MCQ Quiz: Medicare

Medicare is the United States’ federal health insurance program for seniors and certain individuals with disabilities, representing a significant portion of any pharmacy’s patient population. A thorough understanding of its components, especially the Medicare Part D prescription drug benefit, is essential for modern pharmacy practice. This topic, covered in courses like Principles of Pharmacy Law and Ethics and *Patient Care 5*, includes key pharmacist-driven services like Medication Therapy Management (MTM). This quiz will test your knowledge of the structure of Medicare and its direct impact on pharmacy practice.

1. Medicare is a federal health insurance program primarily for which population?

• a. All low-income individuals.
• b. Children under the age of 18.
• c. People aged 65 or older and certain younger people with disabilities.
• d. Only active military personnel.

Answer: c. People aged 65 or older and certain younger people with disabilities.

2. Which part of Medicare provides coverage for inpatient hospital stays and skilled nursing facility care?

• a. Part A
• b. Part B
• c. Part C
• d. Part D

Answer: a. Part A

3. Which part of Medicare provides coverage for outpatient services, physician visits, and some durable medical equipment (DME)?

• a. Part A
• b. Part B
• c. Part C
• d. Part D

Answer: b. Part B

4. The outpatient prescription drug benefit under Medicare is known as:

• a. Part A
• b. Part B
• c. Part C
• d. Part D

Answer: d. Part D

5. The landmark legislation that created Medicare Part D was the:

• a. Health Insurance Portability and Accountability Act (HIPAA) of 1996.
• b. Omnibus Budget Reconciliation Act of 1990 (OBRA ’90).
• c. Food, Drug, and Cosmetic Act of 1938.
• d. Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.

Answer: d. The Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003.

6. Medication Therapy Management (MTM) is a service mandated by the MMA of 2003 for eligible beneficiaries of which Medicare part?

• a. Part A
• b. Part B
• c. Part C
• d. Part D

Answer: d. Part D

7. A “Medicare Advantage” plan is also known as:

• a. Part A
• b. Part B
• c. Part C
• d. Part D

Answer: c. Part C

8. The “coverage gap” or “donut hole” is a stage in the benefit structure of:

• a. Medicare Part A
• b. Medicare Part B
• c. Medicare Part D
• d. Medicaid

Answer: c. Medicare Part D

9. Which of the following supplies can a pharmacy typically bill to Medicare Part B?

• a. Blood glucose test strips for a patient with diabetes.
• b. All over-the-counter medications.
• c. Prescription oral contraceptives.
• d. Band-aids and gauze.

Answer: a. Blood glucose test strips for a patient with diabetes.

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

• a. Have multiple chronic diseases and take multiple medications.
• b. Be over the age of 85.
• c. Have a very low income.
• d. Be enrolled in a Medigap plan.

Answer: a. Have multiple chronic diseases and take multiple medications.

11. The introduction to MTM is a specific learning module in the Patient Care 5 course.

• a. True
• b. False

Answer: a. True

12. Medicare Part D plans are administered directly by the federal government.

• a. True
• b. False

Answer: b. False

13. The annual period when Medicare beneficiaries can change their Part D or Medicare Advantage plans is known as:

• a. The benefit period
• b. The deductible period
• c. The open enrollment period
• d. The initial enrollment period

Answer: c. The open enrollment period

14. A “formulary” in the context of a Medicare Part D plan is:

• a. A list of all pharmacies in the network.
• b. A list of all covered prescription drugs.
• c. The monthly premium for the plan.
• d. The annual deductible.

Answer: b. A list of all covered prescription drugs.

15. A comprehensive medication review (CMR) is the cornerstone of what service?

• a. Dispensing a refill
• b. Medication Therapy Management (MTM)
• c. Sterile compounding
• d. A final prescription check

Answer: b. Medication Therapy Management (MTM)

16. The principles of pharmacy law, including the MMA, are covered in the PHA5703 course.

• a. True
• b. False

Answer: a. True

17. A patient with Original Medicare (Parts A and B) who wants prescription drug coverage must enroll in a:

• a. Medicare Advantage Plan (Part C).
• b. Stand-alone Prescription Drug Plan (PDP).
• c. Medigap plan.
• d. Their coverage is automatic.

Answer: b. Stand-alone Prescription Drug Plan (PDP).

18. Which of the following drug classes is generally excluded from being required on a Part D formulary?

• a. Antidepressants
• b. Antipsychotics
• c. Drugs for weight loss or cosmetic purposes.
• d. Immunosuppressants

Answer: c. Drugs for weight loss or cosmetic purposes.

19. A pharmacist’s role in Medicare includes:

• a. Helping patients compare and select Part D plans.
• b. Identifying and resolving drug therapy problems through MTM.
• c. Billing for certain vaccines and supplies under Part B.
• d. All of the above.

Answer: d. All of the above.

20. The Geriatrics module is part of the Patient Care 5 course.

• a. True
• b. False

Answer: a. True

21. The “catastrophic coverage” stage in Part D is when:

• a. The patient’s coverage ends for the year.
• b. The patient pays 100% of their drug costs.
• c. The patient has passed the coverage gap, and their out-of-pocket costs are significantly reduced for the rest of the year.
• d. The plan’s deductible resets.

Answer: c. The patient has passed the coverage gap, and their out-of-pocket costs are significantly reduced for the rest of the year.

22. A patient asks for help choosing a Part D plan. The most important factor to consider is:

• a. The plan with the lowest monthly premium.
• b. Whether the plan’s formulary covers the patient’s specific, current medications.
• c. The color of the insurance card.
• d. The plan with the most memorable name.

Answer: b. Whether the plan’s formulary covers the patient’s specific, current medications.

23. “Medication synchronization” can help Medicare patients by:

• a. Reducing their pill burden.
• b. Aligning all their refills for a single monthly pickup, which can help them manage their medications and avoid falling into the coverage gap early.
• c. Making their medications more potent.
• d. It does not help Medicare patients.

Answer: b. Aligning all their refills for a single monthly pickup, which can help them manage their medications and avoid falling into the coverage gap early.

24. An active learning session on MTM is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

25. A Personal Medication Record (PMR) and a Medication-related Action Plan (MAP) are key outputs of what service?

• a. A standard dispensing service.
• b. A Comprehensive Medication Review (CMR) as part of MTM.
• c. A sterile compounding service.
• d. A drug information request.

Answer: b. A Comprehensive Medication Review (CMR) as part of MTM.

26. The “donut hole” has been gradually closing due to subsequent legislation like the Affordable Care Act.

• a. True
• b. False

Answer: a. True

27. A patient with End-Stage Renal Disease (ESRD) is eligible for Medicare, regardless of their age.

• a. True
• b. False

Answer: a. True

28. An active learning session on MTM is part of which course module?

• a. Module 5: Urological Disorders
• b. Module 1: Diabetes Mellitus
• c. Module 3: Women’s Health
• d. Module 6: Geriatrics

Answer: a. Module 5: Urological Disorders

29. Which vaccine can a pharmacist typically bill to Medicare Part B?

• a. Influenza vaccine
• b. Pneumococcal vaccine
• c. Both a and b
• d. Neither a nor b

Answer: c. Both a and b

30. The “Principles of Pharmacoeconomics” course would cover how large payers like Medicare make coverage decisions.

• a. True
• b. False

Answer: a. True

31. Medicare Advantage plans (Part C) often have what feature that Original Medicare does not?

• a. They have a network of providers.
• b. They may have lower out-of-pocket costs.
• c. They may offer additional benefits like dental or vision coverage.
• d. All of the above.

Answer: d. All of the above.

32. A “Medigap” policy is supplemental insurance that is purchased to:

• a. Cover prescription drugs.
• b. Help pay for the out-of-pocket costs not covered by Original Medicare (Parts A and B).
• c. Replace Medicare Part A.
• d. Replace Medicare Part B.

Answer: b. Help pay for the out-of-pocket costs not covered by Original Medicare (Parts A and B).

33. A patient who is eligible for both Medicare and Medicaid is known as a:

• a. Self-pay patient.
• b. “Dual eligible.”
• c. A managed care patient.
• d. An uninsured patient.

Answer: b. “Dual eligible.”

34. The “Extra Help” program is a federal program to help Medicare beneficiaries with limited income pay for:

• a. Their hospital stays.
• b. Their physician visits.
• c. Their Medicare Part D prescription drug costs.
• d. Their long-term care needs.

Answer: c. Their Medicare Part D prescription drug costs.

35. A pharmacist counseling a patient during open enrollment is a key component of:

• a. The dispensing process.
• b. Medication Therapy Management.
• c. Public health service.
• d. Both b and c.

Answer: d. Both b and c.

36. A drug’s “tier” on a Part D formulary determines:

• a. Its efficacy.
• b. Its safety.
• c. The patient’s copay level.
• d. Its mechanism of action.

Answer: c. The patient’s copay level.

37. Most Medicare Part D plans use preferred pharmacy networks.

• a. True
• b. False

Answer: a. True

38. The “Introduction to MTM” is a lecture in the Patient Care 5 curriculum.

• a. True
• b. False

Answer: a. True

39. A pharmacist’s understanding of Medicare is essential for which aspect of practice?

• a. Community pharmacy
• b. Hospital pharmacy (for discharge planning)
• c. Managed care pharmacy
• d. All of the above

Answer: d. All of the above.

40. An active learning session covering MTM is part of which course?

• a. PHA5787C Patient Care 5
• b. PHA5163L Professional Skills Lab 3
• c. PHA5781 Patient Care I
• d. PHA5782C Patient Care 2

Answer: a. PHA5787C Patient Care 5

41. The initial deductible is the amount a patient must pay out-of-pocket for their prescriptions:

• a. Each month.
• b. Before their Part D plan begins to pay.
• c. After they reach the catastrophic coverage stage.
• d. It is paid by Medicare.

Answer: b. Before their Part D plan begins to pay.

42. Which of the following is NOT a core chronic disease targeted for MTM by most Part D plans?

• a. Hypertension
• b. Diabetes
• c. Dyslipidemia
• d. Allergic rhinitis

Answer: d. Allergic rhinitis

43. A pharmacist is both a provider of services under Medicare and a resource to help patients navigate the complex system.

• a. True
• b. False

Answer: a. True

44. “Star Ratings” are used by CMS to:

• a. Rate the quality and performance of Medicare Advantage and Part D plans.
• b. Rate individual pharmacies.
• c. Rate pharmaceutical manufacturers.
• d. Rate physicians.

Answer: a. Rate the quality and performance of Medicare Advantage and Part D plans.

45. A key pharmacy quality measure that affects a plan’s Star Rating is:

• a. The speed of dispensing.
• b. The pharmacy’s profit margin.
• c. Medication adherence rates for certain chronic disease states.
• d. The number of prescriptions filled per day.

Answer: c. Medication adherence rates for certain chronic disease states.

46. Medicare Part A is primarily funded by:

• a. Monthly premiums from all beneficiaries.
• b. State taxes.
• c. Payroll taxes paid by employees and employers.
• d. The pharmaceutical industry.

Answer: c. Payroll taxes paid by employees and employers.

47. Explaining the purpose of MTM is a key objective in the CIPPE course.

• a. True
• b. False

Answer: a. True

48. An active learning session on MTM is part of which course module?

• a. Module 5: Urological Disorders
• b. Module 1: Diabetes Mellitus
• c. Module 3: Women’s Health
• d. Module 6: Geriatrics

Answer: a. Module 5: Urological Disorders

49. The overall goal of Medicare Part D and its associated MTM programs is to:

• a. Increase the complexity of the healthcare system.
• b. Provide accessible prescription drug coverage and improve medication-related outcomes for beneficiaries.
• c. Limit access to necessary medications.
• d. Increase out-of-pocket costs for seniors.

Answer: b. Provide accessible prescription drug coverage and improve medication-related outcomes for beneficiaries.

50. The ultimate reason for a pharmacist to have a deep understanding of Medicare is to:

• a. Effectively serve a large and complex patient population by helping them navigate their benefits and optimize their medication therapy.
• b. Be able to answer any question on the MPJE.
• c. Pass the Geriatrics module exam.
• d. Become an expert in health insurance billing.

Answer: a. Effectively serve a large and complex patient population by helping them navigate their benefits and optimize their medication therapy.