Medicare parts, supplement plans, and health insurance marketplace concepts tested on health insurance licensing exams.
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- What does Medicare Part A cover?
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Hospital inpatient care, skilled nursing facility care, hospice care, and some home health services.- Is Medicare Part A premium required for someone who paid Medicare taxes for 10+ years?
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No, Part A is typically premium-free for those who meet the work requirement.- What does Medicare Part B cover?
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Physician services, outpatient hospital care, diagnostic tests, and durable medical equipment.- What is the typical premium structure for Medicare Part B?
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A monthly premium paid by the enrollee, adjusted based on income level.- What does Medicare Part C (Medicare Advantage) do?
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Provides an alternative way to receive Part A and B benefits through private insurance plans, typically including prescription drug coverage.- What is Medicare Part D?
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Coverage for prescription drugs offered by private insurance companies approved by Medicare.- Can someone enroll in both Original Medicare (Parts A and B) and Medicare Advantage (Part C)?
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No, you must choose either Original Medicare or Medicare Advantage, not both.- What are Medigap plans (Medicare Supplement)?
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Private insurance policies that help pay for costs not covered by Original Medicare, such as copayments, coinsurance, and deductibles.- Can you use a Medigap plan with Medicare Advantage?
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No, Medigap supplements Original Medicare only; it cannot be used with Medicare Advantage.- What is the Medigap open enrollment period?
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Six months starting when you are age 65 or older and enrolled in Medicare Part B, or within 63 days of losing other health coverage.- What is the Health Insurance Marketplace?
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A system where individuals can compare and purchase qualified health plans (QHP) from multiple insurers, often with access to subsidies.- What are the four metal levels in the Health Insurance Marketplace?
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Bronze, Silver, Gold, and Platinum, representing different levels of cost-sharing between the plan and the enrollee.- What percentage of healthcare costs does a Silver plan typically cover?
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Approximately 70 percent; the enrollee is responsible for approximately 30 percent.- What is a Bronze plan in the marketplace?
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The lowest-cost tier of marketplace plans where the plan covers approximately 60 percent of healthcare costs and the enrollee covers approximately 40 percent.- What is a Gold plan in the marketplace?
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A marketplace plan where the plan covers approximately 80 percent of healthcare costs and the enrollee covers approximately 20 percent.
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