Medicare Agent & Broker Certification questions with
correct answers
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if so, what
the benefit includes. Where would the agent find this information for plan XYZ? CORRECT
ANSWER Evidence of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the benefit
includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the answer would
be Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a specialist, you
should tell her: CORRECT ANSWER You will likely need a referral from your primary care
physician (PCP) to see a specialist. If you see your specialist without this referral, the plan may
not pay for your visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to seeing a
specialist (except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly premium,
he no longer needs to pay his Part B premium. CORRECT ANSWER False
Beneficiaries are required to continue paying their Part B premium (unless they receive Extra
Help) in addition to any plan-specific premium.
Define: Medicare Part A CORRECT ANSWER Part A of Medicare covers hospital inpatient
care, some SNF care, and home health and hospice care
Define: Medicare Part B CORRECT ANSWER Part B of Medicare covers physician services,
outpatient hospital care, lab tests, mental health services, some preventative services, and
medical equipment considered medically necessary to treat a disease or condition
