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Lesson 4a: Medicare Advantage Plans Exam
Questions and Answers 100% Pass
What is Part C/Medicare Advantage? - ✔✔Medicare Part A + Part B + Part D (a few added perks) = Part
C or Medicare Advantage
Added perks may include: prescriptions, dental, vision, and gym memberships
(MAPD) Medicare Advantage Prescription Drug Plan - ✔✔Medicare Advantage plan that includes
prescription coverage
(MA) Medicare Advantage Plan - ✔✔Medical only Medicare Advantage plan
How do you qualify for an MA/MAPD plan? - ✔✔Must be eligible for Medicare
Must continue to pay Part B premium
Must pay your MA/MAPD plan premium (if applicable)
CANNOT have End Stage Renal Disease (ESRD)
How does an MA/MAPD plan work? - ✔✔Medicare Advantage plan benefits replace Original Medicare
benefits
Advantage plan become primary insurance
Client still pays Part B premium
Client never loses Medicare
Medicare-covered health care is provided by a private health plan
Medicare Advantage plans are NOT supplemental coverage
Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE
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In-network coverage is usually cheaper than out-of-network coverage
The MA/MAPD insurance card replaces the Original Medicare Card
Plans vary throughout the United States
Plans are available by county
There is NO underwriting for MA/MAPDs
You can join these plans with pre-existing conditions except End Stage Renal Disease (ESRD)
You CANNOT be enrolled in an MA/MAPD and a stand alone PDP at the same time
The only time you can have an MA and stand-alone PDP is if the MA is a PFFS private-fee-for-service
without drug coverage
What does the Advantage plan have that Medicare doesn't? - ✔✔The co-pays (set $ amount), deductibles,
and coinsurance (set % of cost) under an MA/MAPD plan are typically lower
Limits your maximum out-of-pocket (Original Medicare has no cap)
Might have extra benefits (dental, vision, gym, etc.)
MAPDs have prescription drug coverage built in to the plan versus having to purchase it separately
What types of Medicare Advantage plans are there? - ✔✔HMO (in-network), PPO (in/out-of-network),
HMO-POS, and SNP (D-SNP and C-SNP)
All plans are network based (except some PFFS plans)
These plans function as MA or MAPDs
(HMO) Health Maintenance Organization - ✔✔In-network benefits only, beneficiary only has access to
certain providers
Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE
Lesson 4a: Medicare Advantage Plans Exam
Questions and Answers 100% Pass
What is Part C/Medicare Advantage? - ✔✔Medicare Part A + Part B + Part D (a few added perks) = Part
C or Medicare Advantage
Added perks may include: prescriptions, dental, vision, and gym memberships
(MAPD) Medicare Advantage Prescription Drug Plan - ✔✔Medicare Advantage plan that includes
prescription coverage
(MA) Medicare Advantage Plan - ✔✔Medical only Medicare Advantage plan
How do you qualify for an MA/MAPD plan? - ✔✔Must be eligible for Medicare
Must continue to pay Part B premium
Must pay your MA/MAPD plan premium (if applicable)
CANNOT have End Stage Renal Disease (ESRD)
How does an MA/MAPD plan work? - ✔✔Medicare Advantage plan benefits replace Original Medicare
benefits
Advantage plan become primary insurance
Client still pays Part B premium
Client never loses Medicare
Medicare-covered health care is provided by a private health plan
Medicare Advantage plans are NOT supplemental coverage
Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE
, 2|Page
In-network coverage is usually cheaper than out-of-network coverage
The MA/MAPD insurance card replaces the Original Medicare Card
Plans vary throughout the United States
Plans are available by county
There is NO underwriting for MA/MAPDs
You can join these plans with pre-existing conditions except End Stage Renal Disease (ESRD)
You CANNOT be enrolled in an MA/MAPD and a stand alone PDP at the same time
The only time you can have an MA and stand-alone PDP is if the MA is a PFFS private-fee-for-service
without drug coverage
What does the Advantage plan have that Medicare doesn't? - ✔✔The co-pays (set $ amount), deductibles,
and coinsurance (set % of cost) under an MA/MAPD plan are typically lower
Limits your maximum out-of-pocket (Original Medicare has no cap)
Might have extra benefits (dental, vision, gym, etc.)
MAPDs have prescription drug coverage built in to the plan versus having to purchase it separately
What types of Medicare Advantage plans are there? - ✔✔HMO (in-network), PPO (in/out-of-network),
HMO-POS, and SNP (D-SNP and C-SNP)
All plans are network based (except some PFFS plans)
These plans function as MA or MAPDs
(HMO) Health Maintenance Organization - ✔✔In-network benefits only, beneficiary only has access to
certain providers
Created by Katelyn Whitman © 2025, All Rights Reserved. 100% PASS GUARANTEE
