RECEIVING THE CALL
What is the Medicare Tier 1 approved greeting?
Thank you for calling Medicare. My name is [INSERT FIRST NAME AND ALIAS LAST NAME]. To better assist you, may I have your name or the name of the person you are calling for?
Which form should a Medicare beneficiary use to submit their own claim?
Form CMS-1490S, Patient's Request for Medical Payment
If a beneficiary’s 65th birthday is in June, what is their Initial Enrollment Period?
March - September
If a beneficiary does not receive SSA benefits, what are the five different ways they can pay their Medicare premiums?
Online Medicare.gov account
Bank's website or mobile app.
Medicare Easy Pay
Check, money order or cashier checks
credit or debit card
Medicare cards aren’t reissued every year and don’t expire.
True
How many pieces of information do you need to pass disclosure?
4 pieces of information
How many days does Medicare have to process an original claim that is submitted without errors?
30 days
When can people with Medicare join, switch, or disenroll from their health or drug plans?
October 15 – December 7
What is the Part B Premium for 2026?
$202.90
Medicare Advantage is the same as Medigap policy.
False
If the beneficiary does not enter any information into the interactive voice response (IVR) system, where do you go in Next Generation Desktop (NGD) to open the call?
BCC Tier 1 screen
How long does a beneficiary have to submit an appeal?
120 calendar days from the date he received the MSN
During the Medicare Advantage Open Enrollment Period (January 1 – March 31), how many opportunities do beneficiaries have to choose the coverage that is right for them?
1 opportunity
How can a beneficiary pay the Medicare Advantage plan premium?
Medigap open enrollment period lasts for 6 months. It starts on the first day of the month that you are both age 65 or older and enrolled in Medicare Part B.
True
Where in NGD do you go to check for authorization?
BCC Tier 1 screen Authorizations view
Within how much time from the date of service must a Medicare claim be filed to avoid being denied for late filing?
1 calendar year after the date of service.
What SEP would you use if a beneficiary was enrolled in a plan without their consent?
Marketing Misrepresentation SEP
What is the premium for Part A for a beneficiary that has less than 30 credits?
$565.00
Medigap policies will work with other types of health insurance, such as Medicare Advantage plans, like an HMO or PPO plan; Medicaid; veterans' health care benefits; TRICARE; or employer or union group coverage.
False
Which part of a beneficiary’s address is not required when collecting information to pass disclosure?
ZIP Code is not required
How many levels can the appeal process include?
The appeal process has up to 5 levels
How long is the Special Enrollment Period (SEP) you get to enroll to Part A or Part B after you stop working or lose your health coverage?
8 months
What is the Part B due date?
Payments are due on the 25th of the same month they receive the Medicare Premium Bill
If you or your spouse has coverage through an employer group health plan with less than 20 employees, you may be able to delay enrolling in Part A and Part B without having to pay a penalty if you enroll later.
False