2022 Medicare Basics: Test Questions and Answers for Medicare Parts A, B, C, and D, Exams of Nursing

Download 2022 Medicare Basics: Test Questions and Answers for Medicare Parts A, B, C, and D and more Exams Nursing in PDF only on Docsity!

Answers 2024 Updated Solutions.

d. Parts A and B - Correct Answer In which two parts of Medicare is enrollment generally automatic for eligible consumers who are receiving Social Security benefits UNLESS they choose to delay their coverage? a. Parts B and D b. Parts C and D c. Parts A and D d. Parts A and B c. When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA Plan. - Correct Answer Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? a. An MA Plan and a Medicare Supplement Insurance Plan work together.

Answers 2024 Updated Solutions.

b. The consumer will be automatically disenrolled from the MA plan when the Medicare Supplement plan takes effect. (WRONG) c. When a consumer enrolls in a Medicare Supplement Insurance Plan, they are not automatically disenrolled from their MA plan. d. The member who is leaving the MA Plan does not need a valid election period to disenroll from the MA Plan. NA - Correct Answer Which of the following consumers are eligible for Medicare if other eligibility requirements are met? Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS (WRONG) Consumers age 65 or older and consumers under 65 years of age with certain disabilities except for ESRD or ALS

Answers 2024 Updated Solutions.

Consumers age 62 or older, consumers under 62 years of age with certain disabilities and consumers of all ages with ESRD or ALS Only consumers age 65 or older with certain disabilities and consumers of all ages with ESRD or ALS a. An MA Plan is a health plan option approved by Medicare and offered by private insurance companies. c. An MA Plan is part of Medicare and is also called Part C. d. An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). - Correct Answer Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) a. An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.

Answers 2024 Updated Solutions.

b. An MA Plan does not have to provide benefits equivalent to Original Medicare. c. An MA Plan is part of Medicare and is also called Part C. d. An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often includes Medicare prescription drug coverage (Part D). d. Medicare Advantage - Correct Answer To be eligible for this plan type, consumers must meet the following requirements:- Entitled to Medicare Part A and enrolled in Part B- Reside in the plan's service area. Which plan is being described? a. Medicaid b. Prescription Drug

Answers 2024 Updated Solutions.

c. Original Medicare d. Medicare Advantage NA - Correct Answer What must be explained to consumers enrolling in an HMO (Health Maintenance Organization) MA Plan? (Select 3) a. The exception to the provider network requirement is emergency visits, urgent care, and renal dialysis services, which can be obtained from out-of-network providers. (WRONG) b. Most benefits are covered out-of-network but at a higher cost. c. They must see contracted network providers in order to receive coverage under the plan. (WRONG) d. In most cases, they will pay the entire cost of the service if they see an out-of-network provider. (WRONG)

Answers 2024 Updated Solutions.

c. HMO, POS, PPO - Correct Answer Which of the following are MA Plans that focus on using network providers to maximize the benefits and reduce out-of-network expenses? a. HMO, PFFS, POS b. HMO, PFFS, PPO c. HMO, POS, PPO d. PFFS, POS, PPO a. During the first six months a consumer is 65 or older and enrolled in Medicare Part B. - Correct Answer When does Medicare Supplement Open Enrollment take place? a. During the first six months a consumer is 65 or older and enrolled in Medicare Part B.

Answers 2024 Updated Solutions.

b. During the first three months a consumer is 65 or older and enrolled in Medicare Part B. c. During the three months prior to the consumer's 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B. d. Annually from October 15 to December 7. a. All MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for Medicare-covered services. - Correct Answer Which statement is true about the Medicare Advantage (MA) Out-of-Pocket Maximum? a. All MA plans have an Out-of-Pocket Maximum to help limit the member's out-of-pocket costs for Medicare-covered services.

Answers 2024 Updated Solutions.

b. Any plan premium payments count toward the Out-of-Pocket Maximum. c. The Out-of-Pocket Maximum amount is determined by Medicare each year and is the same for all MA plans. d. A MAPD member's costs for prescription drugs and any benefits not covered by Original Medicare count toward the Out-of-Pocket Maximum. b. She would be disenrolled automatically from her MAPD Plan. - Correct Answer Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? a. The stand-alone PDP and MAPD plan would coordinate benefits with the stand-alone PDP being primary. b. She would be disenrolled automatically from her MAPD Plan.

Answers 2024 Updated Solutions.

c. Nothing would happen, but she would only be able to use one coverage at a time. d. The application for her stand-alone PDP would be denied. a. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. - Correct Answer Which of the following best defines Medicare Part D? a. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage. b. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage. c. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage.

Answers 2024 Updated Solutions.

d. It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage. b. A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B - Correct Answer Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? a. Consumers do not need to live in the plan's service area b. A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B c. A consumer must receive a pension from a former employer d. Consumers must live in the same zip code as the pharmacy they intend to use a. Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage

Answers 2024 Updated Solutions.

b. Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) - Correct Answer What are two options for Medicare consumers to get Part D prescription drug coverage (assuming they meet all eligibility requirements)? (Select 2) a. Enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage b. Enroll in a stand-alone Medicare Prescription Drug Plan (PDP) c. Sign up for a pharmacy savings card through their local pharmacy d. Enroll in a Medicare Supplement Insurance Plan c. All members reach the Coverage Gap - Correct Answer Which of the following statements is NOT true about the Coverage Gap? a. For 2022, the coverage gap begins when the member has incurred $4,430 in medication spending for the year

Answers 2024 Updated Solutions.

b. Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium The use of lower cost generic medications may prevent the member from reaching the coverage gap c. All members reach the Coverage Gap d. If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications a. Prior authorization, quantity limit, and step therapy are some examples of the UM rules. - Correct Answer Which of these statements is true about the drug utilization management (UM) rules? a. Prior authorization, quantity limit, and step therapy are some examples of the UM rules. b. If a medication has a UM rule, the member will not be able to get that medication. c. UM rules do not need to be disclosed to the consumer.

Answers 2024 Updated Solutions.

d. Neither the member nor the prescriber can ask the plan for an exception if they believe that one of the coverage rules should be waived. b. Late Enrollment Penalty (LEP) - Correct Answer What is the amount added to the member's monthly plan premium if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 or more continuous days? a. Late Election Penalty (LEP) b. Late Enrollment Penalty (LEP) c. Late Enrollment Deductible (LED) d. Late Enrollment Premium (LEP) c. Through subsidies such as lower or no monthly plan premiums and lower or no copayments - Correct Answer How does a consumer who

Answers 2024 Updated Solutions.

qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs? a. Such financial assistance will no longer be available as of January 1, 2022 b. Through a combination of subsidies and annual refund checks c. Through subsidies such as lower or no monthly plan premiums and lower or no copayments d. By receiving annual checks with a refund based on a predetermined percentage of Part D costs d. Drug tiers - Correct Answer Medications that are covered in a Plan's formulary have various levels of associated member cost-sharing (copayments or coinsurance). What are these drug levels called? a. Out-of-Pocket expenses b. Deductible

Answers 2024 Updated Solutions.

c. Formulary prescriptions d. Drug tiers b. Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. - Correct Answer Which of the following is true about Medicare Supplement Insurance underwriting criteria in states where underwriting applies? a. During Medicare Supplement Open Enrollment, consumers will only be required to answer the underwriting eligibility questions. b. Underwriting is required if the consumer is not in their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria. c. If the consumer meets Guaranteed Issue criteria, they may be underwritten to determine their rate. d. Consumers will never be underwritten to determine their rate.

Answers 2024 Updated Solutions.

a. Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F. b. Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose. - Correct Answer Which of the following are true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Plans and the impact to Plans C and F? (Select 2) a. Consumers eligible for Medicare Part A on or after January 1, 2020, will not be able to purchase Medicare Supplement Insurance Plans C or F. b. Consumers eligible for Medicare Part A before January 1, 2020, can enroll in Plan C or F even after 2020 and can keep their plans as long as they choose. c. Consumers already enrolled in Plans C or F are required to change plans.

Answers 2024 Updated Solutions.

b. Insured members must have their care coordinated through a primary care provider. - Correct Answer Which of the following is NOT true of Medicare Supplement Insurance Plans? a. They are regulated by each state's Department of Insurance. b. Insured members must have their care coordinated through a primary care provider. c. They can be purchased at any time of the year. d. Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments. (WRONG) a. Original Medicare - Correct Answer Being 65 or older, being under 65 years of age with certain disabilities for more than 24 months, and being any age with ESRD or ALS are each eligibility requirements for which program?

Answers 2024 Updated Solutions.

a. Original Medicare b. Low Income Subsidy c. Medicaid c. Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) - Correct Answer Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement? a. Resides in the plan's service area b. Enrolled in Medicare Part B c. Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD) d. Entitled to Medicare Part A

Answers 2024 Updated Solutions.

b. HMO-POS Plans only cover in-network services. - Correct Answer Which of the following is NOT a correct statement about in-network provider services? a. HMO Plans cover only in-network services. In most cases, members pay the full cost of any out-of-network services received, with a few important exceptions. b. HMO-POS Plans only cover in-network services. c. Network-based MA plans have a provider network the member can use, and some plans also cover certain services outside the network. d. PPO Plans cover in-network and out-of-network services, but out-of- network services will generally have a high cost share to the member. b. The consumer will be automatically disenrolled from their stand- alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage - Correct Answer A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription Drug

Answers 2024 Updated Solutions.

Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated prescription drug coverage? a. The consumer will no longer be a part of the Medicare program because they will receive their medical and hospital benefits covered by the MA Plan b. The consumer will be automatically disenrolled from their stand- alone PDP upon enrollment in the MA Plan that has integrated prescription drug coverage c. The consumer's MA Plan enrollment application will be denied because they already have a stand-alone PDP d. The consumer will not have to pay anything in the coverage gap because they have a stand-alone PDP and integrated Part D benefits in their MA Plan b. Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area - Correct Answer Which consumer is eligible for a stand-alone Medicare Prescription Drug Plan?

Answers 2024 Updated Solutions.

a. Alice, who is enrolled only in Medicare Part A, but does not reside in the plan's service area b. Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area c. Alvin, who is enrolled only in Medicare Part B, but does not reside in the plan's service area d. Sharon, who is not enrolled in Medicare Part A or Medicare Part B, and resides in the plan's service area c. 63 or more continuous days - Correct Answer A consumer may have to pay a Late Enrollment Penalty (LEP) if they did NOT enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for ______________. a. 120 or more continuous days

Answers 2024 Updated Solutions.

b. 2 or more continuous months c. 63 or more continuous days d. 90 or more continuous days d. Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty - Correct Answer Which of the following lists drug tiers from least expensive cost share to most expensive cost share? a. Specialty, Non-Preferred Drug (and some higher-cost generics), Preferred Brand (and some higher-cost generics), Generics, Preferred Generics b. Preferred Generics, Preferred Brand (and some higher-cost generics), Generics, Non-Preferred Drug (and some higher-cost generics), Specialty c. Generics, Preferred Generics, Non-Preferred Drug (and some higher- cost generics), Brand (and some higher cost generics), Specialty

Answers 2024 Updated Solutions.

d. Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty d. When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria. - Correct Answer When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility? a. Only when the consumer meets Guaranteed Issue criteria applicable in their state. b. Always to determine their acceptance. c. Only when the consumer is in their Medicare Supplement Open Enrollment. d. When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria.