Nurse Executive Certification Practice Exam

Which statement correctly describes the coverage provided by Medicare Advantage Plans?

1. They offer more flexibility than original Medicare

2. They cover only emergency services

3. They must follow rules established by Medicare

4. They do not require network provider selection

The correct answer is: They must follow rules established by Medicare

The correct statement is that Medicare Advantage Plans must follow rules established by Medicare. This is fundamental because Medicare Advantage Plans, also known as Medicare Part C, are required to comply with federal guidelines set by Medicare, ensuring a baseline standard of coverage for beneficiaries. This includes adhering to specific benefits, coverage limitations, and member protections mandated by the Medicare program. When beneficiaries enroll in a Medicare Advantage Plan, they receive all their Medicare Part A (hospital insurance) and Part B (medical insurance) coverage through that plan, but the plan itself must operate within the framework established by Medicare to ensure that essential services are covered. This means that while these plans can offer additional benefits beyond Original Medicare, like vision, dental, or wellness programs, they cannot restrict access to medically necessary services. The other options do not accurately represent the nature of Medicare Advantage Plans. For instance, while these plans may offer additional benefits, they can also impose network restrictions, meaning the flexibility in provider choice is often less than that of Original Medicare. Similarly, Medicare Advantage Plans provide comprehensive coverage that includes more than just emergency services, and it is essential to consider network provider selection, which may be required in many Medicare Advantage programs.