, the individual has what type of drug coverage?

A person may enroll in Medicare _____.

Unless individuals have their Medicare premiums deducted from their Social Security checks, premiums are due month, except for the _____ premium, which is due quarterly.

When beneficiaries make premium payments to Medicare, they can do so in any of the following ways, EXCEPT:

All Medicare premiums are due on the _____ of the month.

Medicare rights and protections prevent plans and producers from doing all the following, EXCEPT:

Producers talking about Medicare coverage CANNOT do which of the following?

Legal documents such as a power of attorney and a living will are types of:

The guidelines that establish how advance directives can be issued and how they were are created by:

Who is responsible for submitting a Medicare claim if the care, services, or supplies were provided by a person or entity NOT accepting assignment?

Beneficiaries can learn why Medicare declined to pay a claim under Original Medicare by:

If a Medicare claim is filed more than _____ from the date care, services, or supplies were provided, Medicare will NOT pay the claim.

The Initial Enrollment Period applies when an individual is either newly eligible for Medicare or:

Medicare beneficiaries can file a claims appeal in all the following circumstances, EXCEPT:

“Abuse” is the term used when a specific form of healthcare fraud is committed by:

Which of the following is NOT a form of Medicare fraud and abuse?

When does Medicare and its representatives call consumers for sales and marketing purposes?

Offers of cash, money, or gifts in exchange for free medical care are:

Many types of Medicare fraud and abuse are also considered _____, which includes “the use of another’s assets without their consent, under false pretenses, undue influence, or through coercion and/or manipulation.”