CSS CSS Medicare & Medicaid Benefits 2 — Questions and Answers
Question 1: Medicaid's 'spend-down' provision allows seniors to qualify for benefits by:
- Investing assets in annuities
- Reducing countable assets to the state's resource limit (Correct answer)
- Transferring assets to adult children
- Applying for Social Security early
Correct answer: Reducing countable assets to the state's resource limit
Medicaid spend-down requires seniors to reduce their countable assets to the program's resource limit through allowable expenditures before qualifying for benefits.
Question 2: What is the 'Medicare donut hole' (coverage gap) in Part D?
- A period with no Medicare coverage
- A temporary gap where beneficiaries pay more for prescription drugs after initial coverage (Correct answer)
- A deductible that applies to hospital stays
- A waiting period before Part D begins
Correct answer: A temporary gap where beneficiaries pay more for prescription drugs after initial coverage
The Part D coverage gap (donut hole) is a phase where beneficiaries historically paid more out-of-pocket for drugs after total drug costs exceeded an initial coverage limit.
Question 3: What is Medicaid's 'estate recovery' program?
- A program that gifts assets to Medicaid recipients
- A state's right to recover Medicaid costs from a beneficiary's estate after death (Correct answer)
- A process for appealing Medicaid denials
- An estate planning service offered by Medicaid
Correct answer: A state's right to recover Medicaid costs from a beneficiary's estate after death
Medicaid estate recovery allows states to recoup costs paid for nursing home and other long-term care services from the deceased beneficiary's estate.
Question 4: Which Medicare benefit covers a senior's need for medically necessary part-time skilled nursing care at home?
- Part A SNF benefit
- Medicare Home Health benefit (Correct answer)
- Part B outpatient therapy
- Medicare Advantage extra benefits
Correct answer: Medicare Home Health benefit
The Medicare Home Health benefit covers part-time skilled nursing, physical therapy, and home health aide services for homebound beneficiaries.
Question 5: What is the Medicare 'Initial Coverage Election Period' (ICEP) for Part D?
- The annual fall enrollment window
- The 7-month window around a person's 65th birthday to enroll in Part D (Correct answer)
- A special period after leaving employer coverage
- The open enrollment period for Marketplace plans
Correct answer: The 7-month window around a person's 65th birthday to enroll in Part D
The ICEP for Part D aligns with the Initial Enrollment Period—three months before, the month of, and three months after turning 65.
Question 6: Which Medicaid waiver program allows states to provide home and community-based services as an alternative to nursing home placement?
- Section 1115 Research Waiver
- 1915(c) Home and Community-Based Services Waiver (Correct answer)
- Medicare Advantage waiver
- COBRA waiver
Correct answer: 1915(c) Home and Community-Based Services Waiver
Section 1915(c) HCBS waivers allow states to offer community-based long-term services and supports to individuals who would otherwise require nursing facility level of care.
CSS CSS Medicare & Medicaid Benefits 2
Medicaid's 'spend-down' provision allows seniors to qualify for benefits by: