CHAA Payer Types and Coordination of Benefits (COB) 2

Question 1

What is the primary difference between Medicare Part A and Medicare Part B coverage?

Accepted Answer

Part A covers inpatient hospital, skilled nursing, hospice, and home health; Part B covers outpatient services, physician visits, and preventive care

Answer

Part A focuses on inpatient/facility care and Part B on outpatient/professional services.

Question 2

A 67-year-old working patient has both Medicare and an employer group health plan. Which is primary?

Accepted Answer

The employer plan is primary if the employer has 20 or more employees

Answer

Under MSP working-aged rules, the employer plan is primary if the employer has 20+ employees.

Question 3

What is Medicaid, and how does it differ from Medicare?

Accepted Answer

Medicaid is a joint federal-state program for low-income individuals; Medicare is federal for those 65+ or with certain disabilities

Answer

Medicaid is needs-based (income) while Medicare is entitlement-based (age/disability).

Question 4

For a dual-eligible patient (Medicare and Medicaid), what is the COB order?

Accepted Answer

Medicare is primary; Medicaid is secondary covering cost-sharing amounts

Answer

Medicare is always primary for dual-eligible patients; Medicaid covers deductibles and copayments.

Question 5

What is TRICARE, and which population does it serve?

Accepted Answer

The healthcare program for active duty military, veterans, retirees, and their families

Answer

TRICARE is the DoD healthcare system serving military members, retirees, and dependents.

CHAA - Certified Healthcare Access Associate Practice Test