CIGNA MEDICARE PRODUCT AND BENEFITS EXAM
ACTUAL EXAM 55 QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+
CMS (Centers for Medicare and Medicaid Services) - ANSWER: The Centers for
Medicare and Medicaid Services is the federal agency that runs the Medicare
program and works with states to manage the Medicaid program. It is an arm of the
U.S. Department of Health and Human Services.
Coinsurance - ANSWER: The amount a member pays usually expressed as a
percentage. (e.g. 20% charges)
Coordinated Care Plan - ANSWER: a plan that includes a network of providers that
are under contract or arrangement with the organization to deliver the benefit
package approved by CMS. The CCP network is approved by CMS to ensure that all
applicable requirements are met, including access and availability, service area, and
quality. CCPs may include mechanisms to control utilization, such as referrals from a
gatekeeper for a member to receive services covered by the plan, and financial
arrangements that offer incentives to providers to furnish high-quality and cost-
effective care.
Co-payment or co-pay - ANSWER: A set amount the member pays for each medical
service, like a doctor's visit, or prescription. (e.g., a $65 co-pay for emergency room
visits).
Election Period - ANSWER: The limited periods of time and situations when Medicare
beneficiaries can change the way they get Medicare coverage and what choices they
can make. An election period is needed to enroll in, or voluntarily disenroll from, a
Medicare Advantage plan.
HMO Plan (Health Maintenance Organization) - ANSWER: With respect to the
Medicare program, this type of plan is a type of coordinated care plan (CCP) or
Medicare managed care plan where a group of doctors, hospitals, and other health
care providers agree to become part of the contracted plan network. Members must
get care from the providers in the plan network.
HMO-POS Plan (Health Maintenance Organization, Point of Service) - ANSWER: To
ease restrictions on access to out-of-network providers, an HMO plan may also offer
a point-of-service (POS) benefit option. The POS benefit lets members see providers
outside the plan network for certain services set by the organization. The cost-
sharing for services provided by non-network providers is often higher than for
services by plan network providers.
MAO
, (Medicare Advantage Organization) - ANSWER: A private sector company licensed by
the state as a risk-bearing entity contracted with CMS to offer Medicare Advantage
plans. MAOs can offer one or more Medicare Advantage plans.
MA only (Medicare Advantage) - ANSWER: A Medicare Advantage plan that covers
Medicare Part A and Part B. It may also cover additional medical services. It does not
include Medicare Part D coverage.
MA- PD - ANSWER: A Medicare Advantage plan that covers Medicare Part A, Part B,
and Part D benefits in one plan. It may also cover additional medical services.
Medicare - ANSWER: The National Health Insurance Program for:
1. People, age 65, who have worked (or spouse worked) more than 40 Social Security
quarters (10 years);
2. People with a disability and who have collected Social Security disability for 24
months; or
3. People of any age with permanent kidney failure/end-stage renal disease or ALS
(Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease).
Medicare Advantage (MA) Plan - ANSWER: Plans offered by MAOs that contract with
CMS to provide members all Medicare Part A and Part B benefits; they may also
provide additional coverage. They are part of the Medicare program and are
sometimes called "Part C" or "MA plans." MA plan types are Coordinated Care Plans
(CCP), MA Medical Savings Accounts (MSA), and Private Fee-For-Service (PFFS) plans.
Medicare Part A - ANSWER: "Hospital insurance." The part of Medicare that covers
inpatient hospital services, has no premium (for most people), and is funded by the
Hospital Trust Fund which is supported through payroll tax deductions.
Medicare Part B - ANSWER: "Medical insurance." The part of Medicare that covers
physician and outpatient services, has voluntary enrollment, and is funded by
enrollee premiums and the federal general fund.
Medicare Part C - ANSWER: "Medicare Advantage plans." Medicare beneficiaries can
choose to receive their Medicare benefits through authorized Medicare Advantage
plans that cover Part A and Part B. These plans may or may not include Part D and/or
additional (supplemental) coverage such as preventive dental.
Medicare Part D - ANSWER: "Outpatient Prescription Drug Insurance." The part of
Medicare that covers outpatient prescription drug costs. Coverage can only be
purchased through private sector companies contracted with Medicare.
"Hospital Insurance" is Medicare Part ___ - ANSWER: Medicare Part A
"Medical Insurance" is Medicare Part ___ - ANSWER: Medicare Part B
"Medicare Advantage Plans" are Medicare Part ___ - ANSWER: Medicare Part C
ACTUAL EXAM 55 QUESTIONS AND CORRECT
ANSWERS|ALREADY GRADED A+
CMS (Centers for Medicare and Medicaid Services) - ANSWER: The Centers for
Medicare and Medicaid Services is the federal agency that runs the Medicare
program and works with states to manage the Medicaid program. It is an arm of the
U.S. Department of Health and Human Services.
Coinsurance - ANSWER: The amount a member pays usually expressed as a
percentage. (e.g. 20% charges)
Coordinated Care Plan - ANSWER: a plan that includes a network of providers that
are under contract or arrangement with the organization to deliver the benefit
package approved by CMS. The CCP network is approved by CMS to ensure that all
applicable requirements are met, including access and availability, service area, and
quality. CCPs may include mechanisms to control utilization, such as referrals from a
gatekeeper for a member to receive services covered by the plan, and financial
arrangements that offer incentives to providers to furnish high-quality and cost-
effective care.
Co-payment or co-pay - ANSWER: A set amount the member pays for each medical
service, like a doctor's visit, or prescription. (e.g., a $65 co-pay for emergency room
visits).
Election Period - ANSWER: The limited periods of time and situations when Medicare
beneficiaries can change the way they get Medicare coverage and what choices they
can make. An election period is needed to enroll in, or voluntarily disenroll from, a
Medicare Advantage plan.
HMO Plan (Health Maintenance Organization) - ANSWER: With respect to the
Medicare program, this type of plan is a type of coordinated care plan (CCP) or
Medicare managed care plan where a group of doctors, hospitals, and other health
care providers agree to become part of the contracted plan network. Members must
get care from the providers in the plan network.
HMO-POS Plan (Health Maintenance Organization, Point of Service) - ANSWER: To
ease restrictions on access to out-of-network providers, an HMO plan may also offer
a point-of-service (POS) benefit option. The POS benefit lets members see providers
outside the plan network for certain services set by the organization. The cost-
sharing for services provided by non-network providers is often higher than for
services by plan network providers.
MAO
, (Medicare Advantage Organization) - ANSWER: A private sector company licensed by
the state as a risk-bearing entity contracted with CMS to offer Medicare Advantage
plans. MAOs can offer one or more Medicare Advantage plans.
MA only (Medicare Advantage) - ANSWER: A Medicare Advantage plan that covers
Medicare Part A and Part B. It may also cover additional medical services. It does not
include Medicare Part D coverage.
MA- PD - ANSWER: A Medicare Advantage plan that covers Medicare Part A, Part B,
and Part D benefits in one plan. It may also cover additional medical services.
Medicare - ANSWER: The National Health Insurance Program for:
1. People, age 65, who have worked (or spouse worked) more than 40 Social Security
quarters (10 years);
2. People with a disability and who have collected Social Security disability for 24
months; or
3. People of any age with permanent kidney failure/end-stage renal disease or ALS
(Amyotrophic Lateral Sclerosis, also called Lou Gehrig's disease).
Medicare Advantage (MA) Plan - ANSWER: Plans offered by MAOs that contract with
CMS to provide members all Medicare Part A and Part B benefits; they may also
provide additional coverage. They are part of the Medicare program and are
sometimes called "Part C" or "MA plans." MA plan types are Coordinated Care Plans
(CCP), MA Medical Savings Accounts (MSA), and Private Fee-For-Service (PFFS) plans.
Medicare Part A - ANSWER: "Hospital insurance." The part of Medicare that covers
inpatient hospital services, has no premium (for most people), and is funded by the
Hospital Trust Fund which is supported through payroll tax deductions.
Medicare Part B - ANSWER: "Medical insurance." The part of Medicare that covers
physician and outpatient services, has voluntary enrollment, and is funded by
enrollee premiums and the federal general fund.
Medicare Part C - ANSWER: "Medicare Advantage plans." Medicare beneficiaries can
choose to receive their Medicare benefits through authorized Medicare Advantage
plans that cover Part A and Part B. These plans may or may not include Part D and/or
additional (supplemental) coverage such as preventive dental.
Medicare Part D - ANSWER: "Outpatient Prescription Drug Insurance." The part of
Medicare that covers outpatient prescription drug costs. Coverage can only be
purchased through private sector companies contracted with Medicare.
"Hospital Insurance" is Medicare Part ___ - ANSWER: Medicare Part A
"Medical Insurance" is Medicare Part ___ - ANSWER: Medicare Part B
"Medicare Advantage Plans" are Medicare Part ___ - ANSWER: Medicare Part C
