North Carolina Medicare Supplement and Long-Term Care Insurance
Exam 2025/2026
Comprehensive Practice Examination | 170+ Questions with Answers
& Rationales
1. Which part of Medicare primarily covers inpatient hospital services?
A) Part B
B) Part C
C) Part D
D) Part A
Rationale: Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing
facility care (following a hospital stay), hospice care, and some home health care. Part B covers
outpatient services, Part C is Medicare Advantage, and Part D covers prescription drugs.
2. What is the standard Medicare Part B monthly premium amount for most beneficiaries in 2025?
A) $148.50
B) $164.90
C) $174.70
D) $199.80
Rationale: While premiums adjust annually, the standard Part B premium for 2025 is approximately
$174.70 for most beneficiaries. Higher-income beneficiaries pay income-related monthly adjustment
amounts (IRMAA). Students should verify current year amounts with CMS, but this reflects typical
exam testing of premium knowledge.
3. Which of the following services is NOT covered under Original Medicare (Parts A & B)?
A) Medically necessary hospital stays
B) Preventive screenings like mammograms
,C) Routine dental care and dentures
D) Doctor visits for illness or injury
Rationale: Original Medicare does not cover routine dental care, vision exams for eyeglasses, hearing
aids, or custodial long-term care. Medicare Supplement policies also generally do not cover these
exclusions. Understanding Medicare's limitations is essential for proper Medigap counseling.
4. The Medicare Initial Enrollment Period (IEP) lasts for how many months?
A) 3 months
B) 5 months
C) 7 months
D) 12 months
Rationale: The IEP is a 7-month period that begins 3 months before the month you turn 65, includes
your birthday month, and ends 3 months after. Missing this period may result in late enrollment
penalties for Part B and Part D.
5. What is the primary purpose of Medicare Part C (Medicare Advantage)?
A) To provide prescription drug coverage only
B) To replace Medicaid for dual-eligible beneficiaries
C) To offer an alternative way to receive Medicare benefits through private insurers
D) To cover long-term custodial care in nursing homes
Rationale: Medicare Advantage (Part C) plans are offered by private companies approved by
Medicare. They provide all Part A and Part B benefits, often include Part D, and may offer additional
benefits like dental or vision. They operate under different rules than Original Medicare.
6. Which statement about the Medicare Part D Late Enrollment Penalty is TRUE?
A) It only applies if you go 60 days without creditable prescription coverage
B) It is calculated as 1% of the national base beneficiary premium for each full month without
creditable coverage
,C) It is a one-time fee paid when you finally enroll
D) It can be waived if you apply for a Medicare Supplement policy
Rationale: The Part D penalty is permanent and calculated as 1% of the national base beneficiary
premium ($34.70 in 2024, adjusted annually) multiplied by the number of full months you were
eligible but didn't enroll and didn't have other creditable coverage. Understanding penalties is critical
for client counseling.
7. A beneficiary becomes eligible for Medicare due to End-Stage Renal Disease (ESRD). When does
coverage typically begin?
A) Immediately upon diagnosis
B) The first day of the third month after dialysis begins
C) The first day of the fourth month after dialysis begins
D) After a 24-month waiting period
Rationale: For ESRD-based eligibility, Medicare coverage generally starts on the first day of the fourth
month of dialysis treatments. There are exceptions for self-dialysis training or kidney transplant
scenarios. This is a frequently tested eligibility rule.
8. Which of the following is a requirement to enroll in a Medicare Part D prescription drug plan?
A) Must be enrolled in a Medicare Supplement Plan F
B) Must have a chronic health condition requiring medications
C) Must be enrolled in Medicare Part A and/or Part B
D) Must reside in a skilled nursing facility
Rationale: To join a Medicare Part D plan, you must have Medicare Part A and/or Part B and live in the
plan's service area. You cannot be enrolled in a Medicare Advantage Plan that already includes drug
coverage (unless switching during a valid enrollment period).
9. What does the term "creditable coverage" mean in relation to Medicare Part D?
A) Coverage that has been approved by the North Carolina Department of Insurance
, B) Prescription drug coverage that is expected to pay, on average, at least as much as Medicare's
standard prescription drug coverage
C) Any employer-sponsored health plan
D) Coverage that guarantees no out-of-pocket costs
Rationale: Creditable coverage means the prescription drug coverage is actuarially equivalent to or
better than Medicare's standard Part D benefit. Beneficiaries with creditable coverage can delay Part
D enrollment without penalty. Employers must provide notices about creditable coverage status.
10. During which enrollment period can a Medicare beneficiary switch from one Medicare Advantage
plan to another or return to Original Medicare?
A) Initial Enrollment Period only
B) Annual Election Period (October 15 - December 7)
C) Medicare Supplement Open Enrollment Period
D) Any time during the calendar year
Rationale: The Annual Election Period (AEP), also called Open Enrollment for Medicare Advantage and
Part D, runs October 15 - December 7 each year. Changes made during this period take effect January
1. Other special enrollment periods exist for qualifying life events.
11. Which Medicare part covers outpatient prescription drugs?
A) Part A
B) Part B
C) Part C
D) Part D
Rationale: Medicare Part D is the voluntary prescription drug benefit program. It is offered through
private insurance companies approved by Medicare. Part B covers only a limited set of outpatient
drugs (like chemotherapy or certain injectables).
12. What is the Medicare "donut hole" or Coverage Gap?
Exam 2025/2026
Comprehensive Practice Examination | 170+ Questions with Answers
& Rationales
1. Which part of Medicare primarily covers inpatient hospital services?
A) Part B
B) Part C
C) Part D
D) Part A
Rationale: Medicare Part A is hospital insurance that covers inpatient hospital stays, skilled nursing
facility care (following a hospital stay), hospice care, and some home health care. Part B covers
outpatient services, Part C is Medicare Advantage, and Part D covers prescription drugs.
2. What is the standard Medicare Part B monthly premium amount for most beneficiaries in 2025?
A) $148.50
B) $164.90
C) $174.70
D) $199.80
Rationale: While premiums adjust annually, the standard Part B premium for 2025 is approximately
$174.70 for most beneficiaries. Higher-income beneficiaries pay income-related monthly adjustment
amounts (IRMAA). Students should verify current year amounts with CMS, but this reflects typical
exam testing of premium knowledge.
3. Which of the following services is NOT covered under Original Medicare (Parts A & B)?
A) Medically necessary hospital stays
B) Preventive screenings like mammograms
,C) Routine dental care and dentures
D) Doctor visits for illness or injury
Rationale: Original Medicare does not cover routine dental care, vision exams for eyeglasses, hearing
aids, or custodial long-term care. Medicare Supplement policies also generally do not cover these
exclusions. Understanding Medicare's limitations is essential for proper Medigap counseling.
4. The Medicare Initial Enrollment Period (IEP) lasts for how many months?
A) 3 months
B) 5 months
C) 7 months
D) 12 months
Rationale: The IEP is a 7-month period that begins 3 months before the month you turn 65, includes
your birthday month, and ends 3 months after. Missing this period may result in late enrollment
penalties for Part B and Part D.
5. What is the primary purpose of Medicare Part C (Medicare Advantage)?
A) To provide prescription drug coverage only
B) To replace Medicaid for dual-eligible beneficiaries
C) To offer an alternative way to receive Medicare benefits through private insurers
D) To cover long-term custodial care in nursing homes
Rationale: Medicare Advantage (Part C) plans are offered by private companies approved by
Medicare. They provide all Part A and Part B benefits, often include Part D, and may offer additional
benefits like dental or vision. They operate under different rules than Original Medicare.
6. Which statement about the Medicare Part D Late Enrollment Penalty is TRUE?
A) It only applies if you go 60 days without creditable prescription coverage
B) It is calculated as 1% of the national base beneficiary premium for each full month without
creditable coverage
,C) It is a one-time fee paid when you finally enroll
D) It can be waived if you apply for a Medicare Supplement policy
Rationale: The Part D penalty is permanent and calculated as 1% of the national base beneficiary
premium ($34.70 in 2024, adjusted annually) multiplied by the number of full months you were
eligible but didn't enroll and didn't have other creditable coverage. Understanding penalties is critical
for client counseling.
7. A beneficiary becomes eligible for Medicare due to End-Stage Renal Disease (ESRD). When does
coverage typically begin?
A) Immediately upon diagnosis
B) The first day of the third month after dialysis begins
C) The first day of the fourth month after dialysis begins
D) After a 24-month waiting period
Rationale: For ESRD-based eligibility, Medicare coverage generally starts on the first day of the fourth
month of dialysis treatments. There are exceptions for self-dialysis training or kidney transplant
scenarios. This is a frequently tested eligibility rule.
8. Which of the following is a requirement to enroll in a Medicare Part D prescription drug plan?
A) Must be enrolled in a Medicare Supplement Plan F
B) Must have a chronic health condition requiring medications
C) Must be enrolled in Medicare Part A and/or Part B
D) Must reside in a skilled nursing facility
Rationale: To join a Medicare Part D plan, you must have Medicare Part A and/or Part B and live in the
plan's service area. You cannot be enrolled in a Medicare Advantage Plan that already includes drug
coverage (unless switching during a valid enrollment period).
9. What does the term "creditable coverage" mean in relation to Medicare Part D?
A) Coverage that has been approved by the North Carolina Department of Insurance
, B) Prescription drug coverage that is expected to pay, on average, at least as much as Medicare's
standard prescription drug coverage
C) Any employer-sponsored health plan
D) Coverage that guarantees no out-of-pocket costs
Rationale: Creditable coverage means the prescription drug coverage is actuarially equivalent to or
better than Medicare's standard Part D benefit. Beneficiaries with creditable coverage can delay Part
D enrollment without penalty. Employers must provide notices about creditable coverage status.
10. During which enrollment period can a Medicare beneficiary switch from one Medicare Advantage
plan to another or return to Original Medicare?
A) Initial Enrollment Period only
B) Annual Election Period (October 15 - December 7)
C) Medicare Supplement Open Enrollment Period
D) Any time during the calendar year
Rationale: The Annual Election Period (AEP), also called Open Enrollment for Medicare Advantage and
Part D, runs October 15 - December 7 each year. Changes made during this period take effect January
1. Other special enrollment periods exist for qualifying life events.
11. Which Medicare part covers outpatient prescription drugs?
A) Part A
B) Part B
C) Part C
D) Part D
Rationale: Medicare Part D is the voluntary prescription drug benefit program. It is offered through
private insurance companies approved by Medicare. Part B covers only a limited set of outpatient
drugs (like chemotherapy or certain injectables).
12. What is the Medicare "donut hole" or Coverage Gap?
