Competency 14 Section 2

Question 1

1. The initial enrollment period for Medicare Part A is 2 months prior to the individual’s birth month, the individual’s birth month, and the following 2 months, which is a 5-month enrollment window

Answer 1

False. The initial enrollment period is 3 months prior to the individuals’ birth month, the individual’s birth month, and the following 3 months, which is a 7-month enrollment window. (LO 14-2-1) a. Some people are automatically enrolled in Medicare—including those individuals who are receiving Social Security benefits, railroad retirement benefits, or have been receiving Medicare because they have been eligible for Social Security disability benefits for 24 months. Others have to enroll.

b. It is important to enroll during the initial enrollment period.
c. This is the seven-month period that begins three months before the month an individual turns 65, includes the month attaining 65, and ends three months after the month attaining 65.
d. Failing to sign up during the initial enrollment period can result in a penalty and the individual will have to wait until the general enrollment period to sign up again. e. General enrollment is January 1–March 31 each year but coverage does not begin until July 1 following sign up.

FCH = May 13 = Feb / Mar/ Apr/ MAY / Jun/July/Aug/

Question 2

2. The initial enrollment period of a 7-month enrollment window for Part A is the same for Part B enrollment

Answer 2

True. (LO 14-2-1)

Question 3

3. Medicare Part A and B have an out-of-pocket limit to protect participants from catastrophic medical costs.

Answer 3

False. There is no out-of-pocket limitation for Part A or B, which is why supplemental insurance is so important. (LO 14-2-1)

Question 4

4. A “benefit period” under Part A starts on the first day of an inpatient hospital stay and ends after 60 consecutive days in which the participant has not received inpatient care at a hospital or skilled nursing facility

Answer 4

True. (LO 14-2-1)

Part A starts on the first day of an inpatient hospital stay and ends after 60 consecutive days in which the participant has not received inpatient care at a hospital or skilled nursing facility

Question 5

5. An individual does not have to pay the $1,184 Part A deductible more than once a year.

Answer 5

False. The deductible will be paid every time a benefit period is initiated, which means a Medicare participant could have to pay the Part A $1,184 deductible several times during a year. (LO 14-2-1)

Question 6

6. Medicare covers long-term care costs.

Answer 6

False. This is a significant health cost that is not covered at all under Medicare. (LO 14-2-1)

Question 7

7. There is a late enrollment penalty for Medicare Part B.

Answer 7

True. (LO 14-2-1)

Question 8

8. Medicare Part B premiums are standard for all individuals, regardless of income level.

Answer 8

False. Medicare Part B premiums are means tested. The higher the income of the individual, the larger the premiums. (LO 14-2-1)

Question 9

9. Medicare Part B has a coinsurance rate that is not subject to an out of pocket limitation.

Answer 9

True. (LO 14-2-1)

Medicare Part B has a coinsurance rate that is not subject to an out of pocket limitation

Question 10

10.Long-term care is not covered by Medicare

Answer 10

True. (LO 14-2-2)

Question 11

11.Medicare Part B covers medically necessary services, such as doctor’s services, tests, outpatient care, and a number of other medical services.

Answer 11

True. (LO 14-2-2)

B= Doctors / Outpatient

Question 12

12.Medicare Part B covers routine dental, hearing, and vision care.

Answer 12

False. This is not covered by Medicare Parts A or B.

dental, hearing, and vision care. (LO 14-2-2)

Question 13

13.Prescription drugs that are administered during an inpatient hospital stay are covered by Medicare Part A.

Answer 13

True. (LO 14-2-2)

Question 14

14.Hospice care services are covered by Medicare Part A if the participant’s life expectancy is 6 months or less and is certified by a doctor.

Answer 14

True. (LO 14-2-2)

.Hospice care services are covered by Medicare Part A if the participant’s life expectancy is 6 months or less and is certified by a doctor.

Question 15

15.There is a late enrollment penalty for Medicare Part D.

Answer 15

True. (LO 14-2-3)

B and D

Question 16

16.Medicare Part D has means tested premiums

Answer 16

True. (LO 14-2-3)

B and D

Question 17

17.Participants in Medicare Part D cannot change plans after their initial enrollment choice.

Answer 17

False. Once enrolled in a plan, they cannot change plans during the year. They must wait until the next open enrollment period to change plans. (LO 14-2-3)

Question 18

18.All Medicare Part D formularies are uniform so this is a factor that need not be addressed when helping a client pick a Part D plan

Answer 18

False. There can be drastic differences between formularies, therefore it will be an important factor to consider when helping a client choose a Part D plan. (LO 14-2-3)

Question 19

19.Part D plans only have a monthly premium, and no other cost-sharing associated with them.

Answer 19

False. Part D plans may have

premiums,

copayments,

coinsurance,

and a deductible.

(LO 14-2-3)

Question 20

20.The overall cost of a Part D plan will be a significant factor to consider when helping a client choose a plan

Answer 20

True. (LO 14-2-5)

Question 21

21.The formulary and a client’s prescription drug needs will be important to compare when choosing a Part D plan.

Answer 21

True. (LO 14-2-5)

Question 22

22.The coverage gap or “donut hole” of Part D is a major planning concern

Answer 22

True. (LO 14-2-6)

Question 23

23.The Affordable Care Act does nothing to eliminate the Part D “donut hole,” therefore it will continue to be a planning issue

Answer 23

False. ACA reduces the coverage gap or “donut hole” over the next 8 years making it less and less of a planning issue. (LO 14-2-6)

Question 24

24.Part D premiums are means tested.

Answer 24

True. (LO 14-2-6)

Question 25

25.The Part D late enrollment penalty will be paid so long as the participant is enrolled in a Part D plan

Answer 25

True. The late enrollment penalty never expires.

A and B

(LO 14-2-6)

Question 26

26.The Part D late enrollment penalty is applied after a participant fails to enroll during the initial enrollment period or there is a period of 63 or more days in a row when the participant does not have a Medicare Part D plan or other creditable coverage.

Answer 26

True. (LO 14-2-6)

The Part D late enrollment penalty is applied after a participant fails to enroll during the initial enrollment period or there is a period of 63 or more days in a row when the participant does not have a Medicare Part D plan or other creditable coverage.

Question 27

16. In 2013, which of the following is the amount of the Part A inpatient hospital deductible? (LO 14-2-1)

A. $1,054 is the 2013 Part A inpatient hospital deductible.

B. $1,184 is the 2013 Part A inpatient hospital deductible.

C. $2,000 is the 2013 Part A inpatient hospital deductible.

D. $2,154 is the 2013 Part A inpatient hospital deductible.

Answer 27

16. The answer is B. $1,184 is the correct deductible for 2013. PART A….eleven eighty four

Question 28

17. Shannon will turn 65 on May 5, 2013 and become eligible for Medicare. Which of the following reflects her initial enrollment period timeline for Medicare Part A? (LO 14-2-1)

A. Shannon may enroll during any of the following months: February, March, April, May, June, July, or August.

B. Shannon may enroll during May only.

C. Shannon may enroll during March, April and May only.

D. Shannon may enroll during any of the following months: May, June, July, August, September, October, or November.

Answer 28

17. The answer is A.

The period is 3 months prior to the month in which the individual turns 65, that month, and the 3 months following (7-month window).

Question 29

45. Which of the following statements about the Medicare Part D late enrollment penalty are true? (LO 14-2-3)

I. The late enrollment penalty applies to the entire time that the individual is enrolled in Part D.

II. The penalty amount is a 10 percent penalty added to the premium for each full year of late enrollment.

A. I only

B. II only

C. Both I and II

D. Neither I nor II

Answer 29

45. The answer is A. Statement II is incorrect.

. The late enrollment penalty applies to the entire time that the individual is enrolled in Part D.

The late enrollment penalty for Part D is calculated by multiplying 1 percent of the “national base beneficiary premium” ($31.08 in 2012) times the number of full, uncovered months the participant was eligible but did not join a Medicare Part D plan and was without creditable prescription drug coverage from another plan.

Question 30

46. Which of the following statements about Medicare Part D are true? (LO 14-2-5)

I. The Affordable Care Act reduces the amount that Medicare Part D enrollees are required to pay for their prescriptions when they reach the coverage gap.

II. In 2010, Part D enrollees that reached the coverage gap received a $250 rebate due to the Affordable Care Act.

A. I only

B. II only

C. Both I and II

D. Neither I nor II

Answer 30

46. The answer is C. Both statements are correct.

In 2010, Part D enrollees that reached the coverage gap received a $250 rebate due to the Affordable Care Ac

Question 31

74. All of the following types of services and care are covered to some extent by Medicare Part B EXCEPT (LO 14-2-2)

A. Preventive care services

B. Durable medical equipment

C. Custodial care

D. Outpatient care

Answer 31

74. The answer is C. Many clients are unaware that Medicare Part B does not cover the cost of custodial care.

It does cover flu shots, screening tests, smoking and obesity counseling, a welcome to Medicare physical, and annual wellness exams