cms world of medicare

Choose the sentence which correctly describes Medicare Advantage (MA) Plans: A.Beneficiaries must be entitled to Medicare Part A, enrolled in Part B, and live in the plan service area to be eligible to enroll in an MA Plan. B.MA Plans always include prescription drug coverage. C.Beneficiaries may enroll in MA Plans during anytime of the year. D.To enroll in an MA Plan, individuals need not be enrolled in Medicare Part B.

A.Beneficiaries must be entitled to Medicare Part A, enrolled in Part B, and live in the plan service area to be eligible to enroll in an MA Plan.

Providers that submit claims for Part A services include: A.Hospitals B.Physicians C.Suppliers D.Non-physician practitioners

A.Hospitals

Select the TRUE statement about Part D plan formularies: A.Formularies must include all Medicare Part D-covered drugs. B.A formulary is a list of drugs covered by a Medicare Prescription Drug Plan. C.All drugs on a plan's formulary always need prior authorization from the plan before they will be covered. D.Plans must notify beneficiaries 365 days in advance of formulary changes that affect a drug they take.

B. A formulary is a list of drugs covered by a Medicare Prescription Drug Plan

Medicare Part B benefits include: A. Inpatient hospital facility care B. Doctor services and outpatient care C. Skilled Nursing Facility (SNF) care D. Hospice care

B. Doctor services and outpatient care

Choose the best definition of Medicare: A.Medicare is a Federal health insurance program created by Congress for government workers and their spouses only. B.Medicare is a national health insurance program that provides hospital insurance, medical insurance, and a voluntary prescription drug benefit. C.The Medicare Program began in 1990 to establish health insurance for the poor and medically indigent. D.Only people age 65 or older are eligible for Medicare.

B. Medicare is a national health insurance program that provides hospital insurance, medical insurance, and a voluntary prescription drug benefit

Medicare Part A benefits include: A.Doctor services B.Inpatient hospital care C.Outpatient care D.Durable medical equipment

B.Inpatient hospital care

Medicare Part A is also known as: A.Supplemental Insurance B.Medical Insurance C.Hospital Insurance D.Long-Term Care Insurance

C. Hospital Insurance

Choose the type of care that is NOT covered by Medicare Part B: A.Doctors' Services B.Preventive Services C.Outpatient Services D.Inpatient Hospital Facility Services

D. Inpatient Hospital Facility Services

Choose the correct statement about Medigap: A.If a beneficiary drops their Medigap policy, they can get it back at any time. B.To be eligible for Medigap, beneficiaries need only be enrolled in Medicare Part A. C.Medigap policies currently sold include prescription drug coverage. D.Medigap helps pay some of the health care costs that the Original Medicare Plan doesn't cover.

D. Medigap helps pay some of the health care costs that the Original Medicare Plan doesn't cover

A Medicare Fee-For-Service (FFS) Contractor is an organization that has an agreement with the Centers for Medicare & Medicaid Services (CMS) to administer the Medicare FFS Program within a specified jurisdiction.

true

A Medicare Fee-For-Service (FFS) Contractor's responsibilities include enrolling providers into Medicare Advantage (MA) Plans, processing Medicare claims, and assisting beneficiaries with the appeals process.

false

A beneficiary does not need to be enrolled in the Original Medicare Plan to purchase a Medigap policy

false

All beneficiaries are automatically enrolled in a Medicare Prescription Drug Plan with a formulary when they become eligible for Medicare.

false

Each Medicare Prescription Drug Plan has a formulary for beneficiaries enrolling in the plan.

false

MA Plans do not generally have provider networks. MA Plan members may use any provider for their health care services

false

People in the Original Medicare Plan can add prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting a Medigap policy that includes prescription drug coverage.

false

Providers and other health care professionals are automatically enrolled in the Medicare Program

false

The Railroad Retirement Board (RRB) oversees the entire Medicare Program

false

A Private Fee-For-Service (PFFS) Plan is a type of MA Plan in which beneficiaries may go to any Medicare-approved provider if the provider agrees to accept the plan's terms of payment before treating the beneficiary

true

A physician is an example of a provider that submits claims for Part B services.

true

Beneficiaries are enrolled in the Medicare Program through an automatic enrollment process or by applying to the program when they are eligible.

true

Beneficiaries should enroll in both a Medicare Advantage (MA) Plan and Medigap to ensure they have complete health insurance coverage.

true

If a Medicare Advantage (MA) organization declines to include a provider in its network, it must furnish a written notice to the provider of the reason for the decision.

true

In addition to Part A and Part B Medicare coverage, MA Plans may offer extra benefits such as vision, hearing, dental and/or health and wellness programs and many include prescription drug coverage.

true

Individuals under age 65 who have certain disabilities will automatically receive Part A after they receive disability benefits from the Social Security Administration (SSA) or Railroad Retirement Board (RRB) for 24 months.

true

Items and services that Medicare does not generally cover include cosmetic surgery, hearing aids, and long-term care

true

Medicare Prescription Drug Plan benefits can vary regarding which prescription drugs are covered, how much the beneficiary pays, and which pharmacies the beneficiary can use

true

Medicare beneficiaries can receive their Medicare benefits, Part A and Part B, through the Original Medicare Plan or through a Medicare Advantage (MA) Plan

true

People with Medicare can obtain prescription drug coverage by either joining a Medicare Prescription Drug Plan or selecting an MA Plan that includes prescription drug coverage

true

Providers and other health care professionals may enroll in the Medicare Program and also be selected as a provider in a Medicare Advantage (MA) Plan.

true

Providers submitting claims for Part A benefits include, but are not limited to, hospitals, Skilled Nursing Facilities (SNFs), Home Health Agencies (HHAs), and hospices

true

The Medicare Program serves the aged, certain disabled individuals, and individuals of any age who have been determined to have End-Stage Renal Disease (ESRD).

true

The Original Medicare Plan includes Part A and Medicare Advantage (MA) Plan benefits.

true

The Original Medicare Plan includes Part A and Part B and is administered by Medicare Fee-For-Service (FFS) Contractors

true