MI Pro Level 1, Course 2: Medicare Overview

Question 1

Who is eligible for Medicare?

Answer 1

Health insurance for people 65+ or qualify for disability.

Question 2

What are the two ways beneficiaries can access Medicare benefits?

Answer 2

Original Medicare – Traditional Medicare program administered by federal government.
Medicare Advantage – Medicare private health plans managed by private insurance companies that contract with the federal government.

Question 3

Medicare Part A covers mostly?

Answer 3

Hospital/Inpatient services, Skilled Nursing Facilities 

Question 4

Medicare Part B covers mostly?

Answer 4

Outpatient services, Durable Medical Equipment

Question 5

What is Medicare part D?

Answer 5

Prescription drug coverage.

Question 6

Is Medicare Part D offered through Medicare or private insurance companies?

Answer 6

Private insurance companies.

Question 7

Medicare Advantage plans or Part C can consist of what 3 parts of Medicare?

Answer 7

Hospital insurance (Part A), Medical insurance (Part B) & usually Prescription drug coverage (Part D).

Question 8

Medicare Advantage plans are offered by private companies. What parts of Medicare do I have to be enrolled in to be eligible for a Medicare Advantage plan?

Answer 8

Medicare Part A & Part B.

Question 9

What colors are on the Original Medicare card?

Answer 9

Red, White, & blue.

Question 10

Individuals are Medicare-eligible the first day of their__________.

Answer 10

65th birthday month.

Question 11

Individuals 65+ are eligible for Medicare if one or two conditions are met:

Answer 11

They either receive or qualify for social security retirement cash benefits or they current reside in the United States and are either A U.S. citizen Or a permanent U.S. resident who has lived in the U.S. continuously for five years prior to applying.

Question 12

If I am receiving social security retirement benefits at the age of 62 does that mean I can receive Medicare benefits at 62?

Answer 12

Medicare eligibility begins at the age of 65, regardless of when Social Security retirement benefits start. If an individual is already collecting SS benefits they will be automatically enrolled in Medicare, otherwise they must actively enroll.

Question 13

Is Medicare eligibility based on work history?

Answer 13

Work history affects Medicare costs, but not eligibility. If you have met the work history requirements you can receive premium free part A.

Question 14

Individuals under 65 are eligible for Medicare if they have been receiving Social Security Disability Insurance for___________

Answer 14

24 Months or the first day of the 25th month of receiving SSDI. Exception: Those who receive SSDI because they have ALS. These individuals are eligible the first month of their SSDI benefits.

Question 15

Individuals are eligible for Medicare under the age of 65 if they have been receiving disability benefits for 24 months or___________?

Answer 15

Have End-Stage Renal Disease (ESRD)

Question 16

What are the two different agencies involved in the Medicare program?

Answer 16

Social Security Administration & Centers for Medicare & Medicaid Services (CMS)

Question 17

The Social security Administration is responsible for what?

Answer 17

Administers SSA and programs, retirement benefits and provides extra help with Part D. They facilitate initial Medicare enrollment and sends replacement Medicare cards.

Question 18

Centers for Medicare & Medicaid Services (CMS) is responsible for?

Answer 18

Medicare: Writes coverage rules, approves Medicare advantage plans contracts.
Medicaid: Writes minimum standards, reviews and approves Medicaid plans, and undertakes improvement initiatives with local partners.

Question 19

If I am dual eligible for Medicare & Medicaid, what additional benefits does Medicaid provide?

Answer 19

Out-of-pocket expenses for Medicare-covered services, some excluded services: dental, vision or hearing.

Question 20

What is the difference between Medicare and Medicaid?

Answer 20

Federal. Eligibility based on age or disability status, not income.
Federal and state funded, state administered health insurance. Eligibility base on state income and asset limits.