CMS Medicare Specialist Coverage Planning Options 2

Question 1

A Medicare beneficiary with End-Stage Renal Disease (ESRD) wants to enroll in a Medicare Advantage plan. Which statement is most accurate?

Accepted Answer

ESRD patients may enroll in Medicare Advantage plans that specifically serve ESRD patients

Answer

Since 2021, individuals with ESRD may enroll in any Medicare Advantage plan available in their area, ending the prior restriction.

Question 2

When comparing Medicare Supplement Plan G and Plan N for a client, what is the key difference in cost-sharing?

Accepted Answer

Plan N requires copays for office visits and emergency room visits while Plan G does not

Answer

Plan N requires copays up to $20 for office visits and up to $50 for emergency room visits that don't result in inpatient admission, whereas Plan G has no such copays.

Question 3

A client is enrolled in a Medicare Advantage plan and moves permanently to another state where their plan has no network. What is their best option?

Accepted Answer

They qualify for a Special Enrollment Period to switch plans or return to Original Medicare

Answer

A permanent move outside a Medicare Advantage plan's service area triggers a Special Enrollment Period, allowing the beneficiary to change plans.

Question 4

Medicare Part D's 'creditable coverage' concept is most important for which planning scenario?

Accepted Answer

Avoiding the Part D late enrollment penalty when delaying enrollment

Answer

Drug coverage is 'creditable' if it's at least as good as standard Medicare Part D, and having it allows beneficiaries to delay Part D enrollment without incurring a late penalty.

Question 5

Which Medicare coverage option allows beneficiaries to see any provider who accepts Medicare without referrals?

Accepted Answer

Original Medicare (Parts A and B)

Answer

Original Medicare allows beneficiaries to visit any provider nationwide who accepts Medicare assignment without needing referrals or network restrictions.

(CMS) Certified Medicare Specialist Practice Test

(CMS) Certified Medicare Specialist Practice Test

CMS Medicare Specialist Coverage Planning Options 2