Medicare: what you need to know

• A. Health insurance for people aged 65 and older, and certain younger people with disabilities ✓
• B. Health insurance for all low-income adults regardless of age
• C. Long-term care in nursing homes for any senior citizen
• D. Life insurance benefits for retired federal employees

Why: Medicare is a federal health insurance program primarily for people aged 65 and older, as well as certain younger people with disabilities and people with End-Stage Renal Disease. Low-income assistance is mainly Medicaid, and Medicare generally does not cover long-term custodial nursing home care.

• A. Part B
• B. Part C
• C. Part D
• D. Part A ✓

Why: Medicare Part A is hospital insurance. It covers inpatient hospital stays, skilled nursing facility care after a qualifying hospital stay, hospice, and some home health care.

• A. Prescription drugs
• B. Medical services such as doctor visits, preventive care, and outpatient services ✓
• C. Dental work and eyeglasses
• D. Emergency care received outside the United States

Why: Medicare Part B is medical insurance covering doctor visits, outpatient care, preventive services, durable medical equipment, and many other medically necessary services. Prescription drugs are covered under Part D, and dental and routine vision care are generally not covered by Original Medicare.

• A. A hospital insurance plan for people under 65
• B. An optional prescription drug coverage plan offered by private insurers ✓
• C. A supplemental dental coverage program
• D. A government pension paid to retired Medicare enrollees

Why: Medicare Part D is optional prescription drug coverage offered through private insurance companies approved by Medicare. Enrollees pay a monthly premium, and coverage varies by plan formulary.

• A. A free supplement that replaces Original Medicare entirely at no cost
• B. A plan run by a private insurer that bundles Part A and Part B coverage, often including drug coverage ✓
• C. A program that only covers emergency room visits
• D. A Medicaid program for seniors with high incomes

Why: Medicare Advantage (Part C) plans are offered by private insurers approved by Medicare. They must cover everything Original Medicare covers, usually bundle Parts A and B and often Part D, and may add benefits like vision or dental, typically using networks and sometimes requiring referrals.

• A. Part A ✓
• B. Part B
• C. Part C
• D. Part D

Why: Medicare Part A is hospital insurance and covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care.

• A. Part A
• B. Part B ✓
• C. Part C
• D. Part D

Why: Medicare Part B is medical insurance and covers doctor visits, outpatient care, preventive services, and durable medical equipment.

• A. A standalone prescription drug plan
• B. A supplemental policy that covers gaps in Original Medicare
• C. An alternative way to receive Part A and Part B benefits through a private insurer ✓
• D. A program that only covers hospice care

Why: Medicare Advantage (Part C) is offered by private insurers approved by Medicare and provides Part A and Part B coverage, often with extra benefits. It replaces Original Medicare rather than supplementing it.

• A. Part A
• B. Part B
• C. Part C
• D. Part D ✓

Why: Medicare Part D is the prescription drug benefit. It is offered through private plans approved by Medicare, and Medicare Advantage plans may also include drug coverage.

• A. Most people pay a monthly premium for Part A
• B. Most people pay no monthly premium for Part A because they paid Medicare taxes while working ✓
• C. Part A premiums are always higher than Part B premiums
• D. Part A is only available to people who buy Part D

Why: Most people do not pay a monthly premium for Part A because they or a spouse paid Medicare taxes for at least 10 years while working. Part B, by contrast, usually has a monthly premium.

• A. The 3 months before your 65th birthday only
• B. The 7-month window that includes the 3 months before, the month of, and the 3 months after your 65th birthday
• C. The entire calendar year in which you turn 65
• D. The 12 months following your 65th birthday

• A. January 1 through March 31
• B. October 1 through December 7
• C. November 15 through December 31
• D. April 1 through June 30

• A. The first day of the month after you sign up
• B. Immediately upon signing up
• C. The first day of the year following your sign-up
• D. Three months after you sign up

• A. January 1 through March 31 each year
• B. October 15 through December 7 each year
• C. July 1 through September 30 each year
• D. November 1 through November 30 each year

• A. Moving to a new ZIP code within the same county
• B. Turning 66 years old
• C. Losing employer group health coverage
• D. Receiving a Social Security cost-of-living adjustment

• A. A supplemental policy that covers only costs Original Medicare does not pay
• B. A private health plan approved by Medicare that replaces Original Medicare (Parts A and B) and typically includes drug coverage ✓
• C. A government-run plan that covers only hospital stays
• D. A free plan available to everyone regardless of Medicare enrollment

Why: Medicare Advantage (Part C) is offered by private insurers approved by Medicare. It replaces Original Medicare and usually includes prescription drug coverage and extra benefits, though it often has networks and copays.

• A. You can see any doctor in the country without a referral
• B. You must use in-network providers and generally need referrals to see specialists ✓
• C. No out-of-pocket maximum applies
• D. Premiums are always zero

Why: HMO plans require members to use a network of providers, except in emergencies, and usually require a primary care referral to see specialists.

• A. Only in the first month after turning 65
• B. From October 15 to December 7 each year ✓
• C. Only in April
• D. Only if they move to a new state

Why: The Annual Enrollment Period runs from October 15 through December 7. Changes made during this window take effect January 1 of the following year.

• A. There is no limit under any Medicare Advantage plan
• B. A limit set each year by Medicare, which plans cannot exceed ✓
• C. $10,000 for all plans
• D. The limit is set by each state government

Why: Medicare sets an annual maximum out-of-pocket limit for in-network covered services each year, and Medicare Advantage plans cannot exceed that cap, which provides protection against very high costs.

• A. Out-of-network doctors are not allowed to treat Medicare patients
• B. Using out-of-network providers may cost significantly more or may not be covered, except in some cases like emergencies ✓
• C. Network status only affects prescription drug prices
• D. Doctors are paid more by Medicare when they are in-network, so patients pay nothing

Why: Many Medicare Advantage plans, especially HMOs, cover care only from in-network providers. Out-of-network care may cost more or not be covered, so confirming your doctors are in network helps avoid unexpected bills.

• A. Part A
• B. Part B
• C. Part C
• D. Part D ✓

Why: Medicare Part D is the prescription drug benefit. It is offered through private insurance companies approved by Medicare and is available as a standalone Prescription Drug Plan (PDP) or bundled into a Medicare Advantage plan.

• A. Medigap
• B. Medicare Supplement
• C. MA-PD ✓
• D. PDP

Why: An MA-PD (Medicare Advantage with Prescription Drug coverage) plan combines Parts A, B, and usually D into one plan offered by a private insurer. PDP is a standalone drug plan, and Medigap is a supplement that does not include drug coverage.

• A. The monthly premium you pay for the plan
• B. A list of prescription drugs the plan covers, often grouped into tiers ✓
• C. The pharmacy network where you can fill prescriptions
• D. The annual deductible amount for Part D

Why: A formulary is the list of covered prescription drugs. Drugs are usually placed in tiers that determine how much you pay, with generics generally costing less than brand-name drugs.

• A. Nothing; you can always enroll later at no extra cost
• B. You may pay a late enrollment penalty added to your premium ✓
• C. You lose eligibility for Medicare Part B
• D. Your Part A coverage is reduced

Why: Going without creditable prescription drug coverage for 63 or more continuous days after your Initial Enrollment Period can result in a permanent late enrollment penalty added to your Part D premium. Enrolling outside the enrollment periods is generally limited to certain times of the year.

• A. Only during their first year on Medicare
• B. Only when they turn 65
• C. The Annual Enrollment Period from October 15 to December 7 ✓
• D. Only if they move out of state

Why: The Annual Enrollment Period runs from October 15 to December 7 each year. Changes made during this window take effect January 1 of the following year, allowing you to switch to a plan that better fits your medications and budget.

• A. Part A (Hospital Insurance)
• B. Part B (Medical Insurance) ✓
• C. Part D (Prescription Drug Coverage)
• D. Medigap Plan A

Why: Most people receive Part A premium-free because they or a spouse paid Medicare taxes for at least 10 years. Part B (Medical Insurance) generally charges a monthly premium, which is deducted from Social Security benefits for most enrollees.

• A. The monthly amount you pay for coverage
• B. The amount you must pay out of pocket before Medicare begins to pay its share of covered services ✓
• C. The percentage of costs you pay after meeting your deductible
• D. The maximum amount you could pay in a year

Why: A deductible is the amount you pay for covered services before Medicare starts paying its share. For example, Part B has an annual deductible that you must meet each calendar year before Medicare pays for most outpatient services.

• A. A fixed dollar copayment for each visit
• B. A percentage of the cost of a covered service that you pay after meeting your deductible ✓
• C. A premium paid to a private insurer
• D. The total cost of a hospital stay

Why: Coinsurance is a percentage of the Medicare-approved amount for a service that you pay after meeting your deductible. For example, under Part B you typically pay 20 percent of the approved cost of most services.

• A. It is always a percentage of the total cost
• B. It is a fixed dollar amount you pay for a specific service or prescription ✓
• C. It is paid only once per lifetime
• D. It is the same as a monthly premium

Why: A copayment is a fixed dollar amount, such as $20 for a doctor visit or $10 for a prescription. Coinsurance, by contrast, is a percentage of the cost of the service.

• A. It sets the highest premium you can be charged
• B. It limits the total amount you pay for covered services in a plan year, after which the plan pays 100 percent ✓
• C. It determines how much Social Security you receive
• D. It sets the price of prescription drugs in Part D

Why: Medicare Advantage plans must include an annual out-of-pocket maximum for in-network covered services. Once you reach this limit, you generally pay nothing more for covered care for the rest of that plan year, which protects you from very high costs.

• A. Enrolling in Part A before they turn 65
• B. Missing their Initial Enrollment Period and facing late enrollment penalties ✓
• C. Choosing a Medicare Advantage plan instead of Original Medicare
• D. Using doctors who accept Medicare assignment

Why: The Initial Enrollment Period lasts seven months around your 65th birthday. Missing it can lead to lifetime late enrollment penalties for Part B and Part D, and possibly gaps in coverage until the General Enrollment Period.

• A. You will always owe a penalty, regardless of your coverage
• B. You can enroll in Part B without penalty during a Special Enrollment Period when your employer coverage ends ✓
• C. You must enroll in Part B within 30 days of retiring
• D. Your employer coverage automatically converts to Medicare

Why: If you have creditable coverage through your own or a spouse's current employer, you can delay Part B without penalty and enroll during a Special Enrollment Period, typically within eight months of employment or coverage ending.

• A. Checking whether your preferred doctors and hospitals are in the plan's network
• B. Comparing out-of-pocket maximums across plans
• C. Assuming you can see any doctor nationwide without referrals or network limits ✓
• D. Reviewing the plan's prescription drug formulary

Why: Most Medicare Advantage plans, such as HMOs, restrict you to in-network providers and may require referrals. Assuming unrestricted access can lead to unexpected costs or needing to switch plans.

• A. January 1 through March 31
• B. April 1 through June 30
• C. October 15 through December 7 ✓
• D. July 1 through September 30

Why: The Annual Enrollment Period runs from October 15 through December 7 each year. Changes made during this window take effect January 1, so missing it can mean waiting a full year to adjust your coverage.

• A. Medigap plans only cover hospital stays
• B. Medigap policies sold after 2006 do not include prescription drug coverage ✓
• C. Prescription drugs are fully covered by Original Medicare Part A
• D. Medigap plans require you to also join a Medicare Advantage plan

Why: Medigap policies sold since 2006 do not include prescription drug coverage. You need a separate Part D plan or drug coverage through a Medicare Advantage plan to cover medications.