Medicare Parts A, B, C, and D

Correct answer: Title XVIII

Medicare is the health insurance program created by Title XVIII of the Social Security Act. Title XIX is Medicaid, and Title II is the Social Security cash-benefit program.

Correct answer: Through their own or a spouse's work history in Social Security- or railroad-covered employment

Medicare is social insurance. Part A entitlement at 65 follows from being entitled (or able to become entitled) to Social Security or railroad retirement benefits, which in turn rests on a work record, the person's own or a spouse's. It has no income or asset test; that is Medicaid.

Correct answer: 24 months

A person under 65 becomes entitled to Part A after having been entitled to Social Security (or railroad retirement) disability benefits for 24 calendar months.

Correct answer: End-stage renal disease

The three eligible groups are people 65 and older with Social Security or railroad retirement entitlement, people under 65 after 24 months of disability benefits, and certain people of any age medically determined to have end-stage renal disease.

Correct answer: Yes; she qualifies because she would be entitled to Social Security retirement benefits if she applied

Section 426(a) entitles a person age 65 who is entitled to monthly Social Security benefits or would be entitled except that no application has been filed. Rosa's work record makes her eligible even if she delays claiming retirement benefits.

Correct answer: After he has been entitled to disability benefits for 24 months, about 14 months from now

Under 426(b), a person under 65 becomes entitled to Part A after 24 months of entitlement to disability benefits. Marcus has 10 months, so he needs 14 more.

Correct answer: Parts A and B

Original Medicare is the government-run fee-for-service program made up of Part A (hospital insurance) and Part B (medical insurance). A beneficiary may instead receive A and B benefits through a Part C Medicare Advantage plan.

Correct answer: Medicare is social insurance based mainly on age, disability, or kidney failure and a work record; Medicaid is need-based assistance

Medicare (Title XVIII) is social insurance: eligibility turns on age 65, 24 months of disability benefits, or end-stage renal disease, with entitlement flowing from a work record. Medicaid (Title XIX) is means-tested assistance for people with limited income and assets.

Correct answer: Hospital insurance

Part A is hospital insurance: it covers hospital, related post-hospital, home health, and hospice care.

Correct answer: Hospice care

Part A covers inpatient hospital care, related post-hospital (skilled nursing facility) care, home health services, and hospice care.

Correct answer: They or a spouse paid Medicare payroll taxes for at least 40 quarters

Premium-free Part A is earned through at least 40 quarters (about 10 years) of Medicare-taxed work by the person or a spouse. Those without enough credits may buy Part A.

Correct answer: It is voluntary and financed by enrollee premiums plus federal government contributions

Part B is a voluntary supplementary medical insurance program for aged and disabled individuals who elect to enroll, financed by enrollee premiums together with contributions from federal funds.

Correct answer: $100

After the annual deductible, Part B typically pays 80 percent of the approved amount and the beneficiary pays 20 percent coinsurance. Twenty percent of $500 is $100.

Correct answer: Part B

Durable medical equipment, such as wheelchairs and oxygen equipment, is covered by Part B along with physician and outpatient services.

Correct answer: Part A, as related post-hospital care

Part A covers hospital and related post-hospital care, which includes skilled nursing facility care after a qualifying hospital stay. It does not cover long-term custodial care.

Correct answer: A Medicare supplement (Medigap) policy

Original Medicare leaves gaps such as deductibles and 20 percent Part B coinsurance with no annual cap. Medicare supplement (Medigap) policies are designed to fill those gaps.

Correct answer: Medicare Advantage

Part C is Medicare Advantage (originally Medicare+Choice), under which a beneficiary elects to receive Medicare benefits through a private plan instead of the original fee-for-service program.

Correct answer: Be entitled to Part A and enrolled in Part B

A Medicare Advantage eligible individual is one who is entitled to benefits under Part A and enrolled under Part B.

Correct answer: It delivers Part A and Part B benefits through a private plan instead of Original Medicare

A Medicare Advantage eligible individual may elect to receive benefits through the original fee-for-service program under Parts A and B or through enrollment in a Medicare Advantage plan. Part C is a different route to the same core benefits, not a new benefit.

Correct answer: A Medigap Plan G

Medicare Advantage plans may be coordinated care plans (HMOs, PPOs, provider-sponsored organization plans, special needs plans), MSA plans, or private fee-for-service plans. A Medigap policy is a supplement to Original Medicare, not a Medicare Advantage plan.

Correct answer: She is not eligible for that plan because it does not serve the area where she lives

In general, an individual may elect a Medicare Advantage plan only if the plan serves the geographic area in which the individual resides.

Correct answer: He fails to pay his required plan premium within the grace period

A Medicare Advantage organization may not terminate an election for any reason except failure to pay premiums on a timely basis (with a grace period), disruptive behavior, or termination of the plan in the area where the individual resides.

Correct answer: Medicare pays the Advantage organization instead of paying providers under Original Medicare

Payments to a Medicare Advantage organization for an enrolled individual are instead of the amounts that would otherwise be payable under Parts A and B, and only the organization is entitled to receive those payments.

Correct answer: The enrollee must keep Part B, and generally keeps paying the Part B premium

Medicare Advantage eligibility requires entitlement to Part A and enrollment in Part B, so the enrollee must keep Part B. The enrollee generally continues paying the Part B premium, sometimes in addition to a plan premium.

Correct answer: Outpatient prescription drug coverage

Part D provides qualified prescription drug coverage to Part D eligible individuals, through prescription drug plans or Medicare Advantage plans with drug coverage.

Correct answer: Entitled to Part A or enrolled in Part B

A Part D eligible individual is one who is entitled to benefits under Part A or enrolled under Part B.

Correct answer: January 1, 2006

Coverage under prescription drug plans and MA-PD plans first became effective on January 1, 2006.

Correct answer: By enrolling in a standalone prescription drug plan (PDP)

A Part D eligible individual who is not enrolled in a Medicare Advantage plan may obtain qualified prescription drug coverage by enrolling in a prescription drug plan.

Correct answer: She generally may not enroll in a standalone PDP while in her MA plan; she gets drug coverage through the MA-PD

A Part D eligible individual enrolled in an MA-PD plan obtains drug coverage through that plan, and, with limited exceptions, a person enrolled in an MA plan may not enroll in a prescription drug plan.

Correct answer: One enrolled in a Medicare Advantage medical savings account (MSA) plan

MA enrollees generally may not enroll in a prescription drug plan. The exceptions are enrollees in an MA private fee-for-service plan that does not provide drug coverage and enrollees in an MA MSA plan.

Correct answer: A standalone Part D prescription drug plan

Part D eligibility requires entitlement to Part A or enrollment in Part B, so Sam qualifies for a standalone PDP. Medicare Advantage requires both Part A and Part B, so he cannot join an MA plan.

Correct answer: Parts C and D

Parts A and B form the government-run fee-for-service Original Medicare program. Part C (Medicare Advantage) and Part D (prescription drug plans and MA-PD plans) are delivered through private plans that contract with Medicare.

Correct answer: Seven months: the three months before the month of the 65th birthday, that month, and the three months after

The initial enrollment period is a seven-month window: the three months before the month a person turns 65, the birthday month, and the three months after.

Correct answer: October 15 through December 7

The annual election period runs from October 15 through December 7, when beneficiaries can switch between Original Medicare and Medicare Advantage or change Part D plans for the following year.

Correct answer: January 1 through March 31

Someone who missed Part B during the initial enrollment period, without a special enrollment period, can enroll during the general enrollment period, January 1 through March 31.

Correct answer: A permanent late-enrollment penalty added to his Part B premium

Delaying Part B (or Part D) without qualifying coverage generally adds a late-enrollment penalty to the premium, and for Part B that surcharge generally lasts as long as the person has Part B.

Correct answer: Are licensed under state law to sell its Medicare Advantage plans

Each Medicare Advantage organization must use only agents and brokers licensed under state law to sell its plans, follow any state appointment law, and report agent terminations to the state as required.

Correct answer: Advertise the seminar and let interested prospects contact the agent to attend

Unsolicited direct contact, including door-to-door soliciting and outbound telemarketing without the prospect initiating contact, is prohibited, as are meals of any sort at promotional and sales events. Prospect-initiated contact is permitted.

Correct answer: Not sell her an annuity during that Medicare Advantage presentation

Cross-selling non-health products, such as annuities and life insurance, during any Medicare Advantage sales or marketing activity or presentation is prohibited.

Correct answer: A Medicare Advantage plan that includes prescription drug coverage (MA-PD)

An MA-PD plan delivers Part A and Part B benefits through a private plan and includes Part D drug coverage, putting hospital, medical, and drug coverage in one private plan. Joan qualifies because she has both Parts A and B.