Practice Test Geeks(CMS) Certified Medicare Specialist Practice Test
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Medicare Specialist Coverage Planning Options Flashcards

7 cards from real CMS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.

Read the first 7 Medicare Specialist Coverage Planning Options flashcards as text

  1. A client asks about the Medicare Preventive Services benefit. Which of the following is TRUE about preventive services under Medicare Part B?

    Answer: Many preventive services are covered at 100% with no cost-sharing when billed correctly as preventive

    Medicare covers most preventive services at 100% with no deductible or coinsurance, provided the provider accepts Medicare and bills the service as preventive.

  2. What distinguishes Medicare Advantage PFFS (Private Fee-for-Service) plans from HMO plans?

    Answer: PFFS plans allow beneficiaries to see any Medicare-accepting provider who agrees to the plan's terms; HMOs require a network

    PFFS plans allow members to see any provider willing to accept the plan's payment terms, whereas HMO plans require beneficiaries to use a contracted provider network.

  3. A client turning 65 is covered by COBRA continuation coverage. How does COBRA affect their Medicare enrollment obligations?

    Answer: Medicare is primary over COBRA; delaying Medicare Part B while on COBRA can result in a late enrollment penalty

    Medicare becomes primary over COBRA at age 65, and delaying Part B enrollment while relying on COBRA can lead to a permanent late enrollment penalty.

  4. Which Medicare Supplement plan is generally considered the most comprehensive coverage available to new enrollees after January 1, 2020?

    Answer: Plan G

    Plan G is the most comprehensive Medigap plan available to new Medicare enrollees after January 1, 2020, as Plans C and F are no longer available to newly eligible beneficiaries.

  5. A Medicare beneficiary is hospitalized and uses up their 60 hospital reserve days. What happens to their Part A cost-sharing after reserve days are exhausted?

    Answer: The beneficiary is responsible for all hospital costs with no Medicare coverage

    Once the 60 lifetime reserve days are used, Medicare provides no further hospital benefit coverage and the beneficiary is responsible for all costs.

  6. What is the primary purpose of a Medicare Part D Medication Therapy Management (MTM) program?

    Answer: To optimize therapeutic outcomes and detect adverse drug events for high-risk beneficiaries

    MTM programs are required in Part D plans to help beneficiaries with multiple chronic conditions, multiple medications, or high drug costs achieve better therapeutic outcomes.

  7. Which situation would qualify a beneficiary for a Medicare Supplement guaranteed issue right without medical underwriting?

    Answer: Losing Medicare Advantage coverage due to plan withdrawal from the service area

    When a Medicare Advantage plan leaves the service area or stops covering the beneficiary's area, the beneficiary has a guaranteed issue right to purchase a Medigap policy.