MEDICARE AGENT & BROKER CERTIFICATION EXAM UPDATED
QUESTIONS AND ANSWERS
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if so, what the benefit
includes. Where would the agent find this information for plan XYZ? - CORRECT ANSWER✅✅Evidence
of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the answer would be
Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a specialist, you should tell
her: - CORRECT ANSWER✅✅You will likely need a referral from your primary care physician (PCP) to see
a specialist. If you see your specialist without this referral, the plan may not pay for your visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to seeing a specialist
(except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly premium, he no
longer needs to pay his Part B premium. - CORRECT ANSWER✅✅False
Beneficiaries are required to continue paying their Part B premium (unless they receive Extra Help) in
addition to any plan-specific premium.
Define: Medicare Part A - CORRECT ANSWER✅✅Part A of Medicare covers hospital inpatient care,
some SNF care, and home health and hospice care
Define: Medicare Part B - CORRECT ANSWER✅✅Part B of Medicare covers physician services,
outpatient hospital care, lab tests, mental health services, some preventative services, and medical
equipment considered medically necessary to treat a disease or condition
, Define: Medicare Part C - CORRECT ANSWER✅✅Part C of Medicare provides an option for beneficiaries
to receive private health plan coverage in lieu of Original Medicare
Define: Medicare Part D - CORRECT ANSWER✅✅Part D of Medicare provides prescription drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January during her Initial
Coverage Election Period (ICEP). When will her coverage begin? - CORRECT ANSWER✅✅On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A and Part B, OR
the first of the month following the month the enrollment request was made (if after entitlement has
occurred).
What enrollment period provides an opportunity for a beneficiary to move from Original Medicare to an
MA plan? - CORRECT ANSWER✅✅The Annual Election Period (AEP) for enrolling in an MA Plan is
October 15 through December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage Election Period
(ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP? - CORRECT ANSWER✅✅January 1 through
February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare (with/without a
stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a Special Enrollment Period?
- CORRECT ANSWER✅✅The member recently moved into a nursing home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as a nursing home,
he or she is eligible for a SEP. He/She would also be eligible for an SEP as a result of moving out of the
plan's service area or if his/her current plan is terminated.
QUESTIONS AND ANSWERS
A prospective beneficiary asks an agent if plan XYZ has an urgent care benefit and if so, what the benefit
includes. Where would the agent find this information for plan XYZ? - CORRECT ANSWER✅✅Evidence
of Coverage
Because the beneficiary asked if plan XYZ has an urgent care benefit and what the benefit includes.
If the beneficiary only wanted to know if plan XYZ has an urgent care benefit, the answer would be
Summary of Benefits & Evidence of Coverage.
If a beneficiary who is enrolled in an HMO tells you that she wants to see a specialist, you should tell
her: - CORRECT ANSWER✅✅You will likely need a referral from your primary care physician (PCP) to see
a specialist. If you see your specialist without this referral, the plan may not pay for your visit.
Because the beneficiary is enrolled in an HMO, she should work with her PCP prior to seeing a specialist
(except in an emergency).
True or False?
Once a beneficiary is enrolled in an MA plan and has paid his plan-specific monthly premium, he no
longer needs to pay his Part B premium. - CORRECT ANSWER✅✅False
Beneficiaries are required to continue paying their Part B premium (unless they receive Extra Help) in
addition to any plan-specific premium.
Define: Medicare Part A - CORRECT ANSWER✅✅Part A of Medicare covers hospital inpatient care,
some SNF care, and home health and hospice care
Define: Medicare Part B - CORRECT ANSWER✅✅Part B of Medicare covers physician services,
outpatient hospital care, lab tests, mental health services, some preventative services, and medical
equipment considered medically necessary to treat a disease or condition
, Define: Medicare Part C - CORRECT ANSWER✅✅Part C of Medicare provides an option for beneficiaries
to receive private health plan coverage in lieu of Original Medicare
Define: Medicare Part D - CORRECT ANSWER✅✅Part D of Medicare provides prescription drug benefit
Mrs. Doe will turn 65 at the end of March and signed up for an MA plan in January during her Initial
Coverage Election Period (ICEP). When will her coverage begin? - CORRECT ANSWER✅✅On March 1
The ICEP coverage begins the first day of the month of entitlement to Medicare Part A and Part B, OR
the first of the month following the month the enrollment request was made (if after entitlement has
occurred).
What enrollment period provides an opportunity for a beneficiary to move from Original Medicare to an
MA plan? - CORRECT ANSWER✅✅The Annual Election Period (AEP) for enrolling in an MA Plan is
October 15 through December 7.
The beneficiary is already enrolled in Original Medicare, so there is no Initial Coverage Election Period
(ICEP) that is applicable.
What is the enrollment period for enrolling in an MADP? - CORRECT ANSWER✅✅January 1 through
February 14
This period only allows a beneficiary to change from an MA plan to Original Medicare (with/without a
stand-alone PDP).
Which conditions would qualify an MA plan member to switch plans during a Special Enrollment Period?
- CORRECT ANSWER✅✅The member recently moved into a nursing home
The member's plan was terminated
The member has moved to another state
If an individual moves into, resides in, or moves out of a long-term care facility, such as a nursing home,
he or she is eligible for a SEP. He/She would also be eligible for an SEP as a result of moving out of the
plan's service area or if his/her current plan is terminated.
