Medicare Certification 200 Questions and Answers
with Complete Solutions UPDATED!!!
Question 1
What does Medicare Part A cover? Inpatient hospital, SNF after 3-day qualifying inpatient,
hospice, some home health. Which is NOT Part A? [Domain 1]
A. Inpatient hospital stay
B. Hospice care
C. Outpatient physician office visit
D. Skilled nursing facility after qualifying inpatient stay
Answer: C
Rationale: Part A is hospital insurance; outpatient physician visits are Part B.
Question 2
Medicare Part B primarily covers which services? [Domain 2]
A. Physician services, outpatient, preventive screenings, DME
B. Inpatient hospital only
C. Retail prescription drugs
D. Long-term custodial nursing home
Answer: A
Rationale: Part B = medical insurance: doctor visits, outpatient, preventive (AWV, mammogram),
DME, with 20% coinsurance after deductible.
Question 3
What is Medicare Part D? [Domain 3]
A. Outpatient prescription drug coverage via private PDP or MA-PD plans
B. Dental coverage only
C. Inpatient hospital only
D. Vision only
Answer: A
Rationale: Part D is optional drug benefit with formularies, tiers, coverage phases.
Question 4
Medicare Advantage Part C must provide at least what? [Domain 4]
A. At least all benefits covered by Original Medicare Parts A and B
, B. Nothing required
C. Only dental
D. Only prescription drugs
Answer: A
Rationale: MA must cover A and B, often includes D and supplemental benefits, but has networks
and MOOP.
Question 5
At what age does initial Medicare eligibility begin for most? [Domain 5]
A. 65 with 40 quarters
B. 55
C. 70
D. 50
Answer: A
Rationale: Age 65 with sufficient work quarters; earlier with 24 months SSDI, ESRD, or ALS.
Question 6
How long is Initial Enrollment Period (IEP)? [Domain 6]
A. 7 months: 3 months before, month of, 3 months after 65th birthday month
B. 1 month
C. 12 months
D. 2 years
Answer: A
Rationale: IEP 7-month window; late enrollment may cause Part B and D penalties if no creditable
coverage.
Question 7
What is the purpose of Medigap? [Domain 7]
A. Supplement to cover cost-sharing of Original Medicare A and B
B. Replace Original Medicare entirely
C. Only cover drugs
D. Only cover dental
Answer: A
Rationale: Medigap pays deductibles, coinsurance, copays; requires A+B, cannot be used with MA.
Question 8
When is an Advance Beneficiary Notice (ABN) required? [Domain 8]
, A. When service expected to be non-covered for medical necessity and you want to shift liability
to beneficiary
B. Always for all services
C. Never allowed
D. Only for covered preventive services
Answer: A
Rationale: ABN Form CMS-R-131 notifies patient of potential non-coverage; without valid ABN,
provider cannot bill patient if denied.
Question 9
Difference between NCD and LCD? [Domain 9]
A. NCD is national CMS decision, LCD is local MAC decision
B. They are identical
C. LCD is national
D. NCD is local
Answer: A
Rationale: NCDs bind nationwide; LCDs are contractor-specific coverage rules.
Question 10
When is Medicare secondary payer (MSP)? [Domain 10]
A. When GHP primary due to current employment 20+ employees, workers comp, liability, or
ESRD coordination period
B. Never secondary
C. Always primary
D. Only for beneficiaries under 30
Answer: A
Rationale: MSP: EGHP primary when aged working with large employer, WC, auto/liability, ESRD
first 30 months.
Question 11
General Enrollment Period - When is GEP for Part B if missed IEP? [Case 11]
A. Jan 1 - Mar 31, coverage starts month after enrollment (2023 rule)
B. Dec 1 only
C. Never
D. Only in emergency
Answer: A
Rationale: GEP Jan-Mar for those who missed IEP and no SEP; may incur penalty. Coverage now
starts month after enrollment.
, Question 12
Special Enrollment Period SEP for losing employer coverage? [Case 12]
A. 8 months to enroll in Part B after employment ends
B. No SEP
C. 1 day
D. 10 years
Answer: A
Rationale: Loss of group coverage triggers 8-month SEP for Part B and 63-day SEP for Part D
without penalty.
Question 13
What is IRMAA? [Case 13]
A. Income-related monthly adjustment amount for higher-income for Part B and D
B. Low-income subsidy
C. Free premium
D. Dental benefit
Answer: A
Rationale: IRMAA surcharges Part B and D premiums for higher MAGI from 2 years prior.
Question 14
LIS/Extra Help helps with? [Case 14]
A. Part D costs for low-income beneficiaries
B. Part A inpatient only
C. Dental
D. Gym
Answer: A
Rationale: Extra Help/LIS pays Part D premiums, deductibles, copays, eliminates donut hole for
eligible.
Question 15
Preventive - AWV vs Welcome to Medicare? [Case 15]
A. Welcome IPPE within first 12 months of Part B, then AWV annually
B. Same thing
C. Neither covered
D. Only for MA
Answer: A
Rationale: IPPE one-time within first year of Part B; AWV annually after, includes HRA, prevention
planning, no copay.
with Complete Solutions UPDATED!!!
Question 1
What does Medicare Part A cover? Inpatient hospital, SNF after 3-day qualifying inpatient,
hospice, some home health. Which is NOT Part A? [Domain 1]
A. Inpatient hospital stay
B. Hospice care
C. Outpatient physician office visit
D. Skilled nursing facility after qualifying inpatient stay
Answer: C
Rationale: Part A is hospital insurance; outpatient physician visits are Part B.
Question 2
Medicare Part B primarily covers which services? [Domain 2]
A. Physician services, outpatient, preventive screenings, DME
B. Inpatient hospital only
C. Retail prescription drugs
D. Long-term custodial nursing home
Answer: A
Rationale: Part B = medical insurance: doctor visits, outpatient, preventive (AWV, mammogram),
DME, with 20% coinsurance after deductible.
Question 3
What is Medicare Part D? [Domain 3]
A. Outpatient prescription drug coverage via private PDP or MA-PD plans
B. Dental coverage only
C. Inpatient hospital only
D. Vision only
Answer: A
Rationale: Part D is optional drug benefit with formularies, tiers, coverage phases.
Question 4
Medicare Advantage Part C must provide at least what? [Domain 4]
A. At least all benefits covered by Original Medicare Parts A and B
, B. Nothing required
C. Only dental
D. Only prescription drugs
Answer: A
Rationale: MA must cover A and B, often includes D and supplemental benefits, but has networks
and MOOP.
Question 5
At what age does initial Medicare eligibility begin for most? [Domain 5]
A. 65 with 40 quarters
B. 55
C. 70
D. 50
Answer: A
Rationale: Age 65 with sufficient work quarters; earlier with 24 months SSDI, ESRD, or ALS.
Question 6
How long is Initial Enrollment Period (IEP)? [Domain 6]
A. 7 months: 3 months before, month of, 3 months after 65th birthday month
B. 1 month
C. 12 months
D. 2 years
Answer: A
Rationale: IEP 7-month window; late enrollment may cause Part B and D penalties if no creditable
coverage.
Question 7
What is the purpose of Medigap? [Domain 7]
A. Supplement to cover cost-sharing of Original Medicare A and B
B. Replace Original Medicare entirely
C. Only cover drugs
D. Only cover dental
Answer: A
Rationale: Medigap pays deductibles, coinsurance, copays; requires A+B, cannot be used with MA.
Question 8
When is an Advance Beneficiary Notice (ABN) required? [Domain 8]
, A. When service expected to be non-covered for medical necessity and you want to shift liability
to beneficiary
B. Always for all services
C. Never allowed
D. Only for covered preventive services
Answer: A
Rationale: ABN Form CMS-R-131 notifies patient of potential non-coverage; without valid ABN,
provider cannot bill patient if denied.
Question 9
Difference between NCD and LCD? [Domain 9]
A. NCD is national CMS decision, LCD is local MAC decision
B. They are identical
C. LCD is national
D. NCD is local
Answer: A
Rationale: NCDs bind nationwide; LCDs are contractor-specific coverage rules.
Question 10
When is Medicare secondary payer (MSP)? [Domain 10]
A. When GHP primary due to current employment 20+ employees, workers comp, liability, or
ESRD coordination period
B. Never secondary
C. Always primary
D. Only for beneficiaries under 30
Answer: A
Rationale: MSP: EGHP primary when aged working with large employer, WC, auto/liability, ESRD
first 30 months.
Question 11
General Enrollment Period - When is GEP for Part B if missed IEP? [Case 11]
A. Jan 1 - Mar 31, coverage starts month after enrollment (2023 rule)
B. Dec 1 only
C. Never
D. Only in emergency
Answer: A
Rationale: GEP Jan-Mar for those who missed IEP and no SEP; may incur penalty. Coverage now
starts month after enrollment.
, Question 12
Special Enrollment Period SEP for losing employer coverage? [Case 12]
A. 8 months to enroll in Part B after employment ends
B. No SEP
C. 1 day
D. 10 years
Answer: A
Rationale: Loss of group coverage triggers 8-month SEP for Part B and 63-day SEP for Part D
without penalty.
Question 13
What is IRMAA? [Case 13]
A. Income-related monthly adjustment amount for higher-income for Part B and D
B. Low-income subsidy
C. Free premium
D. Dental benefit
Answer: A
Rationale: IRMAA surcharges Part B and D premiums for higher MAGI from 2 years prior.
Question 14
LIS/Extra Help helps with? [Case 14]
A. Part D costs for low-income beneficiaries
B. Part A inpatient only
C. Dental
D. Gym
Answer: A
Rationale: Extra Help/LIS pays Part D premiums, deductibles, copays, eliminates donut hole for
eligible.
Question 15
Preventive - AWV vs Welcome to Medicare? [Case 15]
A. Welcome IPPE within first 12 months of Part B, then AWV annually
B. Same thing
C. Neither covered
D. Only for MA
Answer: A
Rationale: IPPE one-time within first year of Part B; AWV annually after, includes HRA, prevention
planning, no copay.
