CCM CCM Financial & Benefits Navigation 1 — Questions and Answers
Question 1: Which federal program provides health insurance primarily to individuals aged 65 and older or those with certain disabilities in the US?
- Medicaid
- CHIP
- Medicare (Correct answer)
- TRICARE
Correct answer: Medicare
Medicare is the federal health insurance program for Americans 65+ and those with qualifying disabilities or end-stage renal disease.
Question 2: Medicare Part D covers which of the following?
- Hospital inpatient services
- Physician office visits
- Outpatient prescription drugs (Correct answer)
- Skilled nursing facility care
Correct answer: Outpatient prescription drugs
Medicare Part D is the prescription drug benefit, covering outpatient medications through approved private plans.
Question 3: A CCM case manager helping a low-income client access both Medicare and Medicaid benefits should be aware that these clients are called:
- Preferred beneficiaries
- Dual-eligible individuals (Correct answer)
- Co-insured members
- Supplemental enrollees
Correct answer: Dual-eligible individuals
Individuals who qualify for both Medicare and Medicaid are called 'dual-eligible' and require coordination of both programs' benefits.
Question 4: The Extra Help program (Low Income Subsidy) assists Medicare beneficiaries with:
- Hospital copayments only
- Part D prescription drug costs including premiums, deductibles, and copays (Correct answer)
- Home health aide services
- Dental and vision benefits
Correct answer: Part D prescription drug costs including premiums, deductibles, and copays
Extra Help (LIS) reduces or eliminates Part D drug plan costs — premiums, deductibles, and copayments — for qualifying low-income beneficiaries.
Question 5: When assisting a client with a Medicare Advantage (Part C) plan, the case manager should know that these plans:
- Provide identical coverage to Original Medicare with no differences
- Are offered by private insurers and may include extra benefits beyond Original Medicare (Correct answer)
- Do not require prior authorization for any services
- Only cover services within a hospital setting
Correct answer: Are offered by private insurers and may include extra benefits beyond Original Medicare
Medicare Advantage plans are private insurance alternatives to Original Medicare and often include additional benefits like dental, vision, or wellness programs.
Question 6: A client loses employer-sponsored health coverage. Under COBRA, they are typically eligible to continue coverage for up to:
- 6 months
- 12 months
- 18 months (Correct answer)
- 36 months
Correct answer: 18 months
COBRA continuation coverage is available for up to 18 months for employees and their dependents after qualifying events such as job loss.
CCM CCM Financial & Benefits Navigation 1
Which federal program provides health insurance primarily to individuals aged 65 and older or those with certain disabilities in the US?