Updated for 2026-2027
1.
A 65-year-old individual who is already receiving Social Security benefits
approaches you for advice about Medicare enrollment. They are unsure whether
they need to take any action to enroll in Parts A and B. Considering Medicare’s
automatic enrollment rules, which of the following situations would most likely
apply to this individual?
A. They must apply manually for both Part A and B regardless of Social Security
status
B. They will be automatically enrolled in Part A only and must apply for Part B
separately
C. They will be automatically enrolled in both Part A and Part B
D. They will not be enrolled in Medicare at all until they submit a request
Correct Answer: C — They will be automatically enrolled in both Part A and Part
B.
Explanation: Individuals who are already receiving Social Security benefits when
they turn 65 are typically auto-enrolled in Medicare Part A and Part B. Their
coverage starts the month they turn 65, and their Medicare card arrives a few
months earlier. Manual action is not required unless they want to refuse Part B.
,Updated for 2026-2027
2.
Many Medicare beneficiaries are unaware of the differences between Original
Medicare and Medicare Advantage. Suppose a client wants to know the primary
purpose of Medicare Part C and how it affects their coverage choices. They are
especially interested in whether enrolling in a Medicare Advantage plan means
they leave Medicare completely. Which of the following best describes Medicare
Part C (Medicare Advantage)?
A. It only covers inpatient hospital services and nothing else
B. It replaces Medicare Part A and B completely, removing beneficiaries from
Medicare
C. It allows beneficiaries to receive their Medicare benefits through approved
private health plans
D. It is exclusively for individuals under age 65 who have disabilities
Correct Answer: C — It allows beneficiaries to receive their Medicare benefits
through approved private health plans.
Explanation: Medicare Advantage is offered by private companies that contract
with Medicare. Enrollees remain in the Medicare program but receive their Part A
and B benefits through the plan. Many plans also include Part D and extra benefits
like dental or vision, which Original Medicare doesn’t cover.
3.
A Medicare beneficiary currently enrolled in a Medicare Advantage plan is
considering switching back to Original Medicare because they want more provider
flexibility. They are unsure when they can make this change without penalty or
delay. You explain that there are specific enrollment periods for this type of switch,
and some allow enrollment in a Part D plan at the same time. During which of the
following periods may a Medicare Advantage enrollee switch to Original Medicare
and enroll in a Part D plan without penalty?
A. Annual Election Period (AEP)
B. Initial Coverage Election Period (ICEP)
C. General Enrollment Period (GEP)
D. Special Enrollment Period (SEP) for disability
,Updated for 2026-2027
Correct Answer: A — Annual Election Period (AEP).
Explanation: The Annual Election Period, held from October 15 to December 7, is
when beneficiaries can change Medicare Advantage or Part D plans, or switch back
to Original Medicare. Changes take effect January 1. This is the main period for
coverage adjustments each year.
4.
Medicare covers many essential medical services, but there are notable gaps that
beneficiaries often misunderstand. Imagine a client assuming that all health
services, including dental checkups and eyeglasses, are covered once they enroll in
Original Medicare. They are surprised to learn that some services are excluded.
Which of the following services is not typically covered by Original Medicare?
A. Inpatient hospital stays
B. Skilled nursing facility care (limited)
C. Routine dental care
D. Home health care
Correct Answer: C — Routine dental care.
Explanation: Original Medicare Parts A and B do not cover most routine dental,
vision, or hearing services. Some Medicare Advantage plans may include these as
extra benefits, but beneficiaries relying only on Original Medicare will need to pay
out of pocket or buy supplemental coverage.
5.
Consider a 66-year-old employee who continues to work and has employer-
sponsored group health insurance through a company with more than 20
employees. The employee becomes eligible for Medicare but is unsure whether
they should sign up for Part B immediately. They want to avoid unnecessary
premiums or penalties. What is the most appropriate guidance regarding their Part
B enrollment?
A. They should automatically enroll in Part B and drop employer coverage
immediately
B. They may delay Part B enrollment without penalty as long as they have active
employer coverage
, Updated for 2026-2027
C. They must enroll in both Medicare and employer coverage simultaneously to
avoid penalties
D. They should decline all coverage until they fully retire
Correct Answer: B — They may delay Part B enrollment without penalty as long
as they have active employer coverage.
Explanation: When employer coverage is primary and the company has 20+
employees, individuals can delay Part B without incurring late penalties. After they
retire, they get a Special Enrollment Period to sign up for Part B, ensuring
continuous coverage.
6.
Prescription drug coverage is an important part of Medicare, and beneficiaries have
several choices for obtaining it. A new enrollee is confused about how Part D
works and believes it is automatically included with Original Medicare. They also
think it might be mandatory. To clarify, which of the following statements
accurately describes Medicare Part D coverage?
A. It covers inpatient hospital stays and skilled nursing care
B. It is mandatory for all Medicare beneficiaries
C. It offers outpatient prescription drug coverage through private plans approved
by Medicare
D. It is automatically included in Medicare Parts A and B
Correct Answer: C — It offers outpatient prescription drug coverage through
private plans approved by Medicare.
Explanation: Medicare Part D is optional but strongly recommended to avoid
lifetime penalties. It provides outpatient prescription coverage and is offered by
private insurers that contract with Medicare. Beneficiaries must actively enroll
unless they have other creditable drug coverage.
7.
A 67-year-old individual missed their Initial Enrollment Period and does not
qualify for any Special Enrollment Period. They want to know when they can next
sign up for Medicare Part B. They are also worried about whether they will have to
1.
A 65-year-old individual who is already receiving Social Security benefits
approaches you for advice about Medicare enrollment. They are unsure whether
they need to take any action to enroll in Parts A and B. Considering Medicare’s
automatic enrollment rules, which of the following situations would most likely
apply to this individual?
A. They must apply manually for both Part A and B regardless of Social Security
status
B. They will be automatically enrolled in Part A only and must apply for Part B
separately
C. They will be automatically enrolled in both Part A and Part B
D. They will not be enrolled in Medicare at all until they submit a request
Correct Answer: C — They will be automatically enrolled in both Part A and Part
B.
Explanation: Individuals who are already receiving Social Security benefits when
they turn 65 are typically auto-enrolled in Medicare Part A and Part B. Their
coverage starts the month they turn 65, and their Medicare card arrives a few
months earlier. Manual action is not required unless they want to refuse Part B.
,Updated for 2026-2027
2.
Many Medicare beneficiaries are unaware of the differences between Original
Medicare and Medicare Advantage. Suppose a client wants to know the primary
purpose of Medicare Part C and how it affects their coverage choices. They are
especially interested in whether enrolling in a Medicare Advantage plan means
they leave Medicare completely. Which of the following best describes Medicare
Part C (Medicare Advantage)?
A. It only covers inpatient hospital services and nothing else
B. It replaces Medicare Part A and B completely, removing beneficiaries from
Medicare
C. It allows beneficiaries to receive their Medicare benefits through approved
private health plans
D. It is exclusively for individuals under age 65 who have disabilities
Correct Answer: C — It allows beneficiaries to receive their Medicare benefits
through approved private health plans.
Explanation: Medicare Advantage is offered by private companies that contract
with Medicare. Enrollees remain in the Medicare program but receive their Part A
and B benefits through the plan. Many plans also include Part D and extra benefits
like dental or vision, which Original Medicare doesn’t cover.
3.
A Medicare beneficiary currently enrolled in a Medicare Advantage plan is
considering switching back to Original Medicare because they want more provider
flexibility. They are unsure when they can make this change without penalty or
delay. You explain that there are specific enrollment periods for this type of switch,
and some allow enrollment in a Part D plan at the same time. During which of the
following periods may a Medicare Advantage enrollee switch to Original Medicare
and enroll in a Part D plan without penalty?
A. Annual Election Period (AEP)
B. Initial Coverage Election Period (ICEP)
C. General Enrollment Period (GEP)
D. Special Enrollment Period (SEP) for disability
,Updated for 2026-2027
Correct Answer: A — Annual Election Period (AEP).
Explanation: The Annual Election Period, held from October 15 to December 7, is
when beneficiaries can change Medicare Advantage or Part D plans, or switch back
to Original Medicare. Changes take effect January 1. This is the main period for
coverage adjustments each year.
4.
Medicare covers many essential medical services, but there are notable gaps that
beneficiaries often misunderstand. Imagine a client assuming that all health
services, including dental checkups and eyeglasses, are covered once they enroll in
Original Medicare. They are surprised to learn that some services are excluded.
Which of the following services is not typically covered by Original Medicare?
A. Inpatient hospital stays
B. Skilled nursing facility care (limited)
C. Routine dental care
D. Home health care
Correct Answer: C — Routine dental care.
Explanation: Original Medicare Parts A and B do not cover most routine dental,
vision, or hearing services. Some Medicare Advantage plans may include these as
extra benefits, but beneficiaries relying only on Original Medicare will need to pay
out of pocket or buy supplemental coverage.
5.
Consider a 66-year-old employee who continues to work and has employer-
sponsored group health insurance through a company with more than 20
employees. The employee becomes eligible for Medicare but is unsure whether
they should sign up for Part B immediately. They want to avoid unnecessary
premiums or penalties. What is the most appropriate guidance regarding their Part
B enrollment?
A. They should automatically enroll in Part B and drop employer coverage
immediately
B. They may delay Part B enrollment without penalty as long as they have active
employer coverage
, Updated for 2026-2027
C. They must enroll in both Medicare and employer coverage simultaneously to
avoid penalties
D. They should decline all coverage until they fully retire
Correct Answer: B — They may delay Part B enrollment without penalty as long
as they have active employer coverage.
Explanation: When employer coverage is primary and the company has 20+
employees, individuals can delay Part B without incurring late penalties. After they
retire, they get a Special Enrollment Period to sign up for Part B, ensuring
continuous coverage.
6.
Prescription drug coverage is an important part of Medicare, and beneficiaries have
several choices for obtaining it. A new enrollee is confused about how Part D
works and believes it is automatically included with Original Medicare. They also
think it might be mandatory. To clarify, which of the following statements
accurately describes Medicare Part D coverage?
A. It covers inpatient hospital stays and skilled nursing care
B. It is mandatory for all Medicare beneficiaries
C. It offers outpatient prescription drug coverage through private plans approved
by Medicare
D. It is automatically included in Medicare Parts A and B
Correct Answer: C — It offers outpatient prescription drug coverage through
private plans approved by Medicare.
Explanation: Medicare Part D is optional but strongly recommended to avoid
lifetime penalties. It provides outpatient prescription coverage and is offered by
private insurers that contract with Medicare. Beneficiaries must actively enroll
unless they have other creditable drug coverage.
7.
A 67-year-old individual missed their Initial Enrollment Period and does not
qualify for any Special Enrollment Period. They want to know when they can next
sign up for Medicare Part B. They are also worried about whether they will have to
