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 Medicare beneficiary with End-Stage Renal Disease (ESRD) wants to enroll in a Medicare Advantage plan. Which statement is most accurate?

    Answer: ESRD patients may enroll in Medicare Advantage plans that specifically serve ESRD patients

    Since 2021, individuals with ESRD may enroll in any Medicare Advantage plan available in their area, ending the prior restriction.

  2. When comparing Medicare Supplement Plan G and Plan N for a client, what is the key difference in cost-sharing?

    Answer: Plan N requires copays for office visits and emergency room visits while Plan G does not

    Plan N requires copays up to $20 for office visits and up to $50 for emergency room visits that don't result in inpatient admission, whereas Plan G has no such copays.

  3. A client is enrolled in a Medicare Advantage plan and moves permanently to another state where their plan has no network. What is their best option?

    Answer: They qualify for a Special Enrollment Period to switch plans or return to Original Medicare

    A permanent move outside a Medicare Advantage plan's service area triggers a Special Enrollment Period, allowing the beneficiary to change plans.

  4. Medicare Part D's 'creditable coverage' concept is most important for which planning scenario?

    Answer: Avoiding the Part D late enrollment penalty when delaying enrollment

    Drug coverage is 'creditable' if it's at least as good as standard Medicare Part D, and having it allows beneficiaries to delay Part D enrollment without incurring a late penalty.

  5. Which Medicare coverage option allows beneficiaries to see any provider who accepts Medicare without referrals?

    Answer: Original Medicare (Parts A and B)

    Original Medicare allows beneficiaries to visit any provider nationwide who accepts Medicare assignment without needing referrals or network restrictions.

  6. A 67-year-old client has been working and covered by employer group health insurance. She retires and loses coverage. How long does she have to enroll in Medicare Part B without penalty?

    Answer: 8 months from the loss of employer coverage

    The Special Enrollment Period for losing employer coverage is 8 months from the date employment ends or employer coverage ends, whichever comes first.

  7. When does the Medicare Advantage Annual Enrollment Period (AEP) occur, and what can beneficiaries do during this time?

    Answer: October 15–December 7; switch between any Medicare coverage options

    The AEP runs October 15 through December 7 each year, during which beneficiaries can join, switch, or drop Medicare Advantage or Part D plans, with changes effective January 1.