Part A
What is Part A of Medicare?
Hospital
What is Part B of Medicare?
Medical(Doctors)
What is Part C of Medicare?
Medicare Advantage
What is Part D of Medicare?
Drugs
Another name for a Medicare Supplement?
Medigap
Name 2 things covered by Part A.
Inpatient Hospital, Skilled nursing, hospice, blood, & home health care
Name 2 things covered by Part B.
Doctor services, outpatient services, DME, preventative services, labs/imaging, drugs administered at facility, and ambulance
Name the 3 networks used for Part C.
HMO, HMOPOS, PPO
What are the three coverage stages for Part D.
Initial, Deductible, and Catastrophic
True or False: Medicare Supplements come with dental, vision, and hearing.
False...need a standalone plan!!
What is the Part A Deductible for 2026?
$1736
What is the Part B deductible for 2026?
$283
What does the Maximum out of Pocket do?
Once the specified amount is reached in copays for the year the plan will then pick up 100% of bills for the rest of the calendar year.
What is the Part D cap limit for 2026?
$2100
Name the 3 things not covered under Plan N.
Part b deductible, excess charges, and possible copay up to $20 for dr visit and up to $50 for ER
What is maximum amount of days of covered in a Skilled Nursing Facility?
100 days, but can be cut off at any time if not showing signs of improvement or refusing to participate
Name 2 types of coverage that would cause Late Enrollment Penalties if part B was delayed past 65.
ACA, VA, Tricare, COBRA, Medicaid, Small Employer plans, Individual major medical plans, Tri term/short term medical plans, and some retiree/federal plans offered through previous employers.
True or False: you can have both an HMO and a standalone part D at the same time
False
What does it mean if a deductible on a part d plan says it "excludes tiers 1 & 2"
Any medication that is considered a tier 1 or 2 on the plans formulary will not be calculated into the plans deductible, but tiers 3 and up will be full cost until the specified deductible is met.
Name the 2 plan letters that offer a High Deductible option.
F and G
True or False: Everyone turning 65 receives Part A for free
False...it is only free for those who have worked their 40 quarters or if they are eligible through spouse if married 10 years or more
Name a type of medication that would be billed under part B, instead of part D
medications that are not self administered like; chemotherapy, radiation, injections, IVs, vaccines, etc.
Name the 3 main chronic conditions that qualifies someone for a CSNP
Heart/cardio vascular, diabetes, and lung
What happens if a medication is not on the plans formulary?
The prescriber can ask for a formulary acceptation as long as it is medically necessary. If no acceptation is granted only other options is to find a substitute that is covered on the formulary or pay full cost.
Who is eligible for open enrollment for Medicare supplements?
Someone turning 65 or someone who has delayed part b with credible coverage