Understanding Medicare: A Comprehensive Guide, Exams of Nursing

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AHIP STUDY GUIDE

Question 1 What is the primary purpose of the Medicare program? A. To provide health insurance for low-income individuals and families B. To offer comprehensive health coverage for all age groups C. To provide health insurance for people aged 65 and older, and certain younger people with disabilities D. To fund private health insurance plans Answer: C. To provide health insurance for people aged 65 and older, and certain younger people with disabilities Question 2 Which part of Medicare covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D Answer: A. Medicare Part A Question 3 Which of the following is not covered under Medicare Part B? A. Doctor visits B. Outpatient hospital services C. Prescription drugs D. Preventive services

Answer: C. Prescription drugs Question 4 Medicare Advantage Plans, also known as Medicare Part C, are offered by: A. The federal government B. Private insurance companies approved by Medicare C. State Medicaid agencies D. Non-profit organizations Answer: B. Private insurance companies approved by Medicare Question 5 Which part of Medicare provides prescription drug coverage? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D Answer: D. Medicare Part D Question 6 What is the Initial Enrollment Period (IEP) for Medicare? A. A three-month period after turning 65 B. A seven-month period around the 65th birthday, including three months before, the month of, and three months after the birthday C. The month of turning 65 only D. The first six months of the year when turning 65

Answer: B. A seven-month period around the 65th birthday, including three months before, the month of, and three months after the birthday Question 7 Medicare beneficiaries with limited income and resources may qualify for help with health care costs through: A. Medicaid B. TRICARE C. Private health insurance D. Health Savings Accounts (HSAs) Answer: A. Medicaid Question 8 The term "formulary" in Medicare Part D refers to: A. The network of doctors and hospitals B. The list of prescription drugs covered by the plan C. The schedule of premium payments D. The process for appealing coverage decisions Answer: B. The list of prescription drugs covered by the plan Question 9 Medicare Supplement Insurance (Medigap) is designed to cover: A. Long-term care services B. Prescription drug costs C. Gaps in coverage like copayments, coinsurance, and deductibles not covered by Original Medicare D. Vision and dental services

Answer: C. Gaps in coverage like copayments, coinsurance, and deductibles not covered by Original Medicare Question 10 Which of the following is true about Medicare Part C (Medicare Advantage Plans)? A. They are free for all Medicare beneficiaries B. They combine Part A and Part B benefits, and often include additional benefits such as vision, dental, and prescription drugs C. They are exclusively offered by the federal government D. They cannot be combined with any other type of health insurance Answer: B. They combine Part A and Part B benefits, and often include additional benefits such as vision, dental, and prescription drugs Question 11 What is the coverage gap in Medicare Part D often referred to as? A. Catastrophic coverage B. The coverage gap or "donut hole" C. Initial coverage limit D. Out-of-pocket threshold Answer: B. The coverage gap or "donut hole" Question 12 Which of the following statements is true about Medicare Part B premiums? A. They are the same for all beneficiaries regardless of income. B. They are income-based, with higher income beneficiaries paying more. C. They are completely covered by Medicaid for all beneficiaries.

D. They decrease every year after initial enrollment. Answer: B. They are income-based, with higher income beneficiaries paying more. Question 13 What is required for someone to be eligible for Medicare Advantage (Part C)? A. Must be enrolled in both Medicare Part A and Part B B. Must have a chronic health condition C. Must be under 65 years old D. Must have private health insurance Answer: A. Must be enrolled in both Medicare Part A and Part B Question 14 Which of the following services is typically not covered by Medicare? A. Cosmetic surgery B. Inpatient hospital care C. Outpatient doctor visits D. Preventive screenings Answer: A. Cosmetic surgery Question 15 The "Medicare Open Enrollment Period" occurs annually from: A. January 1 to March 31 B. April 1 to June 30 C. July 1 to September 30 D. October 15 to December 7

Answer: D. October 15 to December 7 Question 16 What does the term "assignment" mean in the context of Medicare? A. The process of enrolling in a Medicare Advantage Plan B. The agreement by a doctor or provider to accept the Medicare-approved amount as full payment for covered services C. The distribution of Medicare cards to beneficiaries D. The allocation of funds to different parts of Medicare Answer: B. The agreement by a doctor or provider to accept the Medicare-approved amount as full payment for covered services Question 17 Which type of Medicare Advantage Plan allows beneficiaries to see any doctor or specialist without a referral? A. Health Maintenance Organization (HMO) B. Preferred Provider Organization (PPO) C. Private Fee-for-Service (PFFS) D. Special Needs Plan (SNP) Answer: B. Preferred Provider Organization (PPO) Question 18 What is the purpose of the Medicare Savings Program (MSP)? A. To help beneficiaries save money on their premiums and out-of-pocket costs B. To provide additional prescription drug coverage C. To offer long-term care services D. To fund private insurance plans

Answer: A. To help beneficiaries save money on their premiums and out-of-pocket costs Question 19 In Medicare Part D, what is "catastrophic coverage"? A. Coverage for catastrophic events like natural disasters B. Coverage that begins after reaching a certain out-of-pocket threshold, significantly reducing prescription costs C. Coverage that includes vision and dental services D. Initial coverage for all medications Answer: B. Coverage that begins after reaching a certain out-of-pocket threshold, significantly reducing prescription costs Question 20 What is the role of a Medicare Advantage Plan's network? A. To limit the number of beneficiaries in the plan B. To provide a list of approved doctors, hospitals, and other healthcare providers C. To offer financial advice to beneficiaries D. To handle billing and administrative tasks Answer: B. To provide a list of approved doctors, hospitals, and other healthcare providers Question 21 Which of the following is a key feature of Medicare Part C? A. It includes coverage for prescription drugs B. It provides hospice care

C. It is managed by the federal government D. It offers fee-for-service plans Answer: A. It includes coverage for prescription drugs Question 22 What is the main difference between Original Medicare and Medicare Advantage Plans? A. Original Medicare is free, while Medicare Advantage Plans have premiums B. Medicare Advantage Plans are offered by private insurers, while Original Medicare is provided by the federal government C. Original Medicare covers prescription drugs, while Medicare Advantage Plans do not D. Medicare Advantage Plans do not require enrollment in Part A and Part B Answer: B. Medicare Advantage Plans are offered by private insurers, while Original Medicare is provided by the federal government Question 23 Medigap policies are standardized. What does this mean? A. All Medigap policies are the same price B. All Medigap policies must offer the same benefits, no matter which insurance company sells them C. Medigap policies must be renewed every year D. Medigap policies cover prescription drugs Answer: B. All Medigap policies must offer the same benefits, no matter which insurance company sells them Question 24

What is the primary function of the Annual Notice of Change (ANOC)? A. To notify beneficiaries about changes in Medicare eligibility requirements B. To inform beneficiaries about upcoming open enrollment dates C. To provide details about changes in plan costs and coverage for the next year D. To outline the process for appealing coverage decisions Answer: C. To provide details about changes in plan costs and coverage for the next year Question 25 Which of the following statements is true about the "Extra Help" program? A. It provides additional coverage for vision and dental care B. It helps pay for Medicare prescription drug plan costs C. It is only available to those enrolled in Medicare Advantage Plans D. It replaces Medigap policies Answer: B. It helps pay for Medicare prescription drug plan costs Question 26 Which of the following is not a type of Medicare Advantage Plan? A. Health Maintenance Organization (HMO) B. Preferred Provider Organization (PPO) C. Private Fee-for-Service (PFFS) D. Medicaid Managed Care Plan Answer: D. Medicaid Managed Care Plan Question 27 What is a Special Enrollment Period (SEP) in Medicare?

A. A specific time each year when anyone can join a Medicare plan B. A time outside the regular enrollment periods when people can enroll due to special circumstances C. The first three months of the year when Medicare enrollment is free D. A period designated for changes in premium payments only Answer: B. A time outside the regular enrollment periods when people can enroll due to special circumstances Question 28 Which part of Medicare helps cover the cost of outpatient care and medical supplies? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D Answer: B. Medicare Part B Question 29 What is the purpose of the Medicare Part D "late enrollment penalty"? A. To encourage timely enrollment by penalizing late enrollees with higher premiums B. To cover administrative costs of Medicare C. To fund additional benefits under Medicare Part D D. To discourage beneficiaries from enrolling in multiple plans Answer: A. To encourage timely enrollment by penalizing late enrollees with higher premiums

Question 30 Which of the following is true about Medicare Part B preventive services? A. They are not covered by Medicare B. They include screenings and vaccinations to prevent illness or detect health conditions early C. They are only available to beneficiaries with chronic illnesses D. They require a 50% copayment by beneficiaries Answer: B. They include screenings and vaccinations to prevent illness or detect health conditions early Question 31 What is the function of a "Primary Care Provider" (PCP) in an HMO plan? A. To provide specialty care exclusively B. To coordinate all of the beneficiary's health care services C. To offer only emergency medical services D. To approve only hospital admissions Answer: B. To coordinate all of the beneficiary's health care services Question 32 In which situation would a Medicare beneficiary typically not be eligible for a Special Enrollment Period (SEP)? A. Moving to a new area that isn't in their current plan's service area B. Losing other credible drug coverage C. Turning 65 D. Being eligible for Medicaid Answer: C. Turning 65

Question 33 What is the primary purpose of the Medicare & You handbook? A. To provide financial advice for Medicare beneficiaries B. To offer a detailed overview of Medicare coverage, costs, and options for the upcoming year C. To advertise private health insurance plans D. To summarize recent changes in healthcare legislation Answer: B. To offer a detailed overview of Medicare coverage, costs, and options for the upcoming year Question 34 Which of the following services is covered under Medicare Part A? A. Routine dental care B. Inpatient hospital stays C. Outpatient surgery D. Durable medical equipment Answer: B. Inpatient hospital stays Question 35 What is an important feature of a Medigap Plan? A. It can be used in conjunction with Medicare Advantage Plans B. It covers long-term care services C. It helps pay for costs that Original Medicare doesn't cover, like copayments and deductibles D. It includes prescription drug coverage

Answer: C. It helps pay for costs that Original Medicare doesn't cover, like copayments and deductibles Question 36 What is the "Initial Coverage Election Period" (ICEP) in Medicare Advantage? A. A period when beneficiaries can switch from Original Medicare to a Medicare Advantage Plan for the first time B. A period when beneficiaries can add or drop prescription drug coverage C. A specific time for Medicare Part D enrollment D. The first three months of the year when all Medicare changes can be made Answer: A. A period when beneficiaries can switch from Original Medicare to a Medicare Advantage Plan for the first time Question 37 How are Medicare Part D premiums determined? A. Based on the beneficiary's income B. The same for all beneficiaries regardless of plan C. Determined by the federal government only D. Set by the insurance companies offering the plans Answer: D. Set by the insurance companies offering the plans Question 38 What is the main goal of Medicare Cost Plans? A. To provide dental and vision coverage B. To combine features of both Medicare Advantage and Original Medicare C. To offer only hospital insurance D. To replace Medicare Supplement Insurance (Medigap)

Answer: B. To combine features of both Medicare Advantage and Original Medicare Question 39 Which of the following is a requirement for a Medigap policy to be effective? A. The beneficiary must be enrolled in a Medicare Advantage Plan B. The beneficiary must be enrolled in both Medicare Part A and Part B C. The beneficiary must not be eligible for any other insurance D. The beneficiary must be under 65 years old Answer: B. The beneficiary must be enrolled in both Medicare Part A and Part B Question 40 Which of the following is true about Medicare Advantage Special Needs Plans (SNPs)? A. They are available to all Medicare beneficiaries B. They are designed for specific groups of people, such as those with certain chronic conditions C. They do not include prescription drug coverage D. They are only available in rural areas Answer: B. They are designed for specific groups of people, such as those with certain chronic conditionsQuestion 41 What is the main purpose of the Medicare Summary Notice (MSN)? A. To notify beneficiaries about the amount of their premiums B. To provide a summary of the health care services and supplies billed to Medicare C. To list all available Medicare plans D. To offer financial advice for retirement

Answer: B. To provide a summary of the health care services and supplies billed to Medicare Question 42 Which of the following is a characteristic of Medicare Special Needs Plans (SNPs)? A. They are available to all Medicare beneficiaries B. They are tailored for specific groups of people with unique health care needs C. They exclude prescription drug coverage D. They are managed exclusively by the federal government Answer: B. They are tailored for specific groups of people with unique health care needs Question 43 Which of the following does not qualify as a preventive service covered by Medicare Part B? A. Annual wellness visits B. Mammograms C. Colonoscopies D. Cosmetic procedures Answer: D. Cosmetic procedures Question 44 What is the late enrollment penalty for Medicare Part B? A. A flat fee added to the premium B. A percentage increase in the premium for each 12-month period one could have had Part B but did not sign up C. A one-time fee paid at the time of enrollment

D. A reduction in benefits Answer: B. A percentage increase in the premium for each 12-month period one could have had Part B but did not sign up Question 45 Which Medicare plan option allows beneficiaries to receive all their health care services through a private health insurance plan? A. Medicare Part A B. Medicare Part B C. Medicare Advantage (Part C) D. Medicare Part D Answer: C. Medicare Advantage (Part C) Question 46 Which of the following does Medicare Part A not cover? A. Inpatient hospital care B. Skilled nursing facility care C. Home health care D. Outpatient surgery Answer: D. Outpatient surgery Question 47 What is the main benefit of enrolling in a Medicare Part D plan? A. Access to long-term care facilities B. Coverage for prescription drugs C. Reduced hospital costs

D. Access to vision and dental care Answer: B. Coverage for prescription drugs Question 48 How often can Medicare beneficiaries change their Medicare Advantage Plan? A. Only during the Annual Election Period (AEP) from October 15 to December 7 B. Anytime throughout the year C. Once every five years D. Only during the first quarter of the year Answer: A. Only during the Annual Election Period (AEP) from October 15 to December 7 Question 49 Which of the following services is typically covered under Medicare Part B? A. Inpatient hospital care B. Hospice care C. Durable medical equipment D. Private nursing care Answer: C. Durable medical equipment Question 50 Which of the following is true regarding the "doughnut hole" in Medicare Part D coverage? A. It refers to the period when Medicare covers all drug costs B. It is the phase when beneficiaries must pay all prescription drug costs out of pocket

C. It is the initial coverage phase of Part D D. It is the period of catastrophic coverage Answer: B. It is the phase when beneficiaries must pay all prescription drug costs out of pocket Question 51 What is the primary advantage of Medicare Advantage Plans over Original Medicare? A. They are free of charge B. They often provide additional benefits like vision, dental, and hearing coverage C. They do not require enrollment in Medicare Part B D. They cover only emergency services Answer: B. They often provide additional benefits like vision, dental, and hearing coverage Question 52 What is the primary role of the State Health Insurance Assistance Program (SHIP)? A. To sell Medicare Advantage Plans B. To provide free counseling and assistance to Medicare beneficiaries C. To process Medicare claims D. To manage Medicare trust funds Answer: B. To provide free counseling and assistance to Medicare beneficiaries Question 53 Which of the following is true about the Initial Enrollment Period (IEP) for Medicare? A. It is a two-month period around the beneficiary’s 65th birthday

B. It is a seven-month period that includes the three months before, the month of, and the three months after the 65th birthday C. It occurs once every ten years D. It can only be utilized if the beneficiary is still working Answer: B. It is a seven-month period that includes the three months before, the month of, and the three months after the 65th birthday Question 54 What is the purpose of the Medicare "Extra Help" program? A. To provide additional dental and vision coverage B. To assist beneficiaries with paying for Medicare Part D prescription drug costs C. To cover long-term care costs D. To offer free annual wellness visits Answer: B. To assist beneficiaries with paying for Medicare Part D prescription drug costs Question 55 Which of the following does not qualify someone for a Special Enrollment Period (SEP) in Medicare? A. Moving to a new area with different Medicare plan options B. Losing other health coverage C. Qualifying for Medicaid D. Choosing to delay enrollment without other coverage Answer: D. Choosing to delay enrollment without other coverage Question 56 Medicare Supplement Insurance (Medigap) is designed to:

A. Replace Medicare Advantage Plans B. Cover the costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles C. Provide prescription drug coverage D. Offer dental and vision care Answer: B. Cover the costs not paid by Original Medicare, such as copayments, coinsurance, and deductibles Question 57 Which of the following services is covered by Medicare Part A? A. Doctor’s office visits B. Outpatient surgery C. Hospice care D. Prescription drugs Answer: C. Hospice care Question 58 What is required for someone to be eligible for a Medicare Advantage Plan? A. Must be enrolled in both Medicare Part A and Part B B. Must have a chronic health condition C. Must be under 65 years old D. Must have private health insurance Answer: A. Must be enrolled in both Medicare Part A and Part B Question 59 Which of the following is true about Medicare Part C (Medicare Advantage Plans)?

A. They are free for all Medicare beneficiaries B. They combine Part A and Part B benefits, and often include additional benefits such as vision, dental, and prescription drugs C. They are exclusively offered by the federal government D. They cannot be combined with any other type of health insurance Answer: B. They combine Part A and Part B benefits, and often include additional benefits such as vision, dental, and prescription drugs Question 60 Which of the following is true about Medigap policies? A. They are available to everyone regardless of age B. They cover long-term care, dental care, vision care, and hearing aids C. They must follow federal and state laws designed to protect beneficiaries D. They replace Medicare Part A and Part B Answer: C. They must follow federal and state laws designed to protect beneficiariesQuestion 61 What is the main function of Medicare Part A? A. To cover outpatient services and medical supplies B. To cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care C. To provide prescription drug coverage D. To offer dental and vision care Answer: B. To cover inpatient hospital stays, skilled nursing facility care, hospice, and some home health care Question 62

Which of the following statements is true regarding the Annual Election Period (AEP) for Medicare? A. It occurs from January 1 to March 31 each year B. Beneficiaries can only make changes to their Medicare Part A coverage C. It allows beneficiaries to enroll in, switch, or drop Medicare Advantage and Medicare Part D plans D. It is the only time beneficiaries can enroll in Medicare Supplement plans Answer: C. It allows beneficiaries to enroll in, switch, or drop Medicare Advantage and Medicare Part D plans Question 63 What is a key benefit of a Medicare Advantage Plan over Original Medicare? A. No need to pay any premiums B. Inclusion of additional benefits such as dental, vision, and wellness programs C. Coverage for long-term care facilities D. Exemption from all copayments and deductibles Answer: B. Inclusion of additional benefits such as dental, vision, and wellness programs Question 64 Which Medicare plan is designed specifically to help cover the cost of prescription drugs? A. Medicare Part A B. Medicare Part B C. Medicare Part C D. Medicare Part D

Answer: D. Medicare Part D Question 65 What is the "out-of-pocket maximum" in a Medicare Advantage Plan? A. The highest premium that beneficiaries can pay annually B. The maximum amount beneficiaries will have to pay for covered services in a year C. The total cost of all prescriptions in a year D. The maximum amount Medicare will pay for a beneficiary's care Answer: B. The maximum amount beneficiaries will have to pay for covered services in a year Question 66 What does the Medicare Part B deductible refer to? A. The amount paid for prescription drugs B. The amount a beneficiary must pay out of pocket before Medicare starts to pay for covered services each year C. The monthly premium for Part B D. The cost of long-term care Answer: B. The amount a beneficiary must pay out of pocket before Medicare starts to pay for covered services each year Question 67 Which of the following statements is true about Medigap policies? A. They cover prescription drugs B. They can be used with Medicare Advantage Plans C. They help cover some of the costs not covered by Original Medicare D. They replace Medicare Part A and Part B

Answer: C. They help cover some of the costs not covered by Original Medicare Question 68 What is the primary role of the State Health Insurance Assistance Program (SHIP)? A. To sell Medicare Advantage Plans B. To provide free, unbiased counseling and assistance to Medicare beneficiaries C. To process Medicare claims D. To manage Medicare trust funds Answer: B. To provide free, unbiased counseling and assistance to Medicare beneficiaries Question 69 Which of the following services is not typically covered under Medicare Part B? A. Doctor visits B. Outpatient hospital services C. Preventive services D. Long-term care Answer: D. Long-term care Question 70 When does the Medicare Advantage Open Enrollment Period (OEP) occur? A. January 1 to March 31 B. April 1 to June 30 C. July 1 to September 30 D. October 15 to December 7

Answer: A. January 1 to March 31 Question 71 What does the term "formulary" refer to in Medicare Part D? A. The list of doctors approved by Medicare B. The schedule of premiums and deductibles C. The list of prescription drugs covered by a Medicare Part D plan D. The guideline for Medicare billing Answer: C. The list of prescription drugs covered by a Medicare Part D plan Question 72 Which of the following is not a Medicare Advantage Plan type? A. Health Maintenance Organization (HMO) B. Preferred Provider Organization (PPO) C. Private Fee-for-Service (PFFS) D. Employer Group Health Plan (EGHP) Answer: D. Employer Group Health Plan (EGHP) Question 73 Which of the following is true about the Medicare "donut hole"? A. It refers to a coverage gap in Medicare Part D where beneficiaries pay higher out- of-pocket costs for prescription drugs B. It is a phase where Medicare pays for all drug costs C. It only affects those with Medicare Part B D. It is the initial coverage period for all Medicare plans