CMS Medicare Specialist Coverage Planning Options 3 — Questions and Answers
Question 1: A client with Medicare Parts A and B wants to add drug coverage. They choose a standalone Part D plan. Which Medicare Supplement plan covers the Part B excess charges that Original Medicare may not fully cover?
- Plan A
- Plan D
- Plan G (Correct answer)
- Plan K
Correct answer: Plan G
Medicare Supplement Plan G covers Part B excess charges, protecting beneficiaries who see providers that do not accept Medicare assignment.
Question 2: What is the Medicare Advantage Open Enrollment Period (OEP) and when does it occur?
- October 15–December 7; allows all coverage changes
- January 1–March 31; allows MA enrollees to switch MA plans or return to Original Medicare once (Correct answer)
- April 1–June 30; allows enrollment in Part D only
- February 15–March 31; allows enrollment in Medigap only
Correct answer: January 1–March 31; allows MA enrollees to switch MA plans or return to Original Medicare once
The MA OEP runs January 1 through March 31 and allows current MA enrollees to make one plan change or switch back to Original Medicare.
Question 3: Which of the following best describes a Medicare Medical Savings Account (MSA) plan?
- A plan with no deductible and low copays funded by Medicare
- A high-deductible Medicare Advantage plan paired with a tax-advantaged savings account funded by Medicare (Correct answer)
- A savings account beneficiaries fund to pay Medicare premiums
- A Part D plan with a savings component for drug costs
Correct answer: A high-deductible Medicare Advantage plan paired with a tax-advantaged savings account funded by Medicare
MSA plans combine a high-deductible Medicare Advantage plan with a special savings account that Medicare deposits money into to help pay medical costs.
Question 4: A client has both Medicare and Medicaid (dual eligible). Which statement about their coverage coordination is correct?
- Medicare always pays after Medicaid for all services
- Medicare is the primary payer and Medicaid is the payer of last resort (Correct answer)
- Medicaid covers all costs not covered by Medicare with no limitations
- Dual eligibles must choose between Medicare and Medicaid coverage
Correct answer: Medicare is the primary payer and Medicaid is the payer of last resort
For dual-eligible beneficiaries, Medicare always pays first as the primary payer, and Medicaid may cover remaining cost-sharing as the payer of last resort.
Question 5: What is a Medicare Advantage Special Needs Plan (SNP) and who qualifies?
- A plan for any Medicare beneficiary who wants specialty care
- A plan specifically designed for individuals with certain diseases, dual eligibles, or institutionalized individuals (Correct answer)
- A plan for beneficiaries under age 65 only
- A plan providing enhanced dental and vision benefits for all enrollees
Correct answer: A plan specifically designed for individuals with certain diseases, dual eligibles, or institutionalized individuals
SNPs are Medicare Advantage plans tailored to specific populations: chronic condition SNPs (C-SNPs), dual-eligible SNPs (D-SNPs), or institutional SNPs (I-SNPs).
Question 6: Under the Part D standard benefit structure, what is the significance of the True Out-of-Pocket (TrOOP) threshold?
- It is the point at which Medicare pays 100% of drug costs with no further cost-sharing (Correct answer)
- It is the deductible amount a beneficiary must meet before coverage begins
- It is the premium cap for low-income beneficiaries
- It is the maximum formulary tier level allowed under Part D regulations
Correct answer: It is the point at which Medicare pays 100% of drug costs with no further cost-sharing
Once a beneficiary's TrOOP costs reach the catastrophic threshold, Medicare pays the vast majority of remaining drug costs with minimal cost-sharing for the rest of the year.
Question 7: A beneficiary enrolled in a Medicare Cost plan moves to a new county still served by the same plan. What enrollment action is typically required?
- They must re-enroll in the plan for the new service area
- No action is needed as Cost plans typically adjust service areas automatically (Correct answer)
- They must disenroll and join a new plan
- They must notify CMS within 30 days to maintain coverage
Correct answer: No action is needed as Cost plans typically adjust service areas automatically
Medicare Cost plans generally allow beneficiaries to continue coverage if they remain within the plan's service area without requiring re-enrollment.
CMS Medicare Specialist Coverage Planning Options 3
A client with Medicare Parts A and B wants to add drug coverage.
They choose a standalone Part D plan.
Which Medicare Supplement plan covers the Part B excess charges that Original Medicare may not fully cover?