MCQ Quiz-Medicare

MCQ Quiz: Medicare

by

As the federal health insurance program for millions of seniors and individuals with disabilities, Medicare plays a dominant role in the U.S. healthcare landscape. For pharmacists, a deep understanding of this system, especially the Part D prescription drug benefit, is essential. This knowledge is critical for assisting patients with plan selection, managing medication therapy through MTM programs, and contributing to quality measures that impact both patient health and pharmacy performance.

1. Medicare Part D provides coverage for what type of healthcare service?

  • Inpatient hospital stays
  • Outpatient prescription drugs
  • Long-term custodial care
  • Physician office visits


Answer: Outpatient prescription drugs

2. The CMS Medicare 5-Star Quality Rating program is primarily designed to:

  • Set the price for new brand-name drugs
  • Help beneficiaries compare the quality of Medicare Advantage and Part D plans
  • Punish pharmacies for dispensing generic drugs
  • Regulate the pharmaceutical supply chain


Answer: Help beneficiaries compare the quality of Medicare Advantage and Part D plans

3. A Medication Therapy Management (MTM) program is a required service for certain beneficiaries in which part of Medicare?

  • Part A
  • Part B
  • Part D
  • It is not a required service


Answer: Part D

4. A physician-administered injectable drug, like a chemotherapy agent given in a clinic, is typically covered under which part of Medicare?

  • Part A
  • Part B
  • Part C only
  • Part D


Answer: Part B

5. The stage in the Medicare Part D benefit design where the beneficiary pays a higher portion of drug costs after the initial coverage limit is reached is commonly known as the:

  • Deductible phase
  • Catastrophic coverage phase
  • Coverage Gap or “Donut Hole”
  • Initial enrollment period


Answer: Coverage Gap or “Donut Hole”

6. Which of the following is a key pharmacy-related quality measure in the CMS Star Ratings?

  • The number of prescriptions dispensed per hour
  • Medication adherence rates for chronic conditions like diabetes and hypertension
  • The pharmacy’s daily operating hours
  • The aesthetic design of the prescription label


Answer: Medication adherence rates for chronic conditions like diabetes and hypertension

7. To be eligible for MTM services under Medicare Part D, a beneficiary must typically:

  • Be under the age of 65
  • Have multiple chronic diseases and take multiple Part D medications
  • Have no chronic conditions
  • Reside in a nursing home


Answer: Have multiple chronic diseases and take multiple Part D medications

8. Medicare Advantage Plans are also known as:

  • Medicare Part A
  • Medigap Plans
  • Medicare Part C
  • Stand-alone Prescription Drug Plans


Answer: Medicare Part C

9. Medicare Part D formularies must include drugs in all or substantially all therapeutic categories as defined by:

  • The American Medical Association (AMA)
  • The Pharmaceutical Research and Manufacturers of America (PhRMA)
  • The United States Pharmacopeia (USP)
  • The Food and Drug Administration (FDA)


Answer: The United States Pharmacopeia (USP)

10. The core service provided during an MTM encounter is the:

  • Dispensing of a new prescription
  • Administration of a vaccine
  • Comprehensive Medication Review (CMR)
  • Sale of an over-the-counter product


Answer: Comprehensive Medication Review (CMR)

11. Which piece of recent legislation grants Medicare the authority to negotiate prices for certain high-cost drugs?

  • The Affordable Care Act (ACA)
  • The Health Insurance Portability and Accountability Act (HIPAA)
  • The Inflation Reduction Act (IRA)
  • The Drug Quality and Security Act (DQSA)


Answer: The Inflation Reduction Act (IRA)

12. Medicare Part A primarily provides coverage for:

  • Inpatient hospital services
  • Prescription drugs from a community pharmacy
  • Routine dental and vision exams
  • Outpatient physician services


Answer: Inpatient hospital services

13. A pharmacy’s performance on the CMS Star Ratings can affect:

  • The pharmacy’s reimbursement and its status in a plan’s preferred network
  • The price the pharmacy pays for its inventory
  • The number of technicians the pharmacy is allowed to employ
  • The state laws governing pharmacy practice


Answer: The pharmacy’s reimbursement and its status in a plan’s preferred network

14. A key role for a pharmacist is helping patients select a Part D plan during which period?

  • The Special Enrollment Period
  • The Initial Enrollment Period
  • The Annual Open Enrollment Period
  • All of the above


Answer: All of the above

15. “Protected classes” in Medicare Part D are therapeutic categories where plans must cover all or substantially all available drugs. Which of the following is a protected class?

  • Antidepressants
  • Over-the-counter cough and cold remedies
  • Lifestyle drugs like those for hair loss
  • Vitamins and minerals


Answer: Antidepressants

16. The Inflation Reduction Act included a provision to cap the monthly out-of-pocket cost for which product for Medicare beneficiaries?

  • Insulin
  • Acetaminophen
  • Statins
  • All prescription drugs


Answer: Insulin

17. What is the primary source of funding for the Medicare program?

  • State government taxes
  • Payroll taxes, premiums, and federal general revenue
  • Private donations
  • Sales taxes on prescription drugs


Answer: Payroll taxes, premiums, and federal general revenue

18. A Targeted Medication Review (TMR), as part of an MTM program, is designed to:

  • Occur annually for all of a patient’s medications
  • Address a specific, potential medication-related problem
  • Be conducted only when a patient is hospitalized
  • Replace the need for a physician visit


Answer: Address a specific, potential medication-related problem

19. A Medicare Advantage plan is offered by:

  • The federal government directly
  • State Medicaid agencies
  • Private insurance companies approved by Medicare
  • Large hospital systems


Answer: Private insurance companies approved by Medicare

20. A pharmacist can directly improve a plan’s Star Ratings by:

  • Counseling patients on medication adherence
  • Selling more front-store items
  • Extending the pharmacy’s hours
  • Offering the lowest cash prices


Answer: Counseling patients on medication adherence

21. Besides age 65, individuals with what condition are generally eligible for Medicare regardless of age?

  • Seasonal allergies
  • End-Stage Renal Disease (ESRD)
  • Type 2 Diabetes
  • Hypertension


Answer: End-Stage Renal Disease (ESRD)

22. The standard Medicare Part D benefit design includes which of the following phases?

  • Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage
  • Copayment only
  • Coinsurance only
  • First-dollar coverage for all medications


Answer: Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage

23. Under the Inflation Reduction Act, what major change is happening to the structure of the Part D benefit?

  • The “donut hole” is being made larger
  • The out-of-pocket spending for beneficiaries is being capped
  • All drugs will have a $0 copay
  • The deductible is being eliminated for all plans


Answer: The out-of-pocket spending for beneficiaries is being capped

24. A stand-alone Prescription Drug Plan (PDP) offers coverage for:

  • Only drugs covered under Part B
  • Hospital, medical, and prescription drug services
  • Only prescription drugs under Part D
  • Only generic medications


Answer: Only prescription drugs under Part D

25. A pharmacist providing MTM services aims to:

  • Increase the number of prescriptions a patient is taking
  • Identify and resolve medication therapy problems
  • Sell high-margin dietary supplements
  • Discourage patients from seeing their doctor


Answer: Identify and resolve medication therapy problems

26. The entity that is at risk for the quality and cost of care provided in a Medicare Advantage plan is the:

  • Federal government
  • Private health plan
  • Patient
  • Community pharmacy


Answer: Private health plan

27. Improving a plan’s Star Rating is important because higher-rated plans receive:

  • Fewer members
  • Financial bonuses and can offer more attractive benefits
  • More regulatory scrutiny
  • Lower reimbursement from CMS


Answer: Financial bonuses and can offer more attractive benefits

28. A patient is “dual-eligible,” which means they are eligible for:

  • Two different private insurance plans
  • Part A and Part B of Medicare
  • Both Medicare and Medicaid
  • A pharmacy discount card and a manufacturer coupon


Answer: Both Medicare and Medicaid

29. The formulary is a key tool used by Part D plans to:

  • Manage which drugs are covered and at what cost to the member
  • List all pharmacies in their network
  • Provide patient education materials
  • Communicate with the FDA


Answer: Manage which drugs are covered and at what cost to the member

30. The “Welcome to Medicare” visit is a preventive service covered under:

  • Medicare Part B
  • Medicare Part D
  • A Medigap policy
  • The patient’s supplemental insurance


Answer: Medicare Part B

31. After MTM services are provided, the pharmacist must provide the patient with a(n):

  • Bill for the services rendered
  • Referral to a specialist
  • Personal Medication List (PML) and Medication Action Plan (MAP)
  • New prescription for a different medication


Answer: Personal Medication List (PML) and Medication Action Plan (MAP)

32. The government body that administers the Medicare program is the:

  • Food and Drug Administration (FDA)
  • Centers for Medicare & Medicaid Services (CMS)
  • Drug Enforcement Administration (DEA)
  • National Institutes of Health (NIH)


Answer: Centers for Medicare & Medicaid Services (CMS)

33. What is a key reason a Medicare beneficiary might choose a Medicare Advantage (Part C) plan over Original Medicare (Parts A & B)?

  • Part C plans often include prescription drug coverage and have an annual out-of-pocket maximum
  • Original Medicare has lower premiums
  • Part C plans have no network restrictions
  • Original Medicare covers routine dental and vision


Answer: Part C plans often include prescription drug coverage and have an annual out-of-pocket maximum

34. A pharmacist helping a patient compare Part D plans should consider:

  • The plan’s premium and deductible
  • The plan’s formulary and coverage of the patient’s specific medications
  • The patient’s preferred pharmacy and whether it is in-network
  • All of the above


Answer: All of the above

35. A high Star Rating for medication adherence to oral diabetes medications indicates that a plan’s members are:

  • Receiving free diabetes testing supplies
  • Consistently filling their prescriptions for these medications
  • Enrolled in a research study
  • Avoiding all carbohydrates in their diet


Answer: Consistently filling their prescriptions for these medications

36. “Medigap” policies are supplemental insurance plans sold by private companies to:

  • Replace Medicare Part A and B
  • Help pay for out-of-pocket costs not covered by Original Medicare
  • Provide prescription drug coverage
  • Cover long-term nursing care


Answer: Help pay for out-of-pocket costs not covered by Original Medicare

37. True or False: All pharmacies must accept all Medicare Part D plans.

  • True
  • False


Answer: False

38. The MTM fact sheet for a given year provides information on:

  • The new drugs approved by the FDA that year
  • The criteria plans use to auto-enroll beneficiaries into the MTM program
  • Changes to pharmacy law
  • The financial performance of pharmaceutical companies


Answer: The criteria plans use to auto-enroll beneficiaries into the MTM program

39. A “preferred pharmacy network” in a Part D plan typically offers members:

  • Lower cost-sharing compared to standard in-network pharmacies
  • Slower prescription filling times
  • A smaller selection of available medications
  • Higher prescription drug costs


Answer: Lower cost-sharing compared to standard in-network pharmacies

40. A pharmacist’s role in Medicare Part D extends beyond dispensing to include:

  • Acting as a key resource for patient education and medication management
  • Setting the monthly premium for the plan
  • Deciding which drugs the plan will cover
  • Enrolling new members into the plan


Answer: Acting as a key resource for patient education and medication management

41. The introduction of Medicare Part D in 2006 significantly expanded the role of pharmacists in:

  • Sterile compounding
  • Medication Therapy Management
  • Drug manufacturing
  • Basic research


Answer: Medication Therapy Management

42. For a pharmacy, having poor performance on Star Ratings measures can lead to:

  • An increase in reimbursement rates
  • Being excluded from a plan’s preferred pharmacy network
  • A bonus payment from CMS
  • An award for quality service


Answer: Being excluded from a plan’s preferred pharmacy network

43. A significant change to the Medicare Part D program under the IRA is the ability for CMS to:

  • Eliminate the program entirely
  • Negotiate the price of some high-spend drugs directly with manufacturers
  • Require all beneficiaries to pay 100% of drug costs
  • Remove all clinical quality measures


Answer: Negotiate the price of some high-spend drugs directly with manufacturers

44. What happens when a Medicare Part D beneficiary’s spending reaches the catastrophic coverage threshold?

  • They are disenrolled from the plan
  • Their out-of-pocket costs are significantly reduced for the rest of the year
  • They must pay 100% of the cost of their drugs
  • Their premium doubles for the next month


Answer: Their out-of-pocket costs are significantly reduced for the rest of the year

45. A key objective of the Medicare MTM program is to:

  • Increase adverse drug events
  • Reduce adverse drug events and improve medication adherence
  • Increase the number of hospitalizations
  • Promote the use of high-risk medications


Answer: Reduce adverse drug events and improve medication adherence

46. Which of these is a pharmacist-driven intervention that can improve a health plan’s Star Ratings?

  • Ensuring patients with diabetes are on a statin when appropriate
  • Recommending patients stop all their chronic medications
  • Discouraging patients from getting vaccinated
  • Providing inaccurate information about drug side effects


Answer: Ensuring patients with diabetes are on a statin when appropriate

47. A patient newly eligible for Medicare has a limited time to enroll to avoid potential late-enrollment penalties. This period is called the:

  • Annual Open Enrollment Period
  • Initial Enrollment Period
  • Medigap Enrollment Period
  • MTM Enrollment Period


Answer: Initial Enrollment Period

48. Why is it important for a patient to review their Part D plan each year?

  • Because plan formularies, costs, and preferred networks can change annually
  • Because Medicare requires all beneficiaries to switch plans every year
  • Because the patient’s medications never change
  • Because all plans are identical


Answer: Because plan formularies, costs, and preferred networks can change annually

49. The financial stability of the Medicare program is a significant topic of discussion for:

  • Healthcare policymakers
  • Only beneficiaries over the age of 85
  • Pharmaceutical manufacturers only
  • Hospital administrators only


Answer: Healthcare policymakers

50. For a PharmD student, a strong understanding of Medicare is essential because:

  • It is a small program that affects very few patients
  • The Medicare population is a major consumer of prescription drugs and pharmacy services
  • It is the simplest part of the US healthcare system
  • Pharmacists have no role in caring for Medicare beneficiaries


Answer: The Medicare population is a major consumer of prescription drugs and pharmacy services

Leave a Comment