Disclaimer: Since Medicaid rules and insurance regulations are updated regularly, past blog posts may not present the most accurate or relevant data. Please contact our office for up-to-date information, strategies, and guidance.
1. Who is eligible for Medicare benefits?
a. People aged 65 and older
b. Individuals under 65 who qualify for SSDI (eligible after 24 months)
c. People with End-Stage Renal Disease (ESRD) or ALS
d. All the above
2. Does Medicare have an annual limit on out-of-pocket costs?
3. Which of the following services does Medicare cover?
a. Hospitalization
b. Doctor visits
c. Prescription drugs
d. All the above
4. Which long-term care service does Medicare NOT pay for?
a. Hospice
b. Residential nursing home care
c. Rehabilitation in a facility
5. Which of these vision services does Original Medicare NOT cover?
a. Treatment of age-related macular degeneration
b. Annual eye exam for people with diabetes
c. Cataract surgery
d. Eyeglasses and contact lenses
6. Which Medicare option sometimes pays for dental care?
a. Original Medicare
b. Medicare Advantage
c. Medigap Plan
7. What costs does Medicare cover while outside of the United States?
a. Doctor visits for minor issues such as a virus
b. Emergency life-threatening issues
c. Care provided by a nurse only
d. Transportation home
e. None of the above
8. Is COBRA considered creditable coverage once Medicare eligible?
9. Is employer coverage (Group Health Plan) creditable coverage once Medicare eligible?
10. What is the Medicare Part B premium for 2023 for most beneficiaries?
a. $180.20
b. $164.90
c. $226
d. $0
Answer Guide
1. Who is eligible for Medicare benefits?
D. All groups mentioned qualify for Medicare.
2. Does Medicare have an annual limit on out-of-pocket costs?
No. There are no out-of-pocket limits on Original Medicare. It’s important that your client has a plan to cap costs and get assistance or coverage for these costs.
3. Which of these services does Medicare cover?
D. Medicare pays for a portion of all of these medical needs, though some of these services have premiums, deductibles, and copays. Prescription drug coverage under Original Medicare is extremely limited to a select group of drugs. Enrolling in a drug coverage plan is voluntary, though failure to enroll when first eligible may result in a lifetime penalty. Help your clients understand these rules in order to avoid costly penalties.
4. Which long-term care service does Medicare NOT pay for?
B. Medicare pays for hospice care for terminally ill patients and covers rehab costs at a skilled nursing facility after episodes like a stroke or a fall that required three-day hospitalization or longer. However, Medicare doesn’t cover nursing home care that is just custodial, such as help with bathing, dressing, and other activities of daily living. It’s important that you help your clients cover these costs by encouraging them to purchase long-term care insurance.
5. Which of these vision services does Original Medicare NOT cover?
D. Original Medicare does not cover routine vision exams or eyeglasses and contact lenses. Some Medicare Advantage plans, which are private insurance plans that are an alternative to Original Medicare, do provide some coverage for these needs. In most cases, your clients should consider a standalone vision plan to help with these costs.
6. Which Medicare option sometimes pays for dental care?
B. Some Medicare Advantage plans pay for certain dental services. In most cases, your clients should consider a standalone dental plan to help cover these costs.
7. What costs does Medicare cover while outside of the United States?
E. Medicare typically doesn’t cover care received while traveling outside of the U.S., except in very limited circumstances (such as on a cruise ship within six hours of a U.S. port). But Medicare Supplement (Medigap) plans C through G, M, and N cover 80% of the cost of emergency care abroad, with a lifetime limit of $50,000. Some Medicare Advantage plans also cover emergency care abroad. Your clients should consider purchasing medical travel insurance that pays some medical expenses while outside of the U.S. Some travel insurance even covers emergency medical evacuation, which can otherwise cost tens of thousands of dollars. If you have questions about this product, contact us.
8. Is COBRA considered creditable coverage once Medicare eligible?
No. If a client wants to keep employer insurance coverage after retirement, they must enroll in Medicare Part A and Part B, or they risk incurring a hefty penalty and a possible delay in Medicare coverage.
9. Is employer coverage (Group Health Plan) creditable coverage once Medicare eligible?
It depends. If the employer group is 20 or more, it is creditable for Medicare Part B. It’s possible that a very high deductible plan might not be creditable for Part D. If the group is less than 20, your client should confirm whether it’s necessary to sign up for Part B and possibly Part D. If you have questions about a specific client case, please contact us for consultation.
10. What is the Medicare Part B premium for 2023 for most beneficiaries?
B. In some cases, your client might have to pay more if they are a high-income earner. Please consult brackets on IRMAA for exact Part B premium amounts for your clients.
If you’d like to learn more about helping clients explore Medicare coverage and their options for additional Medicare products, we can help! Schedule a call with us today.
