CMS Medicare Specialist Benefits & Drug Coverage 1 — Questions and Answers
Question 1: Which Medicare part provides outpatient prescription drug coverage?
- Part A
- Part B
- Part C
- Part D (Correct answer)
Correct answer: Part D
Medicare Part D is the voluntary outpatient prescription drug benefit added by the Medicare Modernization Act of 2003.
Question 2: What is a Medicare Part D formulary?
- A list of covered prescription drugs (Correct answer)
- A schedule of premium payments
- A network of pharmacies
- A list of covered medical procedures
Correct answer: A list of covered prescription drugs
A formulary is the plan's list of covered prescription drugs, typically organized into cost-sharing tiers.
Question 3: What does the Low Income Subsidy (LIS) program help Medicare beneficiaries with?
- Hospital co-pays
- Part D premiums, deductibles, and co-pays (Correct answer)
- Part A enrollment fees
- Supplemental vision coverage
Correct answer: Part D premiums, deductibles, and co-pays
LIS, also called Extra Help, assists eligible low-income beneficiaries with Part D premium, deductible, and cost-sharing costs.
Question 4: During the Medicare Part D Initial Coverage Period, a beneficiary pays their plan's cost-sharing until total drug costs reach what threshold (2024)?
- $545
- $1,000
- $5,030 (Correct answer)
- $8,000
Correct answer: $5,030
In 2024, the Initial Coverage Period ends when total drug costs (plan plus beneficiary) reach $5,030.
Question 5: Which of the following is NOT a standard Part D coverage phase?
- Deductible Phase
- Initial Coverage Period
- Coverage Gap
- Extended Benefit Period (Correct answer)
Correct answer: Extended Benefit Period
The standard Part D phases are the Deductible Phase, Initial Coverage Period, Coverage Gap, and Catastrophic Coverage; there is no Extended Benefit Period.
Question 6: What is the maximum standard Part D deductible for 2024?
- $100
- $240
- $545 (Correct answer)
- $800
Correct answer: $545
The standard maximum Part D deductible is $545 in 2024, though plans may offer lower or $0 deductibles.
CMS Medicare Specialist Benefits & Drug Coverage 1
Which Medicare part provides outpatient prescription drug coverage?