General knowledge · Section VII · Life, Accident and Health only
Social insurance
Government programs that interact with private coverage: Medicare Parts A, B, C and D, Medicaid, and Social Security disability benefits. Questions here come from federal sources such as Medicare and Social Security publications.
Questions on the exam
- Life, Accident and Health: 6 questions
- Life Agent: Not on this exam
Life, Accident and Health exam
What the official outline lists
- Medicare (Parts A, B, C, D)
- Medicaid
- Social Security benefits
Practice questions
Choose your answer, then open “Show the answer” to see why each option is right or wrong and the exact source text.
1. According to Medicare & You, a Part D late enrollment penalty may apply after the Initial Enrollment Period if there is a gap of how many days in a row without Medicare drug coverage or other creditable prescription drug coverage?
- 63 or more days
- 30 or more days
- 45 or more days
- 60 or more days
Show the answer
Correct answer: A. 63 or more days
Per CMS, Medicare & You (p. 87), the penalty may apply if there is a period of 63 or more days in a row without Medicare drug coverage or other creditable prescription drug coverage.
Why the other options are wrong
- B. The passage sets the gap at 63 or more days in a row, so a 30-day gap is below the stated threshold.
- C. The passage sets the gap at 63 or more days in a row, so a 45-day gap is below the stated threshold.
- D. The passage sets the gap at 63 or more days in a row, so a 60-day gap is below the stated threshold.
You may have to pay a late enrollment penalty if you enroll at any time after your Initial Enrollment Period is over and there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage.
2. Aldo is already in a Medicare Advantage Plan. Each year from January 1 through March 31, which change may he make once under the Medicare Advantage Open Enrollment Period?
- Switch to a different Medicare Advantage Plan or to Original Medicare
- Switch from Original Medicare into a Medicare Advantage Plan
- Join a separate Medicare drug plan while staying in his current plan
- Drop all Medicare coverage and keep only Medigap
Show the answer
Correct answer: A. Switch to a different Medicare Advantage Plan or to Original Medicare
Per CMS, Medicare & You (p. 84), if you are already in a Medicare Advantage Plan, from January 1-March 31 each year you can switch once to a different Medicare Advantage Plan or to Original Medicare (and join a separate Medicare drug plan).
Why the other options are wrong
- B. The passage applies this period only to people already in a Medicare Advantage Plan and lets them switch away from it or to another plan, not into one from Original Medicare.
- C. The passage ties joining a separate drug plan to switching to Original Medicare, not to staying in the Medicare Advantage Plan.
- D. The passage lists switching plans or going to Original Medicare as the options; dropping all Medicare coverage is not described.
Medicare Advantage Open Enrollment Period (only if you're already in a Medicare Advantage Plan). From January 1 – March 31 each year, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time (page 75).
3. Lee needs nursing facility care and applies for Medicaid long-term services and supports. Three years before applying, Lee gave a house to a nephew for far less than it was worth. What is the likely effect on Lee’s application?
- LTSS coverage will be denied because the transfer occurred within the five-year period before application
- LTSS coverage will be approved because only transfers in the past year count
- LTSS coverage will be approved because gifts to relatives are never considered
- LTSS coverage will be denied only for the months before Lee applied
Show the answer
Correct answer: A. LTSS coverage will be denied because the transfer occurred within the five-year period before application
According to the Medicaid.gov Eligibility Policy page, Medicaid beneficiaries who need LTSS will be denied LTSS coverage if they have transferred assets for less than fair market value during the five-year period preceding their Medicaid application. Lee’s transfer occurred three years before applying, so it is within that period.
Why the other options are wrong
- B. The source uses a five-year period preceding the application, so a transfer three years earlier is included; a one-year limit is not stated.
- C. The source says transfers for less than fair market value are considered, with no exception for relatives.
- D. The source says LTSS coverage will be denied; it does not limit the denial to months before the application.
Medicaid beneficiaries who need LTSS will be denied LTSS coverage if they have transferred assets for less than fair market value during the five-year period preceding their Medicaid application.
4. Under federal law, the "waiting period" for disability insurance benefits is the earliest period of how many consecutive calendar months in which the applicant has been under a disability?
- Three consecutive calendar months
- Five consecutive calendar months
- Six consecutive calendar months
- Twelve consecutive calendar months
Show the answer
Correct answer: B. Five consecutive calendar months
According to 42 U.S.C. 423(c)(2), the term waiting period means, for any application for disability insurance benefits, the earliest period of five consecutive calendar months throughout which the individual has been under a disability.
Why the other options are wrong
- A. Three months is shorter than the waiting period; 42 U.S.C. 423(c)(2) defines it as five consecutive calendar months.
- C. Six months is longer than the waiting period; 42 U.S.C. 423(c)(2) defines it as five consecutive calendar months.
- D. Twelve months is the length of the disability duration in 42 U.S.C. 423(d)(1)(A), not the waiting period, which is five consecutive calendar months under 42 U.S.C. 423(c)(2).
The term “waiting period” means, in the case of any application for disability insurance benefits, the earliest period of five consecutive calendar months— (A) throughout which the individual with respect to whom such application is filed has been under a disability, and
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Key flashcards
Front and back, as in the app.
- Federal law (42 U.S.C. 423(c)(2)): length of the waiting period for disability insurance benefits
- The earliest period of five consecutive calendar months throughout which the applicant has been under a disability (42 U.S.C. 423(c)(2), “Disability insurance benefit payments”)
Terms on this topic
- Disability — Discapacidad
- Application — Solicitud
- Medicaid — Medicaid
- Enrollment — Inscripción
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