Understanding Original Fee-for-Service (FFS) Medicare Coverage Answers

Mr. Schmidt would like to plan for retirement and has asked you what is covered under Original Fee-for-Service (FFS) Medicare? What could you tell him? Choose one answer. a. Part D, which covers prescription drug services, is covered under Original Medicare. Incorrect b. Part A, which covers hospital, skilled nursing facility, hospice, and home health services and Part B, which covers professional services such as those provided by a doctor are covered under Original Medicare. Correct Correct: Original Medicare consists of Part A and Part B. c. Part A, which covers long term custodial care services, is covered under Original Medicare. Incorrect d. Part C, which always covers dental and vision services, is covered under Original Medicare. Incorrect Source: Part 1, Slide – Overview of Medicare (Parts A, B, C, and D), Slide – Overview of Different Ways to Get Medicare Correct Marks for this submission: 1/1. Question2 Marks: 1 Mrs. Turner is comparing her employer’s retiree insurance to Original Medicare and would like to know which of the following services Original Medicare will cover if the appropriate criteria are met? What could you tell her? Choose one answer. a. Original Medicare covers cosmetic surgery. Incorrect b. Original Medicare covers routine long-term custodial care. Incorrect c. Original Medicare covers routine dental care. Incorrect d. Original Medicare covers ambulance services. Correct Correct: Original Medicare does cover ambulance services. Source: Module 1, Slide - Other Part B Items and Services and Not Covered by Medicare Part A &B Correct Marks for this submission: 1/1. Question3 Marks: 1 Ms. Moore plans to retire when she turns 65 in a few months. She is in excellent health and will have considerable income when she retires. She is concerned that her income will make it impossible for her to qualify for Medicare. What could you tell her to address her concern? Choose one answer. a. Medicare is a program for people who have incomes and assets below specific limits, so you will have to find out her exact financial situation before telling her whether she can obtain Medicare coverage. Incorrect b. Medicare is a program for people of all ages with specific mental health disabilities. Since she is in excellent health, she would not qualify, but should instead look into her state’s Medicaid program if she wants further coverage. Incorrect c. Medicare is a program for people age 65 or older and those under age 65 with certain disabilities, end-stage renal disease, and Lou Gehrig’s disease so she will be eligible for Medicare. Correct Correct: Individuals that meet these criteria may be eligible to participate in Medicare. It is not based on income. d. Eligibility for Medicare is based on whether or not a person has ever been employed by the federal government. If she or her husband were ever employed by the federal government, she can enroll in Medicare. Incorrect Source: Module 1, Slide - Eligibility for Part A and Part B Correct Marks for this submission: 1/1. Question4 Marks: 1 Mr. Moy's wife has a Medicare Advantage plan, but he wants to understand what coverage Medicare Supplemental Insurance provides since his health care needs are different from his wife’s needs. What could you tell Mr. Moy? Choose one answer. a. Medicare Supplemental Insurance would help cover his Part A and Part B cost sharing in Original Fee-for-Service (FFS) Medicare as well as possibly some services that Medicare does not cover. Correct Correct: Medicare Supplement Insurance (Medigap) helps to cover Part A and Part B costsharing in Original Medicare as well as possibly offering some services such as medical care when a beneficiary travels outside the United States. b. Medicare Supplemental Insurance would cover his dental, vision and hearing services only. Incorrect c. Medicare Supplemental Insurance would cover all of his IRS approved health care expenditures not covered under Original Fee-for-Service (FFS) Medicare. Incorrect d. Medicare Supplemental Insurance would cover his long-term care services. Incorrect Source: Module 1, Slide - Medigap (Medicare Supplement Insurance) Correct Marks for this submission: 1/1. Question5 Marks: 1 Mrs. Geisler’s neighbor told her she should look at her Part D options during the annual Medicare enrollment period because features of Part D might have changed. Mrs. Geisler can’t remember what Part D is so she called you to ask what her neighbor was talking about. What could you tell her? Choose one answer. a. Part D covers hospital and home health services and the cost sharing has changed this year. Incorrect b. Part D covers prescription drugs and she should look at her premiums, formulary, and costsharing among other factors to see if they have changed. Correct Correct: Part D provides prescription drug coverage. Premiums, plan formularies, and costsharing, among other factors, may change from one plan year to another. c. Part D covers physician and non-physician practitioner services and the deductible has not changed this year, but the physician charges may go up. Incorrect d. Part D covers long-term care services and she shouldn’t worry because there has been no change in coverage. Incorrect Source: Module 1, Slide - Original Medicare and Part D Prescription Drug Coverage Correct Marks for this submission: 1/1. Question6 Marks: 1 Anita Magri will turn age 65 in August 2020. Anita intends to enroll in Original Medicare Part A and Part B. She would also like to enroll in a Medicare Supplement (Medigap) plan. Anita’s older neighbor Mel has told her about the Medigap Part F plan in which he is enrolled. It not only provides foreign travel emergency benefits but also covers his Medicare Part B deductible. Anita comes to you for advice. What should you tell her? Choose one answer. a. You would be happy to help Anita enroll in a Medigap plan but before she can do so, she must also enroll in a Medicare Part D prescription drug plan. Incorrect b. You are sorry to disappoint Anita but a Medigap Part F plan is no longer available to those who turn age 65 after January 1,2020. Anita might instead consider other Medigap plans that offer foreign travel benefits but do not cover the Part B deductible. Correct Correct: Individuals who attain age 65 on or after January 1, 2020 cannot purchase a Medigap plan that pays the Part B deductible. Generally, these are plans C, F, or high deductible F. Anita can still purchase a Medigap plan that provides foreign travel emergency benefits such as plan G. c. You would be happy to help Anita enroll in a Medigap Part F plan will provide foreign travel benefits as a well as cover her Part B deductible. Incorrect d. You are sorry to disappoint Anita but Medigap plans are no longer available to those who turn age 65 after January 1, 2020. Anita should instead consider a Medicare Advantage plan. Incorrect Source: Module 1, Slide - Further Information on Medigap (Medicare Supplement Insurance), Slide - Changes in Medigap for Individuals Who Become Eligible for Medicare After December 31, 2019, Slide - Medigap Plans and Medigap Plans, continued Correct Marks for this submission: 1/1. Question7 Marks: 1 What impact, if any, will recent regulatory changes have upon Medigap plans? Choose one answer. a. The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Correct Correct: Starting January 1, 2020, Medigap plans sold to individuals who are newly eligible to Medicare will not be allowed to cover the Part B deductible. If an individual already had one of the plans before January 1, 2020, they will be able to keep their plan. If an individual was eligible for Medicare before January 1, 2020, but not yet enrolled, his or she may be able to purchase one of these plans. b. The Part A deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020. Incorrect c. The Part A deductible is no longer covered under Medigap plans for all enrollees starting January 1, 2020. Incorrect d. The Part B deductible will be covered for some newly eligible individuals depending on their financial status. Incorrect Source: Module 1, Slide - Changes in Medigap for Individuals Eligible for Medicare after December 31, 2019 Correct Marks for this submission: 1/1. Question8 Marks: 1 Agent John Miller is meeting with Jerry Smith, a new prospect. Jerry is currently enrolled in Medicare Parts A and B. Jerry has also purchased a Medicare Supplement (Medigap) plan which he has had for several years. However, the plan does not provide drug benefits. How would you advise Agent John Miller to proceed? Choose one answer. a. Tell prospect Jerry Smith that he should drop his Medigap coverage and put those premium dollars toward the purchase of a standalone Part D prescription drug plan because he can always reactivate his Medigap policy on a guaranteed issue basis. Furthermore, because he has had Medigap Jerry will not incur a Part D late enrollment penalty. Incorrect b. Tell prospect Jerry Smith that Medigap is simply a variation of a Medicare Advantage plan and the companies John represents offer more comprehensive coverage for a lower price. Incorrect c. Tell prospect Jerry Smith that he should keep his Medigap plan but he should supplement his healthcare coverage by purchasing a Medicare Advantage plan that offers prescription drug coverage (MA-PD). Incorrect d. Tell prospect Jerry Smith that he should consider adding a standalone Part D prescription drug coverage policy to his present coverage. Correct Correct: Agent John Miller can help prospect Jerry select a standalone Part D prescription drug plan that complements his current Original Medicare and Medigap coverage. Alternatively, Agent Miller can suggest that Jerry drop his Medigap coverage and enroll in a MA-PD plan. Source: Module 1, Slide - Medigap (Medicare Supplement Insurance), Slide - Medigap is NOT Correct Marks for this submission: 1/1. Question9 Marks: 1 Mr. Xi will soon turn age 65 and has come to you for advice as to what services are provided under Original Medicare. What should you tell Mr. Xi that best describes the health coverage provided to Medicare beneficiaries? Choose one answer. a. Beneficiaries under Original Medicare have no cost-sharing for most preventive services which include immunizations such as annual flu shots. Correct Correct: Beneficiaries enrolled in both Original Medicare (Parts A and B) have no cost-sharing for most preventive services. These services include immunizations such as annual flu shots. b. Benefits covered by Medicare Parts A and B include routine dental care, hearing aids, and routine eye care. Incorrect c. Medicare Part B generally provides prescription drug coverage. Incorrect d. Medicare Part A generally covers medically necessary physician and other health care professional services. Incorrect Source: Module 1, Slide Medicare Part B Benefits, Preventive Services and Screenings, Slide Not Covered by Medicare Part A & B Correct Marks for this submission: 1/1. Question10 Marks: 1 Mr. Singh would like drug coverage but does not want to be enrolled in a Medicare Advantage plan. What should you tell him? Choose one answer. a. Mr. Singh will have to enroll in Medicaid if he wishes to obtain prescription drug coverage through some means other than a Medicare Advantage plan. Incorrect b. Mr. Singh must leave Original Medicare to receive drug coverage. Incorrect c. Mr. Singh can enroll in a stand-alone prescription drug plan and continue to be covered for Part A and Part B services through Original Fee-for-Service Medicare. Correct Correct: Prescription drug coverage is available to those who enroll in a stand-alone Part D prescription drug plan and continue coverage under Original Medicare Part A and Part B. d. Part D prescription drug coverage can only be obtained by enrollment into a Medicare Advantage plan that also covers Part A and Part B services. Incorrect Source: Module 1, Slide - Original Medicare and Part D Prescription Drug Coverage Correct Marks for this submission: 1/1. Question11 Marks: 1 Mrs. Chen will be 65 soon, has been a citizen for twelve years, has been employed full time, and paid taxes during that entire period. She is concerned that she will not qualify for coverage under part A because she was not born in the United States. What should you tell her? Choose one answer. a. Most individuals who are citizens and age 65 or over and are covered under Part A must pay a monthly premium for that coverage. Incorrect b. Most individuals who are citizens and age 65 or over are covered under Part A by virtue of having paid Medicare taxes while working, though some may be covered as a result of paying monthly premiums. Correct Correct: Most individuals who are citizens and age 65 or older may qualify for coverage either because they pay a monthly premium or because they paid Medicare taxes while working for a specific duration. c. All individuals who are citizens and age 65 or over will be covered under Part A. Incorrect d. Most individuals who are citizens and age 65 or over and wish to be covered under Part A must enroll in a Medicare Advantage Plan. Incorrect Source:Module 1, Slide - Eligibility for Part A and Part B, Slide - Eligibility for Premium-free Part A Correct Marks for this submission: 1/1. Question12 Marks: 1 Juan Perez, who is turning age 65 next month, intends to work for several more years at Smallcap, Incorporated. Smallcap has a workforce of 15 employees and offers employersponsored healthcare coverage. Juan is a naturalized citizen and has contributed to the Medicare system for over 20 years. Juan asks you if he will be entitled to Medicare and if he enrolls how that will impact his employer-sponsored healthcare coverage. How would you respond? Choose one answer. a. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims but Smallcap must continue to offer him coverage under its employer-sponsored group health plan and would become a secondary payor. Incorrect b. Juan is likely to be ineligible for Medicare since he was born outside the United States and has only contributed to the Medicare system for 20 years. Incorrect c. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls his employersponsored coverage would continue to be the primary payor while Medicare would be considered a secondary payor of his healthcare claims. Incorrect d. Juan is likely to be eligible for Medicare once he turns age 65 and if he enrolls Medicare would become the primary payor of his healthcare claims and Smallcap does not have to continue to offer him coverage comparable to those under age 65 under its employersponsored group health plan. Correct Correct: Medicare is the primary payor for individuals who have group health coverage as a result of their or their spouse’s employment with a company that is not a large group health plan (GHP) (basically, one with fewer than 20 employees). Furthermore, small GHPs do not have to continue to offer their age 65 and over employees and their spouses the same benefits under the GHP as individuals under age 65. Source: Module 1, Slide - Eligibility for Part A and Part B, Slide - Medicare for Individuals Who Are Still Working – Small GHPs Correct Marks for this submission: 1/1. Question13 Marks: 1 Mr. Bauer is 49 years old, but eighteen months ago he was declared disabled by the Social Security Administration and has been receiving disability payments. He is wondering whether he can obtain coverage under Medicare. What should you tell him? Choose one answer. a. After receiving such disability payments for 24 months, he will be automatically enrolled in Medicare, regardless of age. Correct Correct: Individuals with disabilities who are under age 65 are automatically enrolled in Medicare Parts A and B the month after they have received Social Security or Railroad Retirement disability benefits for 24 months. b. He became eligible for Medicare when his disability eligibility determination was first made. Incorrect c. Individuals who become eligible for such disability payments only have to wait 12 months before they can apply for coverage under Medicare. Incorrect d. Individuals receiving such disability payments from the Social Security Administration continue to receive those payments but only become eligible for Medicare upon reaching age 65. Incorrect Source: Module 1, Slide Medicare Enrollment - Parts A and B Correct Marks for this submission: 1/1. Question14 Marks: 1 Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare’s coverage of care in a skilled nursing facility? Choose one answer. a. Medicare will cover Mrs. Shield’s skilled nursing services provided during the first 20 days of her stay, after which she would have a copay until she has been in the facility for 100 days. Correct Correct: Mrs. Shields has experienced a long hospital stay, over the 3-day time period to qualify for skilled nursing and rehabilitative care benefits under Medicare. b. Medicare will cover an unlimited number of days in a skilled-nursing facility, as long as a physician certifies that such care is needed. Incorrect c. Once she has expended her liquid assets, Medicare will cover 80% of Mrs. Shields long-term care costs. Incorrect d. Mrs. Shields will have to apply for Medicaid to have her skilled nursing services covered because Medicare does not provide such a benefit. Incorrect Source: Module 1, Slide - Medicare Part A – Original Medicare Cost Sharing for Skilled Nursing and Rehabilitative Care Correct Marks for this submission: 1/1. Question15 Marks: 1 Mrs. Quinn recently turned 66 and decided after many years of work to begin receiving Social Security benefits. Shortly thereafter Mrs. Quinn received a letter informing her that she has been automatically enrolled in Medicare Part B. She wants to understand what this means. What should you tell Mrs. Quinn? Choose one answer. a. Part B will cover her dental and vision needs. Incorrect b. Part B primarily covers physician services. She will be paying a monthly premium and, with the exception of many preventive and screening tests, generally will have 20% coinsurance for these services, in addition to an annual deductible. Correct Correct: Medicare Part B primarily covers physician services. Enrollees pay a monthly premium based on their income level and have 20 percent coinsurance cost-sharing with the exception of preventive benefits. c. She will need to pay no premiums for Part B as she qualifies for premium-free coverage due to the number of quarters she has worked. Incorrect d. She should disenroll if she does not want to pay the monthly premiums. There is no disadvantage in doing so. Incorrect Source: Module 1, Slide – Medicare Premiums for Part B, Slide Medicare Part B Benefits, Slide – Medicare Part B – Original Medicare Cost Sharing, Slide - Preventive Services and Screenings Correct Marks for this submission: 1/1. Question16 Marks: 1 Mr. Diaz continued working with his company and was insured under his employer’s group plan until he reached age 68. He has heard that there is a premium penalty for those who did not sign up for Part B when first eligible and wants to know how much he will have to pay. What should you tell him? Choose one answer. a. During the first year, he is covered under Part B, his premiums will be 10% higher than they otherwise would be, after which point they will return to normal. Incorrect b. Mr. Diaz will not pay any penalty because he had continuous coverage under his employer’s plan. Correct Correct: Individuals with coverage based on their own current employment are not subject to the late enrollment penalty. c. The penalty will be a permanent 10% increase in his Part B premium for every 12-month period that passed during which he could have enrolled and did not. Incorrect d. Mr. Diaz will pay a penalty, which will be a flat amount each year, paid during the first month of coverage. Incorrect Slide: Module 1, Slide Medicare Premium for Part B, Payment Mechanisms and Penalties Correct Marks for this submission: 1/1. Question17 Marks: 1 Mr. Wu is eligible for Medicare. He has limited financial resources but failed to qualify for the Part D low-income subsidy. Where might he turn for help with his prescription drug costs? Choose one answer. a. Mr. Wu may still qualify for help in paying for Part D costs through the local Office of the Aging. Incorrect b. Mr. Wu may still qualify for help in paying for Part D costs through the Federal Pharmaceutical Assistance Program. Incorrect c. Mr. Wu may still qualify for help in paying Part D costs through his State Pharmaceutical Assistance Program. Correct Correct: A State Pharmaceutical Assistance Program may be able to provide assistance with prescription drug costs for those who are of limited means but do not qualify for the Part D lowincome subsidy. d. Mr. Wu has no alternative but to liquidate his remaining assets and apply for coverage through his state’s Medicaid program. Incorrect Source: Module 1, Slide Help for Individuals with Limited Income/Resources - Apply to State Medicaid Office Correct Marks for this submission: 1/1. Question18 Marks: 1 Mrs. Paterson is concerned about the deductibles and co-payments associated with Original Medicare. What can you tell her about Medigap as an option to address this concern? Choose one answer. a. Medigap plans are not sold by private companies and are a government insurance product. Incorrect b. If Mrs. Paterson applies during the Medigap open enrollment period, she will have to undergo a medical review to determine if she has a pre-existing condition that would increase the premium for a Medigap policy. Incorrect c. Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles for medically necessary services. Correct Correct: Medigap plans help beneficiaries cover coinsurance, co-payments, and/or deductibles when Original Medicare determines that a benefit is medically necessary. d. All costs not covered by Medicare are covered by some Medigap plans. Incorrect Source: Module 1, Slide - Medigap (Medicare Supplement Insurance), Slide – Medigap Coverage Correct Marks for this submission: 1/1. Question19 Marks: 1 Madeline Martinez was widowed several years ago. Her husband worked for many years and contributed into the Medicare system. He also left a substantial estate which provides Madeline with an annual income of approximately $130,000. Madeline, who has only worked part-time for the last three years, will soon turn age 65 and hopes to enroll in Original Medicare. She comes to you for advice. What should you tell her? Choose one answer. a. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at more than the standard lowest rate but less than the highest rate due her substantial income. Correct Correct: Madeline will be able to enroll in premium-free Part A due to her husband’s work record. She will pay a premium for Part B coverage based on her income level (her incomerelated monthly adjustment amount [IRMMA]). An income level of $100,00 would mean Mrs. Martinez would pay a premium more than the standard (lowest) amount but not at the highest level which looks at incomes above $500,000 for those filing individual income tax returns. b. You should tell Madeline that she will be able to enroll in both Medicare Part A and Part B without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. Incorrect c. You should tell Madeline that she will need to pay premiums for Part A because of her short work history. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000. Incorrect d. You should tell Madeline that she will be able to enroll in Medicare Part A without paying monthly premiums due to her husband’s long work record and participation in the Medicare system. You should also tell Madeline that she will pay Part B premiums at the highest rate because her income over the last several years has exceeded $100,000. Incorrect Source: Module 1, Slide - Eligibility for Premium -free Part A, Slide - Medicare Premiums for Part B and the IRMAA Correct Marks for this submission: 1/1. Question20 Marks: 1 Mr. Davis is 52 years old and has recently been diagnosed with end-stage renal disease (ESRD) and will soon begin dialysis. He is wondering if he can obtain coverage under Medicare. What should you tell him? Choose one answer. a. He may sign-up for Medicare at any time however coverage usually begins on the sixth month after dialysis treatments start. Incorrect b. He may sign-up for Medicare at any time however coverage usually begins on the fourth month after dialysis treatments start. Correct Correct: Individuals with ESRD may sign up for Medicare at any time. Coverage typically begins on the fourth month after dialysis treatments start, but it could be earlier if certain conditions are met. c. He may not sign-up for Medicare until he reaches age 62, the date he first becomes eligible for Social Security benefits. Incorrect d. He may sign-up for Medicare at any time and coverage usually begins immediately. Incorrect Mrs. Davenport enrolled in the ABC Medicare Advantage (MA) plan several years ago. In midFebruary of 2021, her doctor confirms a diagnosis of end-stage renal disease (ESRD). What options will Mrs. Davenport have regarding her MA plan during the next open enrollment season? Choose one answer. a. She must remain enrolled in her ABC MA plan unless the plan terminates. Incorrect b. She must immediately drop her ABC MA plan and enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Incorrect Incorrect: Because Mrs. Davenport had enrolled in the ABC MA plan before she developed ESRD, she may remain enrolled in the plan. She also has the option to (1) enroll in another MA plan in her service area, or (2) enroll in a Special Needs Plan (SPN) for persons suffering from ESRN if one is available in her area. c. She must immediately drop her ABC MA plan and enroll in Original Medicare. Incorrect d. She may remain in her ABC MA plan, enroll in another MA plan in her service area, or enroll in a Special Needs Plan (SNP) for individuals suffering from ESRD if one is available in her area. Correct Source: Module 2, Slide – Individuals with ESRD Beginning in 2021, Slide - Medicare Advantage Eligibility: SNPs Incorrect Marks for this submission: 0/1. Question2 Marks: 1 Mrs. Kelly, age 65, is entitled to Part A but has not yet enrolled in Part B. She is considering enrollment in a Medicare Advantage plan (Part C). What should you advise her to do before she will be able to enroll in a Medicare Advantage plan? Choose one answer. a. In order to join a Medicare Advantage plan, she also must enroll in Part B. Correct Correct: Eligibility to enroll in a Medicare Advantage plan requires entitlement to benefits under Part A and enrollment in Part B. b. In order to join a Medicare Advantage plan, she must be enrolled in Parts A, B, and D. Incorrect c. To enroll in a Medicare Advantage plan, she need only be entitled to Part A, so she does not need to take any further steps. Incorrect d. Since she is age 65 she may enroll in any Medicare Advantage plan, regardless of whether she is entitled to Part A or Part B coverage. Incorrect Source: Module 2, Slide – Medicare Advantage Eligibility Correct Marks for this submission: 1/1. Question3 Marks: 1 Mr. Greco is in excellent health, lives in his own home, and has a sizeable income from his investments. He has a friend enrolled in a Medicare Advantage Special Needs Plan (SNP). His friend has mentioned that the SNP charges very low cost-sharing amounts and Mr. Greco would like to join that plan. What should you tell him? Choose one answer. a. SNPs do not provide Part D prescription drug coverage, so if he does enroll, he should be aware that he will not have coverage for any medications he may need now or in the future. Incorrect b. SNPs limit enrollment to certain subpopulations of beneficiaries. Given his current situation, he is unlikely to qualify and would not be able to enroll in the SNP. Correct Correct: Mr.Greco’s circumstances would not meet the eligibility criteria to qualify him for any of the SNPs. c. SNPs only serve individuals in long-term care facilities, so he cannot enroll. Incorrect d. SNPs only serve individuals eligible for both Medicaid and Medicare, so he cannot enroll. Incorrect Source: Module 2, Slide - Medicare Advantage Eligibility: SNPs, Side - Medicare Advantage Eligibility - SNP Description Correct Marks for this submission: 1/1. Question4 Marks: 1 Mr. Lopez has heard that he can sign up for a product called “Medicare Advantage” but is not sure about what type of plan designs are available through this program. What should you tell him about the types of health plans that are available through the Medicare Advantage program? Choose one answer. a. They are Medicare health plans such as HMOs, PPOs, PFFS, and MSAs. Correct Correct: There are coordinated care Medicare Advantage plans that include HMOs and PPOs. There are also Private-Fee-for-Service (PFFS), Medicare Savings Account (MSA), and Special Needs Plans (SNPs). b. They are Medigap Supplemental plans that fill in the gaps not covered by Medicare. Incorrect c. They are major medical policies but are only for low-income beneficiaries with Medicare. Incorrect d. They are custodial long-term care plans for people with Medicare. Incorrect Source: Module 2, Slide - Medicare Advantage Plans Correct Marks for this submission: 1/1. Question5 Marks: 1 Ms. Gibson recently lost her employer group health and drug coverage and now she wants to enroll in a PPO that does not include drug coverage. What should you tell her about obtaining drug coverage? Choose one answer. a. She can enroll in the PPO and if she decides that she wants drug coverage, she will be able to drop her PPO at any time in favor of a Medicare Advantage plan that includes such drug coverage. Incorrect b. She can enroll in the PPO and purchase drug coverage through a Medigap plan. Incorrect c. She can enroll in the PPO, but she will not be able to purchase a stand-alone Medicare Part D prescription drug plan. Correct Correct: Ms. Gibson can enroll in a PPO without drug coverage. However, If a beneficiary enrolls in a MA plan that is an HMO or PPO plan that does not include Part D coverage, the beneficiary cannot join a standalone Prescription Drug Plan (PDP). d. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare Part D prescription drug plan. Incorrect Source: Part 2, Slide – MA & Prescription Drugs, continued Correct Marks for this submission: 1/1. Question6 Marks: 1 Mrs. Radford asks whether there are any special eligibility requirements for Medicare Advantage. What should you tell her? Choose one answer. a. Mrs. Radford must be enrolled in both Medigap and Part A to enroll in a Medicare Advantage plan. Incorrect b. Mrs. Radford must be entitled to Part A and enrolled in Part B to enroll in Medicare Advantage. Correct Correct: To be eligible to enroll in Medicare Advantage, an individual must be entitled (not enrolled) to Part A and enrolled in Part B. c. Mrs. Radford can enroll in any Medicare Advantage plan that operates within the United States. Incorrect d. Mrs. Radford must apply to the Medicare Advantage plan, which will include a medical review, prior to being accepted and enrolled. Incorrect Source: Module 2, Slide – Medicare Advantage Eligibility Correct Marks for this submission: 1/1. Question7 Marks: 1 Mrs. Chou likes a Private Fee-for-Service (PFFS) plan available in her area that does not include drug coverage. She wants to enroll in the plan and enroll in a stand-alone prescription drug plan. What should you tell her? Choose one answer. a. She could enroll in a PFFS plan, but not in a stand-alone drug plan. Incorrect b. She could enroll in a PFFS plan and a stand-alone Medicare prescription drug plan. Correct Correct: An individual enrolled in a MA PFFS plan that does not include a Part D benefit may enroll in a stand-alone Part D prescription drug plan. This is true even if the organization offers another PFFS plan under the same MA contract that includes a Part D benefit. c. If she wants drug coverage and a PFFS plan, she could only enroll in a PFFS plan that includes Medicare prescription drug coverage. Incorrect d. She could enroll in the PFFS plan and a Medigap plan that offers drug coverage, but not in a stand-alone Medicare prescription drug plan. Incorrect Source: Module 2, Slide - MA & Prescription Drugs, Slide - MA & Prescription Drugs, continued Correct Marks for this submission: 1/1. Question8 Marks: 1 Mr. Gomez notes that a Private Fee-for-Service (PFFS) plan available in his area has an attractive premium. He wants to know if he must use doctors in a network as his current HMO plan requires him to do. What should you tell him? Choose one answer. a. If he enrolls in the PFFS plan, he can go to any doctor anywhere as long as the doctor accepts Original Medicare. Incorrect b. He may receive services from any physician, regardless of whether or not that physician participates in the plan or Original Medicare. Incorrect c. If he enrolls in the PFFS plan and shows his card to a doctor who participates in Original Medicare, then that doctor is required to accept the plan’s terms and conditions, which could include balance billing. Incorrect d. He may receive health care services from any doctor allowed to bill Medicare, as long as he shows the doctor the plan’s identification card and the doctor agrees to accept the PFFS plan’s payment terms and conditions, which could include balance billing. Correct Correct: Mr. Gomez may receive health care services from any doctor allowed to bill Medicare, provided he shows the doctor the plan’s identification card, and the doctor accepts the PFFS’s payment terms and conditions. These terms may include balance billing up to 15%of the Medicare rate. Source: Module 2, Slide - MA Plan Types Private Fee-for-Service (PFFS) Plans, Slide – MA Plan Types Private Fee-for Service Plans, (2 of 3) Correct Marks for this submission: 1/1. Question9 Marks: 1 Mrs. Ramos is considering a Medicare Advantage PPO and has questions about which providers she can go to for her health care. What should you tell her? Choose one answer. a. In general, Mrs. Ramos will need a referral to see specialists. Incorrect b. Mrs. Ramos should be aware that generally plan providers can decide, on a case-by-case basis, whether they will treat her. Incorrect c. In general, Mrs. Ramos can obtain care from any provider who participates in Original Medicare but will have to pay the difference between the plan’s allowed amount and the provider’s usual and customary charge. Incorrect Incorrect: Mrs. Ramos would be able to see any provider who accepts Medicare. Such providers are considered in-network, and this would result in lower cost-sharing payments for her. d. Mrs. Ramos can obtain care from any provider who participates in Original Medicare, but generally will have a higher cost-sharing amount if she sees a provider who/that is not a part of the PPO network. Correct Source: Part 2, Slide - MA Plan Types Coordinated Care Plans – PPOs Incorrect Marks for this submission: 0/1. Question10 Marks: 1 Mrs. Burton is a retiree with substantial income. She is enrolled in an MA-PD plan and was disappointed with the service she received from her primary care physician because she was told she would have to wait five weeks to get an appointment when she was feeling ill. She called you to ask what she could do so she would not have to put up with such poor access to care. What could you tell her? Choose one answer. a. She must write to the plan and wait for a response and then, if she is still dissatisfied, she could file an appeal with her state Medicaid office requesting transfer to one of its managed care plans. Incorrect b. She could file a grievance with her plan to complain about the lack of timeliness in getting an appointment. Correct Correct: Enrollees or their representatives may file a grievance if they experience problems with their health care services, such as timeliness, appropriateness, access to, and/or setting of a provided health service, procedure, or item. c. She should not expect to get in to see her doctor any more quickly since she is a Medicare patient. Incorrect d. She should call the doctor’s office to complain since the plan cannot do anything about the doctor’s schedule. Incorrect Source: Module 2, Slide – Enrollee Protections, Slide – Enrollee Protections: Complaints, Coverage Decisions, Appeals, Slide – Enrollee Protections: Grievances Correct Marks for this submission: 1/1. Question11 Marks: 1 Mrs. Walters is enrolled in her state’s Medicaid program in addition to Medicare. What should she be aware of when considering enrollment in a Medicare Advantage (MA) plan? Choose one answer. a. She can submit any bills she has for co-payments under Medicare to the state’s Medicaid program and they will always be fully covered. Incorrect b. If a provider accepts her Medicare Advantage plan coverage, that provider is legally obligated to also accept her Medicaid coverage, so she does not need to worry about finding providers who participate in both Medicare and Medicaid. Incorrect c. She cannot enroll in an MA Medical Savings Account (MSA) plan. Correct Correct: Mrs. Walters is a dual-eligible. Dual eligible beneficiaries may enroll in any type of MA plan except a MA Medical Savings Account (MSA) plan. d. State Medicaid programs do not coordinate any of their coverage with Medicare Advantage plans. Incorrect Source: Module 2, Slides - MA Plans and Dual Eligible Beneficiaries, continued #1 and #2 Correct Marks for this submission: 1/1. Question12 Marks: 1 Mr. Kumar is considering a Medicare Advantage HMO and has questions about his ability to access providers. What should you tell him? Choose one answer. a. In most Medicare Advantage HMOs, Mr. Kumar must generally obtain his services only from providers who have a contractual relationship with the plan (except in an emergency or where care is unavailable within the network). Correct Correct: In most Medicare Advantage HMOs, as a general rule, an enrollee must obtain services only from providers who have a contractual relationship with the plan. An exception is made for emergency care. b. In Medicare Advantage HMO plans, services provided by primary care physicians are covered at 100%, but those of specialists are covered at 80%. Incorrect c. Mr. Kumar will be able to obtain routine care outside of the plan’s service area but will pay a higher co-payment (except in an emergency). Incorrect d. With any Medicare Advantage HMO, Mr. Kumar will be able to see any provider he likes, so long as that provider participates in Original Medicare. Incorrect Source: Module 2, Slide - MA Plan Types Coordinated Care Plans – HMOs, Slide - MA Plan Types Coordinated Care Plans – HMOs, continued Correct Marks for this submission: 1/1. Question13 Marks: 1 Dr. Elizabeth Brennan does not contract with the ABC PFFS plan but accepts the plan’s terms and conditions for payment. Mary Rodgers sees Dr. Brennan for treatment. How much may Dr. Brennan charge? Choose one answer. a. Dr. Brennan can charge Mary Rodgers no more than the cost sharing specified in the PFFS plan’s terms and conditions of payment which may include balance billing up to 25% of the Medicare rate. Incorrect b. Dr. Brennan can charge the beneficiary the same cost-sharing as Original Medicare as long as she sends the claim to Medicare and not the plan. Incorrect c. Dr. Brennan can charge Mary Rogers no more than the cost sharing specified in the PFFS plan’s terms and condition of payment which may include balance billing up to 15%of the Medicare rate. Correct Correct: Because Dr. Brennan accepts the plan’s terms and conditions for payment, she is permitted to charge this amount. d. Dr. Brennan can charge Mary Rodgers more than the cost sharing specified in the PFFS plan’s terms and conditions as long as she treats all beneficiaries the same. Incorrect Source: Module 2, Slide - MA Plan Types Private Fee-for-Service Plans (3 of 3) Correct Marks for this submission: 1/1. Question14 Marks: 1 Mr. Wells is trying to understand the difference between Original Medicare and Medicare Advantage. What would be the correct description? Choose one answer. a. Medicare Advantage is a way of covering all the Original Medicare benefits through private health insurance companies. Correct Correct: Medicare Advantage is a way of covering Original Medicare, Part A and Part B benefits, through private health insurance plans. b. Medicare Advantage is a health insurance program operated jointly by the states with the Federal government. Incorrect c. Medicare Advantage is designed to pick up where Original Medicare leaves off, covering those health care services that would not normally be covered by Original Medicare. Incorrect d. Medicare Advantage is a new name for the Original Medicare program. Incorrect Source: Module 2, Slide – Part C: Medicare Advantage Plans. Correct Marks for this submission: 1/1. Question15 Marks: 1 Mrs. Willard wants to know generally how the benefits under Original Medicare might compare to the benefits package of a Medicare Advantage Plan before she starts looking at specific plans. What could you tell her? Choose one answer. a. Medicare Advantage Plans are not permitted to offer any benefits beyond those available under the Original Medicare program and must have the same maximum out-of-pocket limit on Part A and Part B services as FFS Medicare. Incorrect b. Medicare Advantage Plans do not necessarily have to cover all of the Original Medicare Part A and Part B services but must include a maximum out-of-pocket limit. Incorrect c. All Medicare Advantage Plans offer cost-sharing that is lower than Original Medicare for all Part A and Part B covered services, but the maximum out-of-pocket limit is higher than in Original Medicare. Incorrect d. Medicare Advantage Plans may offer extra benefits that Original Medicare does not offer such as vision, hearing, and dental services and must include a maximum out-of-pocket limit on Part A and Part B services. Correct Correct: Some Medicare Advantage Plans offer extra benefits that Original Medicare does not cover. Also, Original Medicare does not have a maximum out-of-pocket limit. Source: Module 2, Slide - Part C: Medicare Health Plans, Slide - Part C: Medicare Advantage Plan Benefits (Pg. 2-3) Correct Marks for this submission: 1/1. Question16 Marks: 1 Daniel is a middle-income Medicare beneficiary. He has chronic bronchitis, putting him at severe risk for pneumonia. Otherwise, he has no problems functioning. Which type of SNP is likely to be most appropriate for him? Choose one answer. a. D-SNP Incorrect b. FIDE-SNP Incorrect c. I-SNP Incorrect d. C-SNP Correct Correct: Because Daniel’s bronchitis is a chronic condition, a Chronic condition SNP would be most appropriate for him to enroll in. Source: Module 2, Slide - Medicare Advantage Eligibility, Slide – Medicare Advantage: SNP Description Correct Marks for this submission: 1/1. Question17 Marks: 1 Mrs. Lyons is in good health, uses a single prescription, and lives independently in her own home. She is attracted by the idea of maintaining control over a Medical Savings Account (MSA) but is not sure if the plan associated with the account will fit her needs. What specific piece of information about a Medicare MSA plan would it be important for her to know, prior to enrolling in such a plan? Choose one answer. a. All beneficiaries enrolled in an MSA set-aside the MSA funds on a pre-tax basis in addition to paying their Part B premium. Incorrect b. All MSAs cover Part A and Part B benefits, but not Part D prescription drug benefits, which could be obtained by also enrolling in a separate prescription drug plan. Correct Correct: MSA enrollees must enroll in a stand-alone prescription drug plan (PDP) if they want prescription drug benefits. c. For enrollees in an MSA, after the annual deductible is met, the MSA plan generally pays 75% of covered services. Incorrect d. MSA enrollees may only receive covered health care services from a limited panel of network providers because otherwise, some providers may charge more than Original Medicare rates. Incorrect Source: Module 2, Slide - MA Plan Types Medicare Savings Account (MSA) Plans, Slide – MA Plan Types: MSA Plans, continued Correct Marks for this submission: 1/1. Question18 Marks: 1 Mr. Barker enjoys a comfortable retirement income. He recently had surgery and expected that he would have certain services and items covered by the plan with minimal out-of-pocket costs because his MA-PD coverage has been very good. However, when he received the bill, he was surprised to see large charges in excess of his maximum out-of-pocket limit that included a number of services and items he thought would be fully covered. He called you to ask what he could do? What could you tell him? Choose one answer. a. You could suggest he call the doctor who performed the surgery to complain about the costs and ask for a discount on the charges. Incorrect b. You can offer to review the plans appeal process to help him ask the plan to review the coverage decision. Correct Correct: Medicare Advantage (MA) plan enrollees have a right to obtain a review (appeal) to certain decisions about health care payment, coverage of services, or prescription drug coverage. Medicare health plans must provide enrollees with a written description of the appeals process. c. You could reassure him that such charges are typical, but if he needs assistance in paying, he should apply to the state for Medicaid assistance. Incorrect d. You could remind him that he cannot do anything until the next Annual Election Period when he will have an opportunity to change plans. Incorrect Source: Part 2, Slide - Enrollee Protections, Slide - Enrollee Protections: Complaints, Coverage Decisions, Appeals and Slide – Enrollee Protections: Complaints, Coverage Decisions, Appeals, continued Correct Marks for this submission: 1/1. Question19 Marks: 1 Mr. Castillo, a naturalized citizen, previously enrolled in Medicare Part B but has recently stopped paying his Part B premium. Mr. Castillo is still covered by Part A. He would like to enroll in a Medicare Advantage (MA) plan and is still covered by Part A. What should you tell him? Choose one answer. a. He is not eligible to enroll in a Medicare Advantage plan until he re-enrolls in Medicare Part B. Correct Correct: In order to enroll in a Medicare Advantage (MA) plan, an individual must be entitled to Part A and enrolled in Part B. Mr. Castillo is covered by Plan A but no longer enrolled in Medicare Part B so he cannot enroll in MA plan until he re-enrolls in Part B. b. He can enroll in a Medicare Advantage plan but it will pay only the benefits associated with Medicare Part A. Incorrect c. He can enroll in a Medicare Advantage plan if he has dropped Part B less than 90 days ago. Incorrect d. He is not eligible to enroll in a Medicare Advantage as a naturalized citizen. Incorrect Source: Part 2, Slide – Medicare Advantage Eligibility. Correct Marks for this submission: 1/1. Question20 Marks: 1 Mr. Sinclair has diabetes and heart trouble and is generally satisfied with the care he has received under Original Medicare, but he would like to know more about Medicare Advantage Special Needs Plans (SNPs). What could you tell him? Choose one answer. a. SNPs have special programs for enrollees with chronic conditions, like Mr. Sinclair, and they provide prescription drug coverage that could be very helpful as well. Correct Correct: Chronic condition SNPs (C-SNPs) restrict enrollment and tailor services to individuals with chronic conditions, such as Mr. Sinclair. All SNPs include prescription drug coverage. b. SNPs offer care from any doctor or hospital Mr. Sinclair would like to use and his costs will always be lower than in Original Medicare. Incorrect c. Since SNPs don’t cover prescription drugs Mr. Sinclair should consider a different option. Incorrect d. SNPs are essentially the same as Original Medicare and are not likely to have a noticeable impact on how Mr. Sinclair receives his care. Incorrect