Joseph has Original Medicare and was a patient in the hospital last week. What part of Med-
icare helps cover the costs of his inpatient hospital stay? - ANSWER Part A
- ANSWER The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? - ANSWER 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
Which of the following defines a Medicare Advantage (MA) Plan? - ANSWER MA Plans
are health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements
must she meet? (Select the two answers that apply.) - ANSWER Not have End Stage Renal
Disease (permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organiza-
tion) MA Plan? (Select 3) - ANSWER
Which of the following are MA Plans that focus on using network providers to maximize the
benefits and reduce out-of-network expenses? - ANSWER HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment? - ANSWER By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and
enrolled in Medicare Part B.
1
, How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? - ANSWER The
OOP maximum is a feature that limits the amount of money a consumer will have to spend
on Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription
Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescription drug coverage? - ANSWER The consumer will be automatically disenrolled
from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription
drug coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescription drug coverage describes which
of the following: - ANSWER Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Pre-
scription Drug Plans? - ANSWER A consumer must be entitled to Medicare Part A and/or
enrolled in Medicare Part B
What are two options for Medicare consumers to get Part D prescription drug coverage (as-
suming they meet all eligibility requirements)? (Select 2) - ANSWER
Which of the following statements is not true about the Coverage Gap? - ANSWER All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) - AN-
SWER
Which of the following best describes the Late Enrollment Penalty (LEP)? - ANSWER 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 cov-
erage for 63 continuous days or more.
2
icare helps cover the costs of his inpatient hospital stay? - ANSWER Part A
- ANSWER The consumer must be in a valid MA election or disenrollment period.
Which of the following consumers would be eligible for Medicare? - ANSWER 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
Which of the following defines a Medicare Advantage (MA) Plan? - ANSWER MA Plans
are health plan options approved by Medicare and offered by private insurance companies.
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements
must she meet? (Select the two answers that apply.) - ANSWER Not have End Stage Renal
Disease (permanent kidney failure)Reside in the plan's service area
What must be explained to consumers enrolling in an HMO (Health Maintenance Organiza-
tion) MA Plan? (Select 3) - ANSWER
Which of the following are MA Plans that focus on using network providers to maximize the
benefits and reduce out-of-network expenses? - ANSWER HMO, POS, PPO
Which is true about Medicare Supplement Open Enrollment? - ANSWER By federal law,
Medicare Supplement Open Enrollment is the first 6 months a consumer is 65 or older and
enrolled in Medicare Part B.
1
, How does the Medicare Advantage Out-of-Pocket (OOP) maximum work? - ANSWER The
OOP maximum is a feature that limits the amount of money a consumer will have to spend
on Medicare-covered health care services each year.
A consumer currently has Original Medicare and is enrolled in a stand-alone Prescription
Drug Plan (PDP). What will happen if the consumer enrolls in an MA Plan that has integrated
prescription drug coverage? - ANSWER The consumer will be automatically disenrolled
from their stand-alone PDP upon enrollment in the MA Plan that has integrated prescription
drug coverage
A government program, offered only through a private insurance company or other private
company approved by Medicare, that provides prescription drug coverage describes which
of the following: - ANSWER Medicare Parts A and B
Which of the following statements is true about eligibility requirements for Medicare Pre-
scription Drug Plans? - ANSWER A consumer must be entitled to Medicare Part A and/or
enrolled in Medicare Part B
What are two options for Medicare consumers to get Part D prescription drug coverage (as-
suming they meet all eligibility requirements)? (Select 2) - ANSWER
Which of the following statements is not true about the Coverage Gap? - ANSWER All
members reach the Coverage Gap
Which of the following options are drug utilization management (UM) rules? (Select 3) - AN-
SWER
Which of the following best describes the Late Enrollment Penalty (LEP)? - ANSWER 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 cov-
erage for 63 continuous days or more.
2
