Medicare Module 1 / Certified Exam Questions & Correct Answers / 2025.QS: What impact, if any, will the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) have upon Medigap plans? - Answer: The Part B deductible will no longer be covered for individuals newly eligible for Medicare starting January 1, 2020.The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) will make changes to Medigap plans effective 2020.Specifically, for individuals newly eligible to Medicare, the Part B deductible cannot be covered. Therefore, Plans C and F will no longer be an option for newly eligible individuals starting January 1, 2020. However, individuals who already have Plans C and F will be able to keep their current versions of the plans and individuals eligible for Medicare prior to January 1, 2020, can purchase the current version of Plans C and F on or after January 1, 2020 Qs: Mrs. Lenard is enrolled in a Medicare Cost plan. Recently the cost plan has transitioned to a Medicare Advantage (MA) contract, and Mrs. Lenard has been told that she has been subject to "deemed enrollment." What does this mean? - Answer: Some cost plans transitioning to MA contracts will have "deemed" or facilitated enrollment. That is, unless a cost plan enrollee opts out, he/she will be automatically enrolled in an MA plan offered by the same organization.Individuals subject to deemed enrollment will be notified by CMS and the plan and given the opportunity to choose another option.Qs: Mr. Carter, who is enrolled in a stand-alone Part D plan, receives the Part D low-income subsidy and just received a letter from the Social Security Administration informing him that he will no longer qualify for the subsidy? He is wondering if he can switch to a lower cost Part D plan. What should you tell him? - Answer: Medicaid: help with health care costs.Medicare Savings Program: help paying for the Medicare Part B premium and, in some cases, deductibles and coinsurance. 1 / 3
Part D low-income subsidy: help paying for prescription drug coverage. The State Medicaid office will check eligibility for this and other programs such as the Medicare Savings Program. Persons interested in Part D help only may call the Social Security Administration (SSA) at 1-800-772-1213 or apply online at www.ssa.gov/prescriptionhelp.Supplemental Security Income (SSI) benefits: help with cash for basic needs. You also may apply through SSA.Qs: Mrs. Shields is covered by Original Medicare. She sustained a hip fracture and is being successfully treated for that condition. However, she and her physicians feel that after her lengthy hospital stay she will need a month or two of nursing and rehabilitative care. What should you tell them about Original Medicare's coverage of care in a skilled nursing facility? - Answer: Skilled nursing and rehabilitative care only after a three day hospital stay, up to 100 days in a benefit period (as defined by Medicare). In 2017, beneficiaries pay $164.50 coinsurance for days 21-100 each benefit period.Inpatient psychiatric care (up to 190 lifetime days) Part A does not cover custodial or long-term care Cost-sharing may differ for enrollees of Medicare Qs: BestCare Health Plan has received a request from a state insurance department in connection with the investigation of several marketing representatives licensed by the state who sell Medicare Advantage plans. What action(s) should BestCare take in response? - Answer: Agent Armstrong is an independent agent under contract with MarketCo, a third party marketing organization. MarketCo has a contract with BestChoice health plan, a Medicare Advantage organization, to offer marketing services through its contracted agents and agencies.Agent Armstrong returns calls to individuals who call MarketCo in response to its mailers promoting BestChoice health plan. Agent Armstrong is a marketing representative of BestChoice. Thus, he is obligated to comply with all marketing requirements, including those regarding using only approved call scripts.Qs: Agent Mark Andrews would like to employ technology to facilitate the growth of his Medicare Advantage (MA) practice. What step(s) would you recommend that Mark take? - Answer: Plans/Part D Sponsors must submit to CMS social media (e.g.,Facebook, Twitter, 2 / 3
YouTube, LinkedIn, Scan Code, or QR Code)posts that meet the definition of marketing materials, specifically those that contain plan-specific benefits, premiums, cost-sharing,or Star Ratings.Social media posts are subject to marketing requirements, such as those related to testimonials.Generally disclaimers are not required unless a communication written for social media has the potential to be disseminated via other mediums, such as youtube.Plans/Part D Sponsors must not include content on social/electronic media that discusses plan-specific benefits, premiums, cost-sharing, or Star Ratings for products offered in the next contract year prior to October 1.Qs: Mrs. Goodman enrolled in an MA-PD plan during the Annual Election Period. In mid-January of the following year, she wants to switch back to Original Medicare and enroll in a stand-alone prescription drug plan. What should you tell her? - Answer: Annual election period (October 15
- December 7)
Medicare Advantage Disenrollment Period (January 1 - February 14) Beneficiaries may only enroll in or change plans at certain fixed times each year or under certain limited special circumstances.If the application does not include information supporting a permissible election period, plans must contact the beneficiary to decide if enrollment is permissible.MA and Part D Enrollment periods are:MA Initial Coverage Election Period (ICEP)Part D Initial Enrollment Period (IEP)MA and Part D Annual Election Period (AEP)MA and Part D Special Enrollment Periods (SEP)Open Enrollment Period for Institutionalized Individuals (OEPI)MA 45-Day Disenrollment Period
(MADP)
Qs: Mrs. Reynolds just signed up for a Medicare Advantage plan on the second of the month.She is leaving for vacation in two weeks and wants to know if her new coverage will start before she leaves. What should you tell her? - Answer: Initial Coverage Election Period (ICEP) The ICEP begins three months immediately before the individual's first entitlement to both
Medicare Part A and Part B and ends on the later of:
The last day of the month preceding entitlement to both Part A and Part B, or;The last day of the individual's Part B initial
- / 3