Early
If you have Medicaid and Medicare, who pays first for covered services?
Medicare pays first, and Medicaid pays second (after Medicare).
What are two key types of services covered under Medicare Part B?
Part B covers medically necessary services (like doctor visits and outpatient care) and preventive services (like screenings and vaccines).
What are the main services covered under Medicare Part A?
Part A covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care.
Name two examples of extra benefits Medicare Advantage Plans may offer.
Examples include vision, dental, hearing services, gym memberships, or transportation to doctor visits.
Medicare Advantage Plans are offered by the federal government instead of private companies.
False – they are offered by private companies approved by Medicare
What is the timeframe for the Initial Enrollment Period (IEP) for Medicare Part A and Part B?
It is a 7-month period that begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after.
What determines how much you pay for Part A hospital services?
Costs depend on where you receive care, how long you receive care, and whether you have other coverage.
What are two requirements to join a Medicare Advantage Plan?
You must:
What are two options you have if you decide to leave a Medicare Advantage Plan early?
You can:
What must someone in Puerto Rico do to get Medicare Part B if they receive Social Security or RRB benefits?
They must sign up for Part B because it is not automatic in Puerto Rico (only Part A is automatic).
How long do you have to enroll in Medicare during a Special Enrollment Period after your employment or employer coverage ends?
You have 8 months to enroll in Part A and/or Part B after employment or group coverage ends (whichever comes first).
What type of Medicare Advantage plan typically requires you to choose a primary care doctor and get referrals?
An HMO (Health Maintenance Organization) Plan.
What is the main purpose of a Medigap policy?
To help pay costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles.
Some Medicare Advantage Plans may require referrals or prior authorization before covering certain services.
True
How long is the Initial Enrollment Period for Medicare?
It lasts 7 months (3 months before, the month of, and 3 months after you become eligible).
You always have to use your red, white, and blue Medicare card when you are in a Medicare Advantage Plan.
False – you use your plan’s card to get services.
How are Medigap plans standardized?
Plans are standardized by letter (A–D, F, G, K–N), and each letter offers the same basic benefits no matter the company.
What happens if you use an out-of-network provider in a PPO plan?
You can still get care, but you will usually pay more than if you stay in-network.
Medicare Advantage Plans typically have a yearly limit on out-of-pocket costs for Part A and Part B services.
True – these plans include a maximum out-of-pocket limit.
When do Medicare Part A and Part B typically start for someone turning 65, and what happens if their birthday is on the first of the month?
They start on the first day of the month the person turns 65. If the birthday is on the first of the month, coverage starts on the first day of the prior month
Which type of coverage allows you to delay enrolling in Medicare Part B without a penalty?
Coverage based on current employment (through your or your spouse’s employer or union). COBRA, retiree, VA, and Marketplace coverage do not qualify.
What must a patient do to qualify for hospice care under Medicare?
A doctor and hospice provider must certify the patient is terminally ill with a life expectancy of 6 months or less, and the patient must choose comfort (palliative) care instead of treatment to cure the illness.
If you join a Medicare Advantage Plan when first eligible, you have a limited time to switch plans.
True
Do you need to have Part A and Part B to join a Medicare Advantage Plan?
Yes, you must have both Part A and Part B.
COBRA coverage is considered coverage based on current employment for delaying Medicare Part B.
False – COBRA is not considered current employment coverage and does not qualify you to delay Part B.