Medicare Certification Examination
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 67-year-old patient who has been enrolled in Medicare Part A and Part B
for the past two years is considering switching to a Medicare Advantage
plan. Which of the following statements about Medicare Advantage plans is
correct?
A. Medicare Advantage plans are only available to beneficiaries who have
been diagnosed with end-stage renal disease
B. Medicare Advantage plans must cover all services that Original Medicare
covers, except for hospice care
C. Medicare Advantage plans are prohibited from charging any cost-sharing
amounts for covered services
D. Medicare Advantage plans automatically include prescription drug
coverage as a mandatory benefit
Answer: B. Medicare Advantage plans must cover all services that Original
Medicare covers, except for hospice care. Medicare Advantage plans (Part C) are
required by law to provide at least the same level of coverage as Original
Medicare (Parts A and B), with the exception of hospice care, which remains
covered under Part A. These plans may offer additional benefits, but they are not
prohibited from charging cost-sharing amounts. Prescription drug coverage is not
automatically included in all Medicare Advantage plans; it must be specifically
offered as part of the plan's benefits. Beneficiaries with end-stage renal disease
were historically restricted from enrolling in Medicare Advantage plans, but recent
legislation has removed this restriction.
, 2. A Medicare beneficiary is admitted to a skilled nursing facility (SNF)
following a three-day inpatient hospital stay. The beneficiary has Medicare
Part A coverage. For Medicare to cover the SNF stay, which additional
requirement must be met?
A. The beneficiary must have a qualifying diagnosis of stroke or hip fracture
B. The beneficiary must require skilled nursing care or skilled rehabilitation
services on a daily basis
C. The beneficiary's physician must certify that the stay will last at least 30
days
D. The beneficiary must have exhausted their lifetime reserve days before
SNF coverage begins
Answer: B. The beneficiary must require skilled nursing care or skilled
rehabilitation services on a daily basis. Medicare Part A covers SNF care only
when the beneficiary requires skilled services (such as skilled nursing care or
physical therapy) that must be provided on a daily basis. The prior hospital stay
must be at least three consecutive inpatient days (not including the discharge
day), and admission to the SNF must occur within 30 days of discharge. There is no
requirement for a specific diagnosis like stroke or hip fracture, and physician
certification does not need to specify a 30-day duration. Lifetime reserve days
apply to hospital stays, not SNF care.
3. Which of the following services is covered under Medicare Part B?
A. Inpatient hospital services
B. Skilled nursing facility care following a hospital stay
C. Hospice care for terminally ill patients
D. Physician services and outpatient care
Answer: D. Physician services and outpatient care. Medicare Part B covers
medically necessary services including physician services, outpatient care,
preventive services, durable medical equipment, and some home health services.
,Inpatient hospital services, SNF care following a qualifying hospital stay, and
hospice care are all covered under Medicare Part A, not Part B. Part B requires
payment of a monthly premium and includes an annual deductible and
coinsurance requirements.
4. A Medicare beneficiary is enrolled in a Medicare Advantage HMO plan and
wishes to see a specialist. Under the HMO plan's rules, what is typically
required?
A. The beneficiary may see any specialist without prior authorization
B. The beneficiary must obtain a referral from their primary care physician
C. The beneficiary must pay the full cost of the specialist visit without any
Medicare coverage
D. The beneficiary must wait at least 30 days before the specialist visit can
be approved
Answer: B. The beneficiary must obtain a referral from their primary care
physician. Medicare Advantage HMO plans typically require beneficiaries to select
a primary care physician and obtain referrals from that physician before seeing a
specialist. This is a standard feature of HMO plan design to coordinate care and
control costs. Some plans may have exceptions for certain specialists, but
generally, referrals are required. Prior authorization may also be required for
certain services. The beneficiary does not have to pay full cost without coverage,
and the referral process typically does not involve a mandatory 30-day waiting
period.
5. During the Medicare Initial Enrollment Period (IEP), how long does a
beneficiary have to enroll in Medicare Part A and Part B?
A. 3 months before and 3 months after the month of their 65th birthday
B. 7 months total, beginning 3 months before the month of their 65th
birthday and ending 3 months after
C. 6 months total, beginning on the first day of the month of their 65th
, birthday
D. 12 months total, beginning on the first day of the month following their
65th birthday
Answer: B. 7 months total, beginning 3 months before the month of their 65th
birthday and ending 3 months after. The Initial Enrollment Period for Medicare is
a 7-month window that includes the three months before the month of the
beneficiary's 65th birthday, the month of their birthday, and the three months
following their birthday month. This period is the initial opportunity for most
individuals to enroll in Medicare Part A and Part B. Enrolling during the first three
months can help ensure coverage begins on the first day of the birth month.
Delaying enrollment beyond the IEP may result in late enrollment penalties for
Part B.
6. A Medicare beneficiary receives an Explanation of Benefits (EOB) from their
Medicare Advantage plan. What is the primary purpose of this document?
A. To serve as a bill requiring immediate payment for services received
B. To explain which services were covered, how much the plan paid, and the
beneficiary's financial responsibility
C. To notify the beneficiary that their coverage has been terminated
D. To provide a summary of the beneficiary's entire medical history
Answer: B. To explain which services were covered, how much the plan paid, and
the beneficiary's financial responsibility. The Explanation of Benefits is a
document that provides detailed information about the services the beneficiary
received, the amount the plan paid, and any remaining balance that the
beneficiary may owe to the provider. It is not a bill and does not require payment
directly from the beneficiary. It serves as an informational tool to help
beneficiaries understand their coverage and track their healthcare costs. It does
not indicate termination of coverage, nor does it contain a complete medical
history.
Questions And Correct Answers
(Verified Answers) Plus Rationales 2026
Q&A | Instant Download Pdf
1. A 67-year-old patient who has been enrolled in Medicare Part A and Part B
for the past two years is considering switching to a Medicare Advantage
plan. Which of the following statements about Medicare Advantage plans is
correct?
A. Medicare Advantage plans are only available to beneficiaries who have
been diagnosed with end-stage renal disease
B. Medicare Advantage plans must cover all services that Original Medicare
covers, except for hospice care
C. Medicare Advantage plans are prohibited from charging any cost-sharing
amounts for covered services
D. Medicare Advantage plans automatically include prescription drug
coverage as a mandatory benefit
Answer: B. Medicare Advantage plans must cover all services that Original
Medicare covers, except for hospice care. Medicare Advantage plans (Part C) are
required by law to provide at least the same level of coverage as Original
Medicare (Parts A and B), with the exception of hospice care, which remains
covered under Part A. These plans may offer additional benefits, but they are not
prohibited from charging cost-sharing amounts. Prescription drug coverage is not
automatically included in all Medicare Advantage plans; it must be specifically
offered as part of the plan's benefits. Beneficiaries with end-stage renal disease
were historically restricted from enrolling in Medicare Advantage plans, but recent
legislation has removed this restriction.
, 2. A Medicare beneficiary is admitted to a skilled nursing facility (SNF)
following a three-day inpatient hospital stay. The beneficiary has Medicare
Part A coverage. For Medicare to cover the SNF stay, which additional
requirement must be met?
A. The beneficiary must have a qualifying diagnosis of stroke or hip fracture
B. The beneficiary must require skilled nursing care or skilled rehabilitation
services on a daily basis
C. The beneficiary's physician must certify that the stay will last at least 30
days
D. The beneficiary must have exhausted their lifetime reserve days before
SNF coverage begins
Answer: B. The beneficiary must require skilled nursing care or skilled
rehabilitation services on a daily basis. Medicare Part A covers SNF care only
when the beneficiary requires skilled services (such as skilled nursing care or
physical therapy) that must be provided on a daily basis. The prior hospital stay
must be at least three consecutive inpatient days (not including the discharge
day), and admission to the SNF must occur within 30 days of discharge. There is no
requirement for a specific diagnosis like stroke or hip fracture, and physician
certification does not need to specify a 30-day duration. Lifetime reserve days
apply to hospital stays, not SNF care.
3. Which of the following services is covered under Medicare Part B?
A. Inpatient hospital services
B. Skilled nursing facility care following a hospital stay
C. Hospice care for terminally ill patients
D. Physician services and outpatient care
Answer: D. Physician services and outpatient care. Medicare Part B covers
medically necessary services including physician services, outpatient care,
preventive services, durable medical equipment, and some home health services.
,Inpatient hospital services, SNF care following a qualifying hospital stay, and
hospice care are all covered under Medicare Part A, not Part B. Part B requires
payment of a monthly premium and includes an annual deductible and
coinsurance requirements.
4. A Medicare beneficiary is enrolled in a Medicare Advantage HMO plan and
wishes to see a specialist. Under the HMO plan's rules, what is typically
required?
A. The beneficiary may see any specialist without prior authorization
B. The beneficiary must obtain a referral from their primary care physician
C. The beneficiary must pay the full cost of the specialist visit without any
Medicare coverage
D. The beneficiary must wait at least 30 days before the specialist visit can
be approved
Answer: B. The beneficiary must obtain a referral from their primary care
physician. Medicare Advantage HMO plans typically require beneficiaries to select
a primary care physician and obtain referrals from that physician before seeing a
specialist. This is a standard feature of HMO plan design to coordinate care and
control costs. Some plans may have exceptions for certain specialists, but
generally, referrals are required. Prior authorization may also be required for
certain services. The beneficiary does not have to pay full cost without coverage,
and the referral process typically does not involve a mandatory 30-day waiting
period.
5. During the Medicare Initial Enrollment Period (IEP), how long does a
beneficiary have to enroll in Medicare Part A and Part B?
A. 3 months before and 3 months after the month of their 65th birthday
B. 7 months total, beginning 3 months before the month of their 65th
birthday and ending 3 months after
C. 6 months total, beginning on the first day of the month of their 65th
, birthday
D. 12 months total, beginning on the first day of the month following their
65th birthday
Answer: B. 7 months total, beginning 3 months before the month of their 65th
birthday and ending 3 months after. The Initial Enrollment Period for Medicare is
a 7-month window that includes the three months before the month of the
beneficiary's 65th birthday, the month of their birthday, and the three months
following their birthday month. This period is the initial opportunity for most
individuals to enroll in Medicare Part A and Part B. Enrolling during the first three
months can help ensure coverage begins on the first day of the birth month.
Delaying enrollment beyond the IEP may result in late enrollment penalties for
Part B.
6. A Medicare beneficiary receives an Explanation of Benefits (EOB) from their
Medicare Advantage plan. What is the primary purpose of this document?
A. To serve as a bill requiring immediate payment for services received
B. To explain which services were covered, how much the plan paid, and the
beneficiary's financial responsibility
C. To notify the beneficiary that their coverage has been terminated
D. To provide a summary of the beneficiary's entire medical history
Answer: B. To explain which services were covered, how much the plan paid, and
the beneficiary's financial responsibility. The Explanation of Benefits is a
document that provides detailed information about the services the beneficiary
received, the amount the plan paid, and any remaining balance that the
beneficiary may owe to the provider. It is not a bill and does not require payment
directly from the beneficiary. It serves as an informational tool to help
beneficiaries understand their coverage and track their healthcare costs. It does
not indicate termination of coverage, nor does it contain a complete medical
history.
