RMA Social Security & Medicare Benefits 2 — Questions and Answers
Question 1: Medicare Part A primarily covers which of the following services?
- Outpatient physician visits and lab tests
- Prescription drugs
- Inpatient hospital stays and skilled nursing facility care (Correct answer)
- Vision and dental care
Correct answer: Inpatient hospital stays and skilled nursing facility care
Medicare Part A is hospital insurance that covers inpatient hospital care, skilled nursing facility stays, hospice, and some home health services.
Question 2: Most Medicare-eligible individuals pay no premium for Part A because they or their spouse:
- Earned income over $100,000 for at least 5 years
- Paid Medicare payroll taxes for at least 40 quarters (Correct answer)
- Enrolled before age 65
- Maintained continuous employer coverage
Correct answer: Paid Medicare payroll taxes for at least 40 quarters
Workers who paid Medicare payroll taxes for 40 or more quarters (10 years) earn premium-free Part A eligibility.
Question 3: The Income-Related Monthly Adjustment Amount (IRMAA) affects which Medicare premiums?
- Part A only
- Part B only
- Parts B and D (Correct answer)
- Parts A, B, and D
Correct answer: Parts B and D
IRMAA surcharges apply to Medicare Part B (medical insurance) and Part D (prescription drug) premiums for higher-income beneficiaries.
Question 4: What is the general enrollment period for Medicare Part B for individuals who did not enroll at initial eligibility?
- January 1 – March 31 each year, with coverage starting July 1 (Correct answer)
- October 15 – December 7 each year
- Any time during the year with a 30-day waiting period
- Only during a Special Enrollment Period triggered by a qualifying event
Correct answer: January 1 – March 31 each year, with coverage starting July 1
The General Enrollment Period for Part B runs January 1 through March 31, with coverage beginning July 1, and a late enrollment penalty may apply.
Question 5: A client retires at age 63 and is covered under a spouse's employer group health plan. When must the client enroll in Medicare Part B without incurring a late enrollment penalty?
- Within 3 months of turning 65
- Within the 8-month Special Enrollment Period after the employer coverage ends (Correct answer)
- Within 63 days of losing employer coverage
- Any time before age 70
Correct answer: Within the 8-month Special Enrollment Period after the employer coverage ends
Individuals covered by an employer group plan based on current employment have an 8-month Special Enrollment Period once that coverage ends to enroll in Part B penalty-free.
Question 6: Medicare Advantage (Part C) plans are required to cover at minimum:
- Only Part A hospital benefits
- Only Part B outpatient benefits
- All services covered by Original Medicare Parts A and B (Correct answer)
- Parts A, B, and D benefits plus dental and vision
Correct answer: All services covered by Original Medicare Parts A and B
By law, Medicare Advantage plans must cover all services included in Original Medicare Parts A and B, though they may structure cost-sharing differently.
Question 7: Which coordination-of-benefits rule generally applies when a retiree has both Medicare and retiree employer health coverage?
- Medicare always pays primary regardless of other coverage
- Retiree group coverage always pays primary
- Medicare pays primary and retiree coverage is secondary (Correct answer)
- Coverage splits claims 50/50
Correct answer: Medicare pays primary and retiree coverage is secondary
For retirees (not actively employed), Medicare is the primary payer and retiree employer health coverage is secondary.
RMA Social Security & Medicare Benefits 2
Medicare Part A primarily covers which of the following services?