CIGNA MEDICARE PRODUCT AND BENEFITS EXAM ACTUAL
EXAM 55 QUESTIONS AND CORRECT ANSWERS|ALREADY
GRADED A+
1. Medicare Part A primarily covers which of the following?
A) Outpatient doctor visits and preventive care.
B) Prescription drugs.
C) Hospital inpatient stays, skilled nursing facility care, hospice care, and some home
health services.
D) Vision and dental services.
E) Foreign travel emergency care.
Correct Answer: C) Hospital inpatient stays, skilled nursing facility care, hospice care,
and some home health services.
Rationale: Medicare Part A is often referred to as "Hospital Insurance" and covers
inpatient care in hospitals, skilled nursing facilities (not long-term custodial care),
hospice care, and some home health services.
2. A beneficiary is turning 65 and is eligible for Medicare. Which of the following is the
standard Initial Enrollment Period (IEP) for Medicare Part A and Part B?
A) January 1st to March 31st each year.
B) The 3 months before their 65th birthday, the month of their birthday, and the 3
months after their birthday.
C) October 15th to December 7th each year.
D) Any time during the year as long as they are 65.
E) Only within 60 days of leaving employer coverage.
Correct Answer: B) The 3 months before their 65th birthday, the month of their
birthday, and the 3 months after their birthday.
Rationale: The Initial Enrollment Period (IEP) is a 7-month window that begins 3
months before a person's 65th birthday, includes the birth month, and ends 3 months
after the birth month.
3. What is the primary difference between a Medicare Advantage (Part C) plan and
Original Medicare?
A) Medicare Advantage plans only cover prescription drugs, while Original Medicare
covers medical services.
B) Medicare Advantage plans are offered by private insurance companies approved by
Medicare and often include additional benefits, while Original Medicare is directly
managed by the federal government.
C) Medicare Advantage plans require beneficiaries to pay a separate premium for Part
A, while Original Medicare does not.
D) Original Medicare includes dental, vision, and hearing benefits, while Medicare
Advantage plans do not.
, E) Medicare Advantage plans have no network restrictions.
Correct Answer: B) Medicare Advantage plans are offered by private insurance
companies approved by Medicare and often include additional benefits, while Original
Medicare is directly managed by the federal government.
Rationale: Medicare Advantage plans are an alternative way to receive Medicare
benefits, bundled into a single plan offered by private insurers. They must cover at least
the same benefits as Original Medicare Parts A and B, but often include extra benefits
and have different cost-sharing structures and provider networks.
4. A client is currently enrolled in Original Medicare (Part A and Part B) and wants to add
prescription drug coverage. Which type of plan should they enroll in?
A) Medicare Supplement (Medigap) Plan.
B) Medicare Advantage (Part C) Plan.
C) Medicare Part D (Prescription Drug) Plan.
D) Special Needs Plan (SNP).
E) Program of All-Inclusive Care for the Elderly (PACE).
Correct Answer: C) Medicare Part D (Prescription Drug) Plan.
Rationale: Medicare Part D plans are stand-alone prescription drug plans offered by
private insurance companies approved by Medicare. They provide prescription drug
coverage for beneficiaries enrolled in Original Medicare.
5. What is the purpose of the Medicare Annual Enrollment Period (AEP)?
A) To enroll in Medicare for the first time when turning 65.
B) To allow beneficiaries to make changes to their Medicare Advantage and Part D plans
for the upcoming year.
C) To switch from a Medicare Advantage plan back to Original Medicare only.
D) To enroll in Medicare if they delayed Part B enrollment due to employer coverage.
E) To switch Medigap plans.
Correct Answer: B) To allow beneficiaries to make changes to their Medicare
Advantage and Part D plans for the upcoming year.
Rationale: AEP (October 15th to December 7th) is the time when Medicare
beneficiaries can make changes to their Medicare health and prescription drug coverage
for the following calendar year, including switching between Original Medicare and
Medicare Advantage, or changing Part D plans.
6. Which of the following is true about Medicare Supplement (Medigap) plans?
A) They replace Original Medicare.
B) They work with Medicare Advantage plans to cover extra benefits.
C) They help pay for some of the out-of-pocket costs of Original Medicare, like
deductibles and coinsurance.
D) They always include prescription drug coverage.
, E) They are regulated by the federal government only, not state.
Correct Answer: C) They help pay for some of the out-of-pocket costs of Original
Medicare, like deductibles and coinsurance.
Rationale: Medigap plans are private insurance policies that work in conjunction with
Original Medicare. They are designed to cover some of the "gaps" in Original Medicare
coverage, such as copayments, coinsurance, and deductibles. They do not work with
Medicare Advantage plans and generally do not include prescription drug coverage
(unless it's an old plan from before 2006).
7. A client who receives both Medicare and Medicaid benefits is eligible for which type of
Medicare Advantage plan?
A) HMO (Health Maintenance Organization) only.
B) PFFS (Private Fee-for-Service) plan.
C) D-SNP (Dual-Eligible Special Needs Plan).
D) PPO (Preferred Provider Organization) only.
E) MA-only plan (without drug coverage).
Correct Answer: C) D-SNP (Dual-Eligible Special Needs Plan).
Rationale: Dual-Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans
designed specifically for individuals who qualify for both Medicare and Medicaid,
coordinating their benefits and often providing additional services tailored to their
needs.
8. What is a "formulary" in the context of Medicare Part D plans?
A) A list of doctors and hospitals that accept the plan.
B) The maximum amount a beneficiary will pay for prescription drugs in a year.
C) A list of prescription drugs covered by the plan.
D) A document outlining the plan's appeal process.
E) The monthly premium for the drug plan.
Correct Answer: C) A list of prescription drugs covered by the plan.
Rationale: A formulary is a list of prescription drugs that a particular Medicare Part D
plan (or Medicare Advantage Prescription Drug plan) covers. Drugs are typically
grouped into different tiers with varying cost-sharing amounts.
9. Which of the following describes a Medicare Advantage HMO plan?
A) Beneficiaries can see any doctor they choose without referrals.
B) Beneficiaries must generally use doctors, hospitals, and other providers in the plan's
network and may need a referral to see a specialist.
C) It does not cover emergency or urgent care.
D) It always has higher premiums than PPO plans.
E) It does not include prescription drug coverage.
Correct Answer: B) Beneficiaries must generally use doctors, hospitals, and other
EXAM 55 QUESTIONS AND CORRECT ANSWERS|ALREADY
GRADED A+
1. Medicare Part A primarily covers which of the following?
A) Outpatient doctor visits and preventive care.
B) Prescription drugs.
C) Hospital inpatient stays, skilled nursing facility care, hospice care, and some home
health services.
D) Vision and dental services.
E) Foreign travel emergency care.
Correct Answer: C) Hospital inpatient stays, skilled nursing facility care, hospice care,
and some home health services.
Rationale: Medicare Part A is often referred to as "Hospital Insurance" and covers
inpatient care in hospitals, skilled nursing facilities (not long-term custodial care),
hospice care, and some home health services.
2. A beneficiary is turning 65 and is eligible for Medicare. Which of the following is the
standard Initial Enrollment Period (IEP) for Medicare Part A and Part B?
A) January 1st to March 31st each year.
B) The 3 months before their 65th birthday, the month of their birthday, and the 3
months after their birthday.
C) October 15th to December 7th each year.
D) Any time during the year as long as they are 65.
E) Only within 60 days of leaving employer coverage.
Correct Answer: B) The 3 months before their 65th birthday, the month of their
birthday, and the 3 months after their birthday.
Rationale: The Initial Enrollment Period (IEP) is a 7-month window that begins 3
months before a person's 65th birthday, includes the birth month, and ends 3 months
after the birth month.
3. What is the primary difference between a Medicare Advantage (Part C) plan and
Original Medicare?
A) Medicare Advantage plans only cover prescription drugs, while Original Medicare
covers medical services.
B) Medicare Advantage plans are offered by private insurance companies approved by
Medicare and often include additional benefits, while Original Medicare is directly
managed by the federal government.
C) Medicare Advantage plans require beneficiaries to pay a separate premium for Part
A, while Original Medicare does not.
D) Original Medicare includes dental, vision, and hearing benefits, while Medicare
Advantage plans do not.
, E) Medicare Advantage plans have no network restrictions.
Correct Answer: B) Medicare Advantage plans are offered by private insurance
companies approved by Medicare and often include additional benefits, while Original
Medicare is directly managed by the federal government.
Rationale: Medicare Advantage plans are an alternative way to receive Medicare
benefits, bundled into a single plan offered by private insurers. They must cover at least
the same benefits as Original Medicare Parts A and B, but often include extra benefits
and have different cost-sharing structures and provider networks.
4. A client is currently enrolled in Original Medicare (Part A and Part B) and wants to add
prescription drug coverage. Which type of plan should they enroll in?
A) Medicare Supplement (Medigap) Plan.
B) Medicare Advantage (Part C) Plan.
C) Medicare Part D (Prescription Drug) Plan.
D) Special Needs Plan (SNP).
E) Program of All-Inclusive Care for the Elderly (PACE).
Correct Answer: C) Medicare Part D (Prescription Drug) Plan.
Rationale: Medicare Part D plans are stand-alone prescription drug plans offered by
private insurance companies approved by Medicare. They provide prescription drug
coverage for beneficiaries enrolled in Original Medicare.
5. What is the purpose of the Medicare Annual Enrollment Period (AEP)?
A) To enroll in Medicare for the first time when turning 65.
B) To allow beneficiaries to make changes to their Medicare Advantage and Part D plans
for the upcoming year.
C) To switch from a Medicare Advantage plan back to Original Medicare only.
D) To enroll in Medicare if they delayed Part B enrollment due to employer coverage.
E) To switch Medigap plans.
Correct Answer: B) To allow beneficiaries to make changes to their Medicare
Advantage and Part D plans for the upcoming year.
Rationale: AEP (October 15th to December 7th) is the time when Medicare
beneficiaries can make changes to their Medicare health and prescription drug coverage
for the following calendar year, including switching between Original Medicare and
Medicare Advantage, or changing Part D plans.
6. Which of the following is true about Medicare Supplement (Medigap) plans?
A) They replace Original Medicare.
B) They work with Medicare Advantage plans to cover extra benefits.
C) They help pay for some of the out-of-pocket costs of Original Medicare, like
deductibles and coinsurance.
D) They always include prescription drug coverage.
, E) They are regulated by the federal government only, not state.
Correct Answer: C) They help pay for some of the out-of-pocket costs of Original
Medicare, like deductibles and coinsurance.
Rationale: Medigap plans are private insurance policies that work in conjunction with
Original Medicare. They are designed to cover some of the "gaps" in Original Medicare
coverage, such as copayments, coinsurance, and deductibles. They do not work with
Medicare Advantage plans and generally do not include prescription drug coverage
(unless it's an old plan from before 2006).
7. A client who receives both Medicare and Medicaid benefits is eligible for which type of
Medicare Advantage plan?
A) HMO (Health Maintenance Organization) only.
B) PFFS (Private Fee-for-Service) plan.
C) D-SNP (Dual-Eligible Special Needs Plan).
D) PPO (Preferred Provider Organization) only.
E) MA-only plan (without drug coverage).
Correct Answer: C) D-SNP (Dual-Eligible Special Needs Plan).
Rationale: Dual-Eligible Special Needs Plans (D-SNPs) are Medicare Advantage plans
designed specifically for individuals who qualify for both Medicare and Medicaid,
coordinating their benefits and often providing additional services tailored to their
needs.
8. What is a "formulary" in the context of Medicare Part D plans?
A) A list of doctors and hospitals that accept the plan.
B) The maximum amount a beneficiary will pay for prescription drugs in a year.
C) A list of prescription drugs covered by the plan.
D) A document outlining the plan's appeal process.
E) The monthly premium for the drug plan.
Correct Answer: C) A list of prescription drugs covered by the plan.
Rationale: A formulary is a list of prescription drugs that a particular Medicare Part D
plan (or Medicare Advantage Prescription Drug plan) covers. Drugs are typically
grouped into different tiers with varying cost-sharing amounts.
9. Which of the following describes a Medicare Advantage HMO plan?
A) Beneficiaries can see any doctor they choose without referrals.
B) Beneficiaries must generally use doctors, hospitals, and other providers in the plan's
network and may need a referral to see a specialist.
C) It does not cover emergency or urgent care.
D) It always has higher premiums than PPO plans.
E) It does not include prescription drug coverage.
Correct Answer: B) Beneficiaries must generally use doctors, hospitals, and other
