NC MEDICARE SUPPLEMENT AND LONG-TERM CARE
CERTIFICATION 2025/2026 EXAM QUESTIONS ANSWERS
SECTION 1: MEDICARE FUNDAMENTALS & ELIGIBILITY
1. Medicare is health insurance for which of the following groups?
A) Only individuals over age 65
B) Individuals over age 65, those under 65 with certain disabilities, and those with
End Stage Renal Disease (ESRD)
C) All U.S. citizens regardless of age
D) Only low-income individuals regardless of age
Correct Answer: B
Rationale: Medicare is a federal health insurance program primarily serving
people aged 65 and older, but it also covers certain younger individuals with
disabilities and those with End-Stage Renal Disease (ESRD). It is not a universal
program for all citizens.
2. Which federal agency administers the Medicare program?
A) Social Security Administration (SSA)
B) Centers for Medicare and Medicaid Services (CMS)
C) Department of Health and Human Services (HHS)
D) North Carolina Department of Insurance
Correct Answer: B
Rationale: The Centers for Medicare and Medicaid Services (CMS) is the federal
agency responsible for administering the Medicare program. The Social Security
Administration handles enrollment and some appeals, but CMS oversees program
operations.
3. What is the duration of the Initial Enrollment Period for Medicare?
A) 3 months
B) 5 months
C) 7 months
D) 10 months
,Correct Answer: C
Rationale: The Initial Enrollment Period is 7 months long. It includes the 3 months
before the 65th birthday month, the birthday month itself, and the 3 months
after.
4. To be eligible for Medicare, someone must have been a permanent legal
resident for at least how many consecutive years?
A) 1
B) 5
C) 7
D) 10
Correct Answer: B
Rationale: Permanent legal residents must have been lawfully admitted for
permanent residence and have resided in the United States continuously for 5
years prior to applying for Medicare.
5. If one takes Social Security retirement benefits at age 62, what needs to be
done at age 65 to qualify for Medicare?
A) Nothing
B) Apply for coverage through the state
C) Appear for a physical at the Social Security office
D) Apply at a local Social Security office
Correct Answer: A
Rationale: If you are already receiving Social Security benefits when you turn 65,
you are automatically enrolled in Medicare Parts A and B. No additional
application is needed.
SECTION 2: MEDICARE PART A (HOSPITAL INSURANCE)
6. How many days does Medicare pay full cost of inpatient hospital care under
Part A?
A) 20 days
B) 30 days
,C) 60 days
D) 90 days
Correct Answer: C
Rationale: For each benefit period, Medicare Part A pays the full cost of inpatient
hospital care for the first 60 days after the beneficiary pays the Part A deductible.
Days 61-90 require a daily coinsurance payment.
7. How many lifetime reserve days can someone draw in inpatient hospital care
under Part A?
A) 30 days
B) 60 days
C) 90 days
D) 100 days
Correct Answer: B
Rationale: Medicare Part A provides 60 lifetime reserve days. These are additional
days that can be used after the 90-day benefit period. Lifetime reserve days
cannot be renewed; once used, they are gone.
8. Under Medicare Part A, a benefit period ends when an individual has been
out of a hospital or skilled nursing facility for:
A) 20 days
B) 30 days
C) 60 days
D) 90 days
Correct Answer: C
Rationale: A benefit period begins the day a beneficiary enters a hospital or
skilled nursing facility. It ends when they have been out of the hospital or skilled
nursing facility for 60 consecutive days.
9. Which of the following services would NOT be covered by Medicare Part A?
A) Home health aide services
B) Full-time skilled care at home
C) Intermittent skilled care at home
D) Hospice care
, Correct Answer: B
Rationale: Medicare Part A does not cover full-time skilled nursing care at home.
It covers part-time or intermittent skilled care, home health aide services, and
hospice care.
10. What is a system of classifying hospital patients on the basis of diagnosis
consisting of distinct groupings?
A) Patient diagnostic system
B) Distinct grouping assignment
C) Patient classification basis
D) Diagnosis-related group
Correct Answer: D
Rationale: Diagnosis-Related Groups (DRGs) are a system of classifying hospital
patients on the basis of diagnosis consisting of distinct groupings. This system is
used for Medicare reimbursement purposes.
11. Medicare Part A covers which of the following services?
A) Medications
B) Hospital room and board
C) Physicians services
D) Surgical services
Correct Answer: B
Rationale: Medicare Part A covers hospital room and board as part of inpatient
hospital care. It does not cover physician services (Part B), most medications (Part
D), or surgical services (Part B).
12. After being released from a week's stay in the hospital, Jim's doctor orders
him into a skilled nursing facility for wound care. How long will Medicare Part A
cover 100% of the approved charges in the facility?
A) 10 days
B) 20 days
C) 30 days
D) 60 days
CERTIFICATION 2025/2026 EXAM QUESTIONS ANSWERS
SECTION 1: MEDICARE FUNDAMENTALS & ELIGIBILITY
1. Medicare is health insurance for which of the following groups?
A) Only individuals over age 65
B) Individuals over age 65, those under 65 with certain disabilities, and those with
End Stage Renal Disease (ESRD)
C) All U.S. citizens regardless of age
D) Only low-income individuals regardless of age
Correct Answer: B
Rationale: Medicare is a federal health insurance program primarily serving
people aged 65 and older, but it also covers certain younger individuals with
disabilities and those with End-Stage Renal Disease (ESRD). It is not a universal
program for all citizens.
2. Which federal agency administers the Medicare program?
A) Social Security Administration (SSA)
B) Centers for Medicare and Medicaid Services (CMS)
C) Department of Health and Human Services (HHS)
D) North Carolina Department of Insurance
Correct Answer: B
Rationale: The Centers for Medicare and Medicaid Services (CMS) is the federal
agency responsible for administering the Medicare program. The Social Security
Administration handles enrollment and some appeals, but CMS oversees program
operations.
3. What is the duration of the Initial Enrollment Period for Medicare?
A) 3 months
B) 5 months
C) 7 months
D) 10 months
,Correct Answer: C
Rationale: The Initial Enrollment Period is 7 months long. It includes the 3 months
before the 65th birthday month, the birthday month itself, and the 3 months
after.
4. To be eligible for Medicare, someone must have been a permanent legal
resident for at least how many consecutive years?
A) 1
B) 5
C) 7
D) 10
Correct Answer: B
Rationale: Permanent legal residents must have been lawfully admitted for
permanent residence and have resided in the United States continuously for 5
years prior to applying for Medicare.
5. If one takes Social Security retirement benefits at age 62, what needs to be
done at age 65 to qualify for Medicare?
A) Nothing
B) Apply for coverage through the state
C) Appear for a physical at the Social Security office
D) Apply at a local Social Security office
Correct Answer: A
Rationale: If you are already receiving Social Security benefits when you turn 65,
you are automatically enrolled in Medicare Parts A and B. No additional
application is needed.
SECTION 2: MEDICARE PART A (HOSPITAL INSURANCE)
6. How many days does Medicare pay full cost of inpatient hospital care under
Part A?
A) 20 days
B) 30 days
,C) 60 days
D) 90 days
Correct Answer: C
Rationale: For each benefit period, Medicare Part A pays the full cost of inpatient
hospital care for the first 60 days after the beneficiary pays the Part A deductible.
Days 61-90 require a daily coinsurance payment.
7. How many lifetime reserve days can someone draw in inpatient hospital care
under Part A?
A) 30 days
B) 60 days
C) 90 days
D) 100 days
Correct Answer: B
Rationale: Medicare Part A provides 60 lifetime reserve days. These are additional
days that can be used after the 90-day benefit period. Lifetime reserve days
cannot be renewed; once used, they are gone.
8. Under Medicare Part A, a benefit period ends when an individual has been
out of a hospital or skilled nursing facility for:
A) 20 days
B) 30 days
C) 60 days
D) 90 days
Correct Answer: C
Rationale: A benefit period begins the day a beneficiary enters a hospital or
skilled nursing facility. It ends when they have been out of the hospital or skilled
nursing facility for 60 consecutive days.
9. Which of the following services would NOT be covered by Medicare Part A?
A) Home health aide services
B) Full-time skilled care at home
C) Intermittent skilled care at home
D) Hospice care
, Correct Answer: B
Rationale: Medicare Part A does not cover full-time skilled nursing care at home.
It covers part-time or intermittent skilled care, home health aide services, and
hospice care.
10. What is a system of classifying hospital patients on the basis of diagnosis
consisting of distinct groupings?
A) Patient diagnostic system
B) Distinct grouping assignment
C) Patient classification basis
D) Diagnosis-related group
Correct Answer: D
Rationale: Diagnosis-Related Groups (DRGs) are a system of classifying hospital
patients on the basis of diagnosis consisting of distinct groupings. This system is
used for Medicare reimbursement purposes.
11. Medicare Part A covers which of the following services?
A) Medications
B) Hospital room and board
C) Physicians services
D) Surgical services
Correct Answer: B
Rationale: Medicare Part A covers hospital room and board as part of inpatient
hospital care. It does not cover physician services (Part B), most medications (Part
D), or surgical services (Part B).
12. After being released from a week's stay in the hospital, Jim's doctor orders
him into a skilled nursing facility for wound care. How long will Medicare Part A
cover 100% of the approved charges in the facility?
A) 10 days
B) 20 days
C) 30 days
D) 60 days
