The Fundamentals of Medicare

The Fundamentals

of Medicare

#7945EXAM MATERIAL

7945 Final Exam • 1

THE FUNDAMENTALS OF MEDICARE (COURSE #7945)

COURSE DESCRIPTION

This course will serve as a guide to help navigate your way through the often-intimidating Medicare process. You’ll find out about the benefits offered and how to avoid common costly pitfalls. Making sense of Medicare can sometimes feel insurmountable, but this course gives you the accurate, practical information you and your clients will need to overcome the confusion and handle the Medicare process with confidence. No prerequisites. Course level: Basic. Course #7945 – 20 CPE hours.

LEARNING ASSIGNMENTS AND OBJECTIVES

As a result of studying each assignment, you should be able to meet the objectives listed below each individual assignment.

ASSIGNMENT 1: SUBJECTGETTING STARTED WITH MEDICAREThe Nuts and Bolts of MedicareSpelling Out What Medicare CoversUnderstanding What You Pay Toward Your Costs in MedicareReducing Your Out-of-Pocket Expenses in Medicare

Study the course materials from pages 1 to 98Complete the review questions at the end of each chapterAnswer the exam questions 1 to 28

Objectives:

• To identify common concerns about Medicare• To identify the type of coverage offered by Medicare Part A and Part B• To identify specifics about Medicare premiums, deductibles, and co-payments• To identify specifics about Medigap supplemental insurance

2 • 7945 Final Exam

ASSIGNMENT 2: SUBJECTTHE HOWS AND WHENS OF MEDICAREQualifying for MedicareEnrolling in Medicare at the Right Time for YouDiscovering How to Sign Up for MedicareUnderstanding How Medicare Fits in with Other Health Insurance


Objectives:

• To identify the eligibility requirements for Medicare at age 65• To identify Medicare’s enrollment period requirements• To recognize the differing enrollment options for Parts A and B• To recognize how to coordinate benefits with additional health insurance

ASSIGNMENT 3: SUBJECTMAKING SMART CHOICES AMONG MEDICARE’S MANY OPTIONSMaking Sense of Medicare’s Many OptionsChoosing Wisely if You Go with Traditional MedicareMaking Smart Choices if You Opt for Medicare AdvantageGetting Help in Making Medicare Choices

Study the course materials for pages 209 to 296Complete the review questions at the end of each chapterAnswer the exam questions 56 to 79

Objectives:

• To recognize the differences between traditional Medicare and Medicare Advantage plans• To recognize the importance of comparing plans carefully• To identify how to pick the right Medicare Advantage plan• To recognize when and where to search for help with decisions on plan choices


ASSIGNMENT 4: SUBJECTNAVIGATING MEDICARE FROM THE INSIDEStarting Out as a New Medicare BeneficiaryGetting the Inside Scoop on Using Certain Medicare BenefitsChanging Your Medicare and Medigap CoverageKnowing Your RightsTop Ten Medicare Mistakes


Objectives:

• To identify what coverage actually covers• To recognize how to make sense of the different parts of Medicare• To recognize the intricacies involved with changing coverage• To identify your legal rights concerning Medicare coverage• To identify the top 10 mistakes often made when using Medicare

ASSIGNMENT 5:• Complete the Answer Sheet and Course Evaluation and submit to PES

NOTICE

This course and test have been adapted from supplemental materials and uses the materials entitled Medicare for Dummies, 4th Edition by Patricia Berry. Copyright © 2021 by John Wiley & Sons, Inc. Displayed by permission of the publisher, John Wiley & Sons, Inc., Hoboken, New Jersey.

Use of these materials or services provided by Professional Education Services, LP (“PES”) is governed by the Terms and Conditions on PES’ website (www.mypescpe.com). PES provides this course with the understanding that it is not providing any accounting, legal, or other professional advice and assumes no liability whatsoever in connection with its use. PES has used diligent efforts to provide quality information and material to its customers, but does not warrant or guarantee the accuracy, timeliness, completeness, or currency of the information contained herein. Ultimately, the responsibility to comply with applicable legal requirements falls solely on the individual licensee, not PES. PES encourages you to contact your state Board or licensing agency for the latest information and to confirm or clarify any questions or concerns you have regarding your duties or obligations as a licensed professional.

© Professional Education Services, LP 2020

Program Publication Date 11/20/2020

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THE FUNDAMENTALS OF MEDICARE (COURSE #7945)

EXAM INFORMATION

COURSE EXPIRATION DATE: Per AICPA and NASBA standards, this course must be completed within ONE YEAR from the date of purchase.

TEST FORMAT: The following final exam, consisting of 100 multiple choice questions, is based specifically on the material included in this course. The answer sheet must be completed and returned to PES for CPE certification. You will find the answer sheet at the back of this exam packet so that you may easily remove it and use it while taking your test.

LICENSE RENEWAL INFORMATION: The Fundamentals of Medicare course (#7945) qualifies for 20 CPE hours.

PROCESSING: You must score 70% or better to pass. If you mail or fax your exam, when you pass, your Certificate of Completion will be mailed. If you do not pass, we will give you a courtesy call to inform you of this. When completing your exam online, grading is instantaneous. Upon achieving a passing score, the completion certificate is immediately available in your account under “My Completed CPE.” Please note: failed exams may be retaken. Per NASBA and AICPA guidelines, missed questions cannot be indicated until after you pass.

GRADING OPTIONS – Please choose only ONE of the following:

GRADING OPTIONS: Please choose only ONE of the following. If mailing or faxing, make sure to fill out your Answer Sheet completely prior to submitting it.

• ONLINE GRADING –Visit our website at http://www.mypescpe.com. Login to your account (if you are a first-time user, you must set up a new user account). Click on the course title of the exam you wish to take. Once all answers have been selected, click the “Submit/Grade Answers” button at the bottom of the page for instant grading and certification. If you do not see the exam listed, click on “My CPE in Progress.” Click on the “Add Exam to Account” button and follow the instructions.

• MAIL – Your exam will be graded and your certificate of completion mailed to you within one business day. Your certificate will be dated according to the postmark date. Please mail your Answer Sheet to:

Professional Education Services, LP4208 Douglas Blvd., Ste 50

Granite Bay, CA 95746

• FAX – Your exam will be graded and you will be contacted either via phone or fax with your results within 4 business hours of receipt. A copy of your graded exam and certificate of completion will be mailed to you. Your certificate will be dated according to the fax date. If you choose to fax your exam, please do not mail it. Your fax will serve as the original. Please refer to the attached answer sheet for further instructions on fax grading. Fax number (916) 791-4099.

THANK YOU FOR USING PROFESSIONAL EDUCATION SERVICES.


THE FUNDAMENTALS OF MEDICARE (COURSE #7945) – FINAL EXAM

The following questions are multiple choice. Please indicate your choice on the enclosed Answer Sheet.

1. Which of the following is correct about Medicare:

A. Medicare began in 1946B. Medicare is available only to seniors with

disabilitiesC. Medicare is a private insurance program

overseen by the federal governmentD. Medicare is the only national health-care

program in the U.S.

2. Which of the following prohibits a person from enrolling in a Medicare Advantage health plan:

A. alcohol useB. advanced kidney failureC. cancerD. diabetes

3. Which of the following would be the proper time to switch from one Part D prescription plan to another:

A. January 1 through May 12B. March 14 through July 4C. May 15 through September 1D. October 15 through December 7

4. Which of the following Medicare parts is typically described as hospital insurance:

A. Part AB. Part BC. Part CD. Part D

5. Which of the following is not covered by Medicare Part B:

A. approved medical services from a doctor that accepts Medicare patients

B. outpatient mental health careC. outpatient prescription medicationsD. counseling to curb alcohol abuse

6. Part A and Part B of Medicare are often referred to as which of the following:

A. Medicare AdvantageB. Medicare PlusC. traditional MedicareD. Medicaid

7. In which of the following years was Medicare’s prescription drug benefit added to the program:

A. 1966B. 1986C. 1996D. 2006

8. Which of the following is typically not covered by Medicare:

A. powered wheelchairs for outdoor useB. heart transplantsC. cancer treatmentsD. allergy shots


9. Which of the following is the term used for a doctor that has agreed to accept the Medicare-approved amount as full payment for a service provided to a Medicare patient, resulting in the patient getting the service for free:

A. pro bonoB. assignmentC. designationD. gratis

10. For which of the following preventive care services covered by Medicare Part B would a patient expect to have a required co-pay and the Part B deductible apply:

A. breast cancer screeningsB. HIV screeningsC. glaucoma testsD. bone mass measurements

11. Medicare coverage of care in a skilled nursing facility requires that the patient must have been in a hospital as a formally admitted patient for at least __________________.

A. one dayB. three daysC. five daysD. seven days

12. All of the following are requirements for Medicare coverage of home health-care services except:

A. the patient must be homeboundB. a doctor must certify the patient needs skilled

nursing, physical or occupational therapy, speech pathology, or some combination thereof

C. the patient must be under a plan of care established by, and regularly reviewed by, a doctor

D. the patient must be at least 75 years old

13. To qualify for Medicare’s hospice benefit, a doctor and medical director of a hospice program must certify that a patient has less than how many months to live:

A. threeB. sixC. nineD. twelve

14. Which of the following is the 2020 limit for the initial coverage phase of Part D drug coverage:

A. $435B. $4,020C. $6,350D. $9,038

15. Which of the following types of drugs is typically excluded from coverage under Medicare Part D:

A. fertility drugsB. antidepressantsC. anticancer drugsD. immunosupressants

16. Medicare will typically deny coverage of which of the following:

A. cataract surgeryB. jaw restorationC. tooth extractionsD. treatment of ear diseases

17. Which of the following programs, typically used by people with very low incomes and resources, will pay the long-term custodial care bills of people that qualify:

A. MedicareB. Medicare AdvantageC. original MedicareD. Medicaid


18. On average, what percentage of a beneficiary’s total health-care costs, assuming they have no additional insurance, does Medicare cover:

A. 15%B. 25%C. 50%D. 75%

19. For 2020, which of the following is the annual deductible for Medicare Part B:

A. $122B. $147C. $198D. $253

20. For 2020, which of the following is the upper limit on out-of-pocket expenses for Medicare Part B, assuming a patient has no Medigap supplemental insurance:

A. $7,500B. $12,750C. $22,150D. there is no upper limit

21. Which of the following is the minimum modified adjusted gross income (MAGI) amount at which a Medicare recipient who is married, living together, and filing joint returns would have to pay higher premiums for Part B and Part D services:

A. MAGI greater than $89,000B. MAGI greater than $129,000C. MAGI greater than $174,000D. MAGI greater than $254,000

22. Which of the following does the Social Security Administration not consider a life-changing event:

A. losing a rental property in a natural disasterB. losing your investment income in a stock

market crashC. having your work hours reducedD. being widowed

23. Which of the following is the name for Medicare supplemental insurance:

A. MedigapB. MediCalC. MedicaidD. Medicare Advantage

24. Which of the following terms is used to describe the newer types of Medigap policies that offer more benefits than the standardized ones:

A. plus policiesB. extras policiesC. innovative policiesD. advantage policies

25. Dual eligibles are eligible for both Medicare and _______________.

A. Social SecurityB. MedicaidC. a Medicare Savings ProgramD. a PACE plan

26. A person can join a Program of All-Inclusive Care for the Elderly (PACE) plan if all of the following are true except:

A. the enrollee is over 45 years oldB. a PACE program serves the enrollee’s areaC. the state has certified that the enrollee is

eligible for nursing home level of careD. the enrollee is also enrolled in Medicare,

Medicaid, or both


27. When applying for Extra Help, which of the following is included as income:

A. cash or credit from a loanB. disaster assistanceC. federal income tax refundsD. workers’ compensation

28. Which of the following cannot be included when taking income tax deductions for Medicare costs:

A. out-of-pocket deductibles for Medicare services

B. the cost of altering a home for medical reasons

C. the amount paid out-of-pocket for prescription drugs

D. payments for services made by an insurer

29. Paying payroll taxes when working covers which of the following premiums:

A. Part A premiums onlyB. Part B premiums onlyC. Part C premiums onlyD. both Part A and Part B premiums

30. Which of the following is correct regarding earning work credits:

A. an individual needs 60 work credits to receive premium-free Part A coverage

B. in 2020, an individual must earn $5,640 in a quarter to receive one work credit

C. an individual can earn a maximum of four work credits in one year

D. the years of work in which an individual earns work credits must all be consecutive

31. Bill and Leticia recently got divorced. Which of the following must be true in order for Bill to use Leticia’s work history to qualify for premium-free Part A coverage:

A. Bill can only use Leticia’s work history if she has not remarried

B. Bill can only use Leticia’s work history if she is at least 62 years old

C. Bill and Leticia had to have been married for at least 15 years

D. Bill can remarry and use Leticia’s work history as long as he has been remarried less than three years

32. Which of the following is not one of three categories of disabled people covered by Medicare:

A. people with permanent kidney failure (ESRD)B. people who were born blindC. people who have received Social Security

disability payments for at least two yearsD. people with Lou Gehrig’s disease (ALS)

33. Typically, Medicare coverage begins the first day of the _____________ month that a person receives Social Security Disability Insurance (SSDI) payments.

A. 10thB. 15thC. 25thD. 32nd

34. Which of the following allows most people who have left or lost a job to continue health coverage through their former employer for up to 18 months by paying the full premiums.

A. the Affordable Care Act of 2010 (ACA)B. the Consolidated Omnibus Budget

Reconciliation Act of 1986 (COBRA)C. Social Security Disability Insurance (SSDI)D. the Graham-Cassidy Act


35. Which of the following situations allows an individual to delay enrolling in Part B during the initial enrollment period (IEP) at 65 and instead sign up during a special enrollment period (SEP) penalty-free:

A. an individual is still employed and has group health insurance from his or her employer

B. an individual is covered by COBRA insurance

C. a person is in prisonD. a person has non-employer insurance that

they pay for themselves

36. Isobel turns 65 on May 22. Which of the following would be her IEP:

A. January 1 through June 30B. February 1 through August 31C. May 1 through November 30D. July 1 through December 31

37. Which of the following is the amount of time offered as the special enrollment period (SEP) to an individual who delayed Part B enrollment due to current employment once that employment has ended:

A. up to three monthsB. up to six monthsC. up to eight monthsD. up to one year

38. Typically, how long must a legal permanent resident (green card holder) live in the U.S. before he or she can become eligible for Medicare benefits:

A. one yearB. three yearsC. five yearsD. seven years

39. Which of the following would not be considered creditable prescription drug coverage:

A. drug coverage from a Medigap supplemental insurance policy

B. drug coverage provided by a federal health program for Native Americans

C. drug coverage provided by the Veterans Administration health program

D. drug coverage provided by the Federal Employees Health Benefits Program

40. Which of the following is the general enrollment period (GEP) for Part B:

A. January 1 to March 31B. January 1 to June 30C. June 1 to August 31D. October 1 to December 31

41. Which of the following is correct regarding Part D late enrollment penalties:

A. the basis of the Part D late penalty is the Consumer Price Index (CPI)

B. the late penalty applies for one year and then is waived

C. the penalty can increase from year to year, but will never decrease

D. the penalty is permanent

42. Typically, how long does an individual have to challenge a ruling once he or she is notified by letter that a penalty is being added to the premium:

A. 10 daysB. 30 daysC. 60 daysD. 90 days


43. Enrollment and disenrollment in Medicare Parts A and B are always handled by ________________.

A. MedicareB. the Social Security AdministrationC. the Internal Revenue ServiceD. Medicaid

44. In which of the following circumstances would an individual not be automatically signed up for Medicare:

A. the individual is almost 65, living in the U.S., and is receiving retirement benefits from Social Security

B. the individual is 35 and is almost eligible for Medicare based on a disability

C. the individual is 68 and delayed enrollment due to coverage based on a spouse’s current employment but has contacted Social Security to begin drawing retirement benefit payments

D. a U.S. citizen residing in Argentina who receives Social Security benefits and who is almost 65 years old

45. The Social Security Administration requires individuals to mail in an original, or certified copy, of which of the following when applying for Medicare online or by phone:

A. a foreign birth certificateB. three years of tax returnsC. a marriage certificateD. social security card

46. Jim is registered to vote in Nevada, but splits his time amongst four states during the year. He spends six months in Idaho at a home he owns, three months in Montana at a rental property, two months in Florida at his mother’s house, and one month in Nevada at an apartment he rents. Which of the following states is considered Jim’s principal residence by the Social Security Administration:

A. IdahoB. MontanaC. FloridaD. Nevada

47. Which of the following is correct regarding disenrolling from Part B:

A. there are no circumstances in which a person would need to disenroll from Part B coverage

B. Social Security insists on an interview to make sure the individual is aware of the consequences of dropping out of Part B

C. the Social Security Administration requires that the disenrollment process occurs online

D. disenrolling in Part B to enroll in primary health insurance from an employer will result in a penalty being added when the individual re-enrolls in Part B at a later date

48. Which of the following is the term used for the system set up by the federal government that determines when, and in what order, Medicare or other insurance pays medical bills:

A. order of operationB. coordination of benefitsC. primary insurance allocationD. the Medicare mandate


49. Which of the following is a restriction on an employer’s health care coverage for employees that also qualify for Medicare:

A. an employer is only required to cover the employee and not spouses

B. employees can be required to drop employer benefits in favor of Medicare

C. an employer must offer the same benefits to employees over 65 as those offered to younger employees

D. an employer may offer inducements to employees to choose Medicare rather than the employer health plan

50. When an individual’s only entitlement to Medicare is that they have permanent kidney failure (ESRD) and they are also covered by an employer group plan, the first _____________ on Medicare count as a coordination period, in which the employer coverage is primary.

A. 30 daysB. 10 monthsC. 20 monthsD. 30 months

51. Which of the following is correct regarding COBRA insurance and Medicare:

A. COBRA benefits cease if an individual becomes eligible for Medicare after signing up for COBRA

B. an individual cannot have COBRA insurance and Medicare at the same time

C. if you have Medicare prior to becoming eligible for COBRA, you have to disenroll from Medicare to receive COBRA

D. Medicare and COBRA are similar in that neither one covers spouses and dependent children

52. Which of the following is not entitled to benefits from the Federal Employees Health Benefits (FEHB) Program:

A. a U.S. postal service employeeB. an army combat veteranC. a researcher working for the U.S.

Department of Health and Human ServicesD. the president of the United States

53. Which of the following is correct regarding TRICARE For Life (TFL):

A. TFL is the federal health insurance program available to active-duty military personnel and their spouses

B. TFL’s premiums are lower than those of Medicare Part B

C. TFL is available to military retirees age 65 or over who have served at least 20 years

D. TFL has no prescription drug coverage benefits

54. The federal Black Lung Program provides income and medical benefits for which of the following:

A. 9/11 first respondersB. railroad workersC. coal minersD. firemen

55. Medicare defines prompt payment as anything less than __________ days.

A. 30B. 60C. 90D. 120

56. Which of the following is the name used collectively for Medicare’s private health plans:

A. Medicare AdvantageB. Medicare PlusC. traditional MedicareD. Medicaid


57. Which of the following is the biggest determinant of how many Medicare Advantage (MA) plans are available to an individual:

A. the individual’s income levelB. the individual’s ageC. the individual’s medical historyD. where the individual lives

58. An individual may drop a Medicare Advantage plan in order to return to traditional Medicare and enroll in a Medigap policy with full federal protections in all of the following situations except:

A. the Medicare Advantage plan stops providing services in the individual’s area

B. the individual can no longer afford the Medicare Advantage premiums

C. the individual joined a Medicare Advantage plan as soon as he or she became eligible for Medicare at 65 and the plan has been in effect for less than 12 months

D. the individual moves out of the Medicare Advantage plan’s service area

59. Which of the following is correct regarding the overall costs of traditional Medicare when compared to Medicare Advantage plans:

A. generally, traditional Medicare offers lower out-of-pocket costs than Medicare Advantage plans

B. traditional Medicare relies on managed care plans, such as HMOs and PPOs, to keep costs lower than Medicare Advantage plans

C. traditional Medicare has no annual out-of-pocket limits while Medicare Advantage plans are required to have annual limits

D. several studies suggest that people with greater health-care needs may ultimately pay more for their care in traditional Medicare than if they were enrolled in a Medicare Advantage plan

60. Which of the following is true regarding Medicare Advantage plans:

A. Medicare Advantage plans only charge fixed-dollar amounts for doctor visits

B. individuals enrolled in Medicare Advantage plans typically pay four or five premiums, depending on the type of plan

C. Medicare Advantage plans are allowed to offer fewer medical services than traditional Medicare offers

D. Medicare Advantage plans can change their costs and benefits each calendar year

61. Which of the following is the main reason people give for choosing or staying in traditional Medicare:

A. traditional Medicare lets enrollees go to any doctor or hospital they want

B. traditional Medicare is much cheaper than Medicare Advantage plans

C. traditional Medicare uses coordinated care, which enrollees prefer

D. traditional Medicare offers premium free prescription drug coverage

62. Roughly how many people are enrolled in traditional Medicare:

A. 10 millionB. 19 millionC. 36 millionD. 57 million

63. Which of the following is correct regarding health maintenance organization (HMO) plans

A. HMO plans are a staple of traditional Medicare

B. if you develop kidney failure while enrolled in an HMO plan, your coverage will be voided

C. HMOs are the most popular Medicare Advantage plan

D. all HMO plans include Part D drug coverage


64. Which of the following is correct regarding private fee-for-service (PFFS) plans:

A. PFFS plans offer managed careB. in 2019, one percent of people enrolled in

Medicare Advantage plans chose PFFS plans

C. PFFS plans do not offer Part D drug coverage

D. PFFS plans became very popular after 2010

65. Which of the following is correct regarding Medical Savings Account (MSA) plans:

A. MSAs are always considered taxable income by the IRS

B. to be eligible to enroll in an MSA, an individual must live in the United States for at least 300 days per year

C. MSAs require individuals to go to only those doctors that are covered by the plan

D. MSAs do not cover prescription drugs

66. According to the author, which of the following factors is the most important in picking the Part D plan that is best for you:

A. the illnesses that you are statistically more likely to have in the future based on your family’s health history

B. the plan’s monthly premiumC. the medications you currently takeD. recommendations from friends or family

67. By 2016, what percentage of drugs covered in Part D plans were being charged as percentages, rather than dollar co-pays:

A. 14%B. 39%C. 58%D. 84%

68. Which of the following factors has the most impact on altering the search results for out-of-pocket costs when researching Part D drug plans:

A. the frequency that you take the drugB. the dosage of the drugC. the exact name of the drugD. the pharmacy that you use to pick up the

drug

69. When using Medicare’s Plan Finder, a plan that has been labeled as _____________ means that Medicare may allow no new enrollments until the plan has rectified violations and met the required standards.

A. sanctionedB. quarantinedC. frozenD. decertified

70. Federal law gives certain protections for people over 65 years of age that purchase Medigap insurance within _________________ of enrolling in Part B.

A. three monthsB. six monthsC. nine monthsD. one year

71. According to the author, which of the following is the best source of information for comparing Medicare Advantage plans:

A. reading brochures received in the mailB. calling the insurance company that offers the

plan you might be interested inC. researching the insurance company’s

website for a plan that interests youD. using the Plan Finder on Medicare’s website


72. Medicare’s Plan Finder tells you which plans are best avoided. A red “Caution” notification icon identifies plans that have received low ratings from Medicare for at least _______________.

A. one yearB. two years in a rowC. three years in a rowD. four years in a row

73. Within how many days in advance must a Medicare Advantage plan provider notify patients in writing that a doctor will be dropped from the plan’s provider list during the plan year:

A. 30 daysB. 60 daysC. 90 daysD. 120 days

74. If a patient decides to leave one Medicare Advantage plan for a different plan that has received a five-star quality rating, they may do so _____________________.

A. only between January 1 to February 14B. only between June 1 to August 31C. only between October 15 to December 7D. at any time during the year

75. Which of the following is correct regarding a State Health Insurance Assistance Program (SHIP):

A. SHIPs operate in all 50 statesB. SHIPs are privately fundedC. the fee for getting assistance from a SHIP is

nominalD. federal employees make up the vast majority

of the SHIP counselors

76. All of the following would be red flags for a possible Medicare scam except:

A. receiving a visit from an uninvited representative of a particular Medicare Advantage plan

B. a caller requesting your Social Security number in order to determine the best stand-alone Part D drug plan for you

C. receiving Medicare Advantage plan brochures asking you to call the plan provider for more information in the mail

D. a Medicare employee showing up and asking to sign you up for a reduced enrollment fee

77. Who should the victim of a Medicare scam contact to report the incident:

A. the Internal Revenue ServiceB. the Federal Trade CommissionC. the Government Accountability OfficeD. the Securities and Exchange Commission

78. Which of the following is used to describe a situation in which a plan’s salesperson or independent insurance agent uses aggressive or unethical tactics to try and push an individual into signing up for a plan:

A. transactional sellingB. soft pedalingC. hard sellingD. cold calling

79. Which of the following is a permissible practice by Medicare for companies selling plans:

A. sending a sales rep to your home with no prior authorization

B. sending promotional brochures and enrollment forms to you through the mail

C. offering a giveaway as an inducement for enrolling

D. giving sales presentations in public places


80. Which of the following is the basis of the Medicare ID number for all cards issued prior to April, 2019:

A. a person’s state driver’s license numberB. a person’s Social Security numberC. a person’s street number and zip codeD. a person’s birth date

81. Which of the following is the abbreviation used by Medicare for stand-alone Part D plans:

A. PDPB. SAPC. SSPD. LRP

82. Which of the following does not automatically deduct Part B premiums from the monthly retirement benefits:

A. retirement benefits received from Social Security

B. retirement benefits received from a private pension plan

C. retirement benefits received from the Civil Service

D. retirement benefits received from the Railroad Retirement Board

83. If an individual falls behind in their monthly premiums for a stand-alone Part D plan, the plan may do all of the following except:

A. allow the individual’s coverage to continueB. send a letter asking the individual to call the

company that issued the planC. stop coverage immediately and with no

warningD. disenroll the individual after giving a grace

period and notice

84. Dr. Langhorn accepts assignment. Juliana’s doctor bill was $550 and the Medicare-approved amount is $400. Assuming Juliana has no other insurance, what amount does she owe Dr. Langhorn:

A. $80B. $150C. $400D. $550

85. Mail order pharmacies allow patients to order __________________ only.

A. 10-day suppliesB. 30-day suppliesC. 60-day suppliesD. 90-day supplies

86. Which of the following is the end date of a hospital benefit period:

A. the day that an individual is discharged from the hospital

B. after an individual has been out of the hospital for 10 days in a row

C. after an individual has been out of the hospital for 30 days in a row

D. after an individual has been out of the hospital for 60 days in a row

87. What is the maximum number of hospital benefit periods allowed by Medicare in one year:

A. 2B. 3C. 4D. there is no maximum number of hospital

benefit periods


88. Which of the following is correct regarding the three-day rule:

A. the three-day rule only applies to people in Medicare Advantage plans

B. the day that an individual is discharged does not count as one of the days in the three-day rule

C. the three-day rule affects only coverage in rehabilitation hospitals

D. skilled nursing facilities are legally forbidden from accepting a patient that has not fulfilled the three-day rule

89. Which of the following is correct regarding observation status:

A. observation status has no bearing on a patient’s costs for a hospital stay

B. observation status only applies to emergency room visits

C. observation status means that a patient is still classified as an outpatient

D. Medicare counts days spent in a hospital in observation status towards the three-day rule

90. All of the following are true regarding ambulance services except:

A. Medicare covers all ambulance costs anytime a patient needs one

B. an ambulance must contain a stretcher and have people onboard specially trained to provide first aid

C. ambulance services are covered under Part B

D. in some instances, air ambulance or helicopter flights are covered

91. Which of the following vaccines is not fully covered under Part B:

A. hepatitis BB. shinglesC. fluD. pneumonia

92. Which of the following represents the final day of coverage for a current plan that is left in favor of a new plan during the open enrollment period:

A. midnight on the day that the current plan is left for a new plan

B. midnight the day after the change is madeC. midnight on December 7, the last day of the

open enrollment periodD. midnight on December 31

93. During an individual’s time in any Medicare- or Medicaid-certified institutional facility and for up to __________________ after he or she leaves it, the individual has a right to shift from traditional Medicare to a Medicare Advantage plan.

A. one monthB. two monthsC. three monthsD. six months

94. Within how many days must an old plan transfer payment records to a new plan:

A. within seven days of when coverage in the old plan ends

B. within three weeks of when coverage in the old plan ends

C. within twelve weeks of when coverage in the old plan ends

D. within six months of when coverage in the old plan ends

95. A plan must disenroll an individual in all of the following instances except:

A. an individual has misrepresented what other coverage they have

B. an individual is imprisonedC. an individual “engages in disruptive behavior”D. an individual dies


96. When an individual who has had a current policy for more than six months switches Medigap policies, which of the following is the insurer forbidden from doing:

A. requiring the individual to pay higher premiums based on their age

B. requiring a waiting period before coverage kicks in

C. temporarily deny benefits in the new policy that were not included in the current one

D. refusing to sell the individual a new policy

97. For which of the following reasons would an individual contact the Social Security Administration rather than the Centers for Medicare & Medicaid Services:

A. to find a doctor who accepts Medicare patients in a specific area

B. to report fraudC. to choose a Medicare Advantage planD. to obtain a replacement Medicare card

98. Which of the following terms is used for the process which allows Social Security to investigate cases and reverse decisions if it finds they were made by a federal employee making a mistake:

A. judicial reviewB. equitable reliefC. grievance overviewD. coverage determination

99. Which level of the Medicare appeal process is reviewed by the Medicare Appeals Council

A. level 1B. level 2C. level 3D. level 4

100. Which of the following is mailed annually in September to participants of Part D prescription drug plans and outlines premium changes or changes in the drug formulary:

A. the Explanation of BenefitsB. the Annual Notice of ChangeC. the Statement of Patient RightsD. the Annual Explanation of Plan Coverage

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you’ve completed the exam!


THE FUNDAMENTALS OF MEDICARE #7945 (20 CPE HOURS) ANSWER SHEET (11/20)

IMPORTANT NOTE: For certification, this answer sheet must be completed and submitted to PES for grading within ONE YEAR from the date of purchase. Please use BLACK INK and PRINT for quicker processing – thank you.

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THE FUNDAMENTALS OF MEDICARE #7945 COURSE EVALUATION

Rate on a scale of 1-10 with 1 being poor and 10 being excellent.

1. The course met the course objectives described in the promotional material. ______

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3. The course materials were understandable, valuable, and suitable for a correspondence course. ______

4. The amount of advance knowledge and stated prerequisites were appropriate. ______

5. The completion time was appropriate for the number of credits allowed. ______

6. The course met my professional education needs. ______

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PLEASE MAIL YOUR EVALUATION TO: Professional Education Services, LP

4208 Douglas Blvd., Ste 50 • Granite Bay, CA 95746

The Fundamentals of Medicare

Documents

Transcript of The Fundamentals of Medicare