CMS Medicare Specialist Benefits & Drug Coverage 2 — Questions and Answers
Question 1: Which Medicare plan type combines Part A, Part B, and usually Part D coverage into a single plan?
- Medigap
- Medicare Part C (Medicare Advantage) (Correct answer)
- Medicare SELECT
- Medicare Cost Plan
Correct answer: Medicare Part C (Medicare Advantage)
Medicare Advantage (Part C) plans are offered by private insurers and bundle hospital, medical, and usually drug coverage.
Question 2: A Medicare Advantage plan that requires referrals to see specialists and uses a primary care gatekeeper is called a:
- PPO
- HMO (Correct answer)
- PFFS
- SNP
Correct answer: HMO
HMO plans typically require beneficiaries to select a primary care physician and obtain referrals for specialist visits.
Question 3: What is a Special Needs Plan (SNP) designed to do?
- Cover only preventive services
- Tailor benefits to specific groups such as dual-eligibles or those with chronic conditions (Correct answer)
- Provide coverage only outside the US
- Replace Original Medicare entirely
Correct answer: Tailor benefits to specific groups such as dual-eligibles or those with chronic conditions
SNPs are a type of Medicare Advantage plan designed to serve beneficiaries with specific needs, such as dual-eligible individuals or those with severe chronic conditions.
Question 4: Which document must Medicare Advantage plans provide annually that summarizes plan costs, benefits, and rules?
- Notice of Creditable Coverage
- Annual Notice of Change (ANOC) (Correct answer)
- Medicare Summary Notice
- Explanation of Benefits
Correct answer: Annual Notice of Change (ANOC)
Plans must send an Annual Notice of Change (ANOC) by September 30 each year so beneficiaries can review changes before the Annual Enrollment Period.
Question 5: What is the Medicare Annual Enrollment Period (AEP) for Medicare Advantage and Part D plans?
- January 1 to March 31
- April 1 to June 30
- October 15 to December 7 (Correct answer)
- July 1 to September 30
Correct answer: October 15 to December 7
The AEP runs October 15 through December 7 each year, during which beneficiaries can join, switch, or drop Medicare Advantage or Part D plans.
Question 6: Medicare Supplement (Medigap) policies are standardized by the federal government and labeled with:
- Numbers 1 through 10
- Letters A through N (Correct answer)
- Colors such as Gold, Silver, and Bronze
- Tiers such as Basic, Standard, and Premium
Correct answer: Letters A through N
Medigap plans are standardized and identified by letters A through N, with each letter offering a defined set of benefits regardless of the insurer.
CMS Medicare Specialist Benefits & Drug Coverage 2
Which Medicare plan type combines Part A, Part B, and usually Part D coverage into a single plan?