Name: Score:
6 Multiple choice questions
Term 1 of 6
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may
the doctor collect from Mr. Rivera?
The doctor may only collect the amount allowable under medicare advantage (ma) ppo
plan cost sharing for non-qmb enrollees.
The doctor may only collect the amount allowable under medicare plus 25 percent balance
billing.
The doctor may only collect the amount allowable under medicare plus 15 percent balance
billing
.
The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
, Term 2 of 6
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing
event and expects about 40 people to attend. He has hired a magician at a cost of $200 to
entertain attendees. Can he do this in a way that complies with guidance from the Medicare
agency?
a. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and
he does not have to be enrolled in Part B.
c. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare
Part D prescription drug plan.
c. Tell Julia that you will meet with her to explain Medicare and should she be interested
you can accept and submit an enrollment request, since this is an initial enrollment
qualifying her for a special enrollment period.
a. He can do this because the estimated number of attendees is based on the venue size
and response rate and the value of the gift does not exceed $15.
Term 3 of 6
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does
not want to be limited in terms of where he obtains his care. What should you tell him about how a
Medicare Cost Plan might fit his needs?
d. If a PFFS enrollee shows his/her card when obtaining services from a provider who
participates in Original Medicare, then that provider is required to accept the plan's terms
and conditions.
d. If the Medicare prescription drug plan can show that reducing coverage early in the year
will result in savings for the Part D plan and the Medicare program, generally the plan may
make such a change.
a. The letter is to inform her that her Medigap drug coverage must be supplemented by
purchasing coverage under a Part D plan. If she does not do so within 63 days, she will not
be able to obtain Part D coverage at a later date.
a. Cost plan enrollees can choose to receive Medicare covered services under the plan's
benefits by going to plan network providers and paying plan cost sharing, or may receive
services from non-network providers and pay cost-sharing due under Original Medicare.
6 Multiple choice questions
Term 1 of 6
Mr. Rivera has Qualified Medicare Beneficiary (QMB) eligibility and is thus covered by both
Medicare and Medicaid. He decides to enroll in a Medicare Advantage (MA) PPO plan. Later he
sees an out-of-network doctor to receive a Medicare covered service. How much The doctor may
only collect from Mr. Rivera the cost sharing allowable under the state's Medicaid program.may
the doctor collect from Mr. Rivera?
The doctor may only collect the amount allowable under medicare advantage (ma) ppo
plan cost sharing for non-qmb enrollees.
The doctor may only collect the amount allowable under medicare plus 25 percent balance
billing.
The doctor may only collect the amount allowable under medicare plus 15 percent balance
billing
.
The doctor may only collect from Mr. Rivera the cost sharing allowable under the state's
Medicaid program.
, Term 2 of 6
Mr. Edwards, a marketing representative of the ACME Insurance Company, scheduled a marketing
event and expects about 40 people to attend. He has hired a magician at a cost of $200 to
entertain attendees. Can he do this in a way that complies with guidance from the Medicare
agency?
a. He is eligible for the Part D prescription drug benefit because he is entitled to Part A and
he does not have to be enrolled in Part B.
c. She can enroll in the PPO and purchase drug coverage through a stand-alone Medicare
Part D prescription drug plan.
c. Tell Julia that you will meet with her to explain Medicare and should she be interested
you can accept and submit an enrollment request, since this is an initial enrollment
qualifying her for a special enrollment period.
a. He can do this because the estimated number of attendees is based on the venue size
and response rate and the value of the gift does not exceed $15.
Term 3 of 6
Mr. Davies is turning 65 next month. He would like to enroll in a Medicare health plan, but does
not want to be limited in terms of where he obtains his care. What should you tell him about how a
Medicare Cost Plan might fit his needs?
d. If a PFFS enrollee shows his/her card when obtaining services from a provider who
participates in Original Medicare, then that provider is required to accept the plan's terms
and conditions.
d. If the Medicare prescription drug plan can show that reducing coverage early in the year
will result in savings for the Part D plan and the Medicare program, generally the plan may
make such a change.
a. The letter is to inform her that her Medigap drug coverage must be supplemented by
purchasing coverage under a Part D plan. If she does not do so within 63 days, she will not
be able to obtain Part D coverage at a later date.
a. Cost plan enrollees can choose to receive Medicare covered services under the plan's
benefits by going to plan network providers and paying plan cost sharing, or may receive
services from non-network providers and pay cost-sharing due under Original Medicare.
