Medicare Agent & Broker Certification test guide

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? - 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: - 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. - 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 - Part A of Medicare covers hospital inpatient care, some SNF care, and home health and hospice care Define: Medicare Part B - 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 - Part C of Medicare provides an option for beneficiaries to receive private health plan coverage in lieu of Original Medicare Define: Medicare Part D - 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? - 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? - The Annual Election Period (AEP) for enrolling in an MA Plan is October 15 through December