Eligibility
Enrollment
Benefits
Cost Sharing
Prior Auths-Referrals
100

At what age do most individuals become eligible for Medicare?

Age 65

100

What part of Medicare must you actively enroll in if not automatically enrolled at 65?

Medicare Part B

100

What does Medicare Part A generally cover?

Hospital stays, skilled nursing, hospice, some home health

100

What is a deductible?

The amount you pay before coverage begins

100

What is prior authorization?

Approval from the plan before receiving certain services

200

True or False: Individuals under 65 can qualify for Medicare due to disability.

True

200

What happens if someone misses their Initial Enrollment Period?

May face late enrollment penalties and coverage delays.

200

What does Medicare Part B generally cover?

Doctor visits, outpatient care, preventive services, durable medical equipment

200

What is coinsurance?

A percentage of costs you pay after reaching the annual deductible

200

True or False: All services require prior authorization under Medicare Advantage.

False – only specific services require it

300

What type of work history is typically required to qualify for premium-free Part A?

10 years (40 quarters) of work paying Medicare taxes

300

What is one way to enroll in an Aetna Medicare Advantage plan?

By visiting AetnaMedicare.com, calling Aetna directly, or working with a licensed agent.

300

What is the purpose of Medicare Advantage (Part C)?

Combines Parts A and B, often includes Part D and extra benefits

300

What is the difference between in-network and out-of-network cost sharing?

In-network usually costs less; out-of-network may have higher costs or no coverage

300

Who is responsible for obtaining prior authorization—member or provider?

The provider

400

Name one condition that qualifies someone for Medicare before age 65.

End-stage renal disease (ESRD).

400

What is the difference between Open Enrollment and Special Enrollment Periods?

Open Enrollment is annual; Special Enrollment is triggered by life events

400

Name one benefit that Medicare Advantage may offer that Original Medicare does not.

Dental, vision, hearing, fitness programs

400

True or False: Medicare Advantage plans have a maximum out-of-pocket limit.

True

400

What happens if a provider does not obtain required prior authorization?

Claim may be denied; member may be responsible for full cost

500

What government agency determines Medicare eligibility?

Social Security Administration

500

What is the difference between enrolling in Original Medicare and Medicare Advantage?

Original Medicare includes Parts A and B; Medicare Advantage (Part C) is offered by private insurers and may include additional benefits like Part D, dental, or vision

500

What is the difference between preventive and diagnostic services under Medicare?

Preventive services are routine screenings; diagnostic services investigate symptoms

500

What is the impact of using a non-participating provider?

Member may pay full cost; provider may bill member directly

500

What is the difference between a referral and prior authorization?

Referral is permission to see a specialist; PA is approval for a specific service

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