UHC certification
Medicare Correct Answer: Federal health insurance program
Medicare is administered by whom? Correct Answer: CMS ( Centers for medic... [Show More] are and medicaid services)
Parts A & B of medicare are Correct Answer: federal health insurance program referred to as original medicare
Part A? Correct Answer: Hospital insurance
Part B? Correct Answer: Medical insurance
What doesnt medicare cover? Correct Answer: routine dental, eye care hearing exam,deductibles, coinsurance and copayments
Part C? Correct Answer: Medicare Advantage Plans
MA covers? Correct Answer: Part A &B coverage, and some part D coverage
MA plans are not? Correct Answer: Medicare supplement insurance plans
What offers lower monthly premiums MADP or supplement? Correct Answer: MADP
do MAP's have a annual maximum OOP maximum that limits the amount of money a member must spend every year for covered services? Correct Answer: YES
MA plans integrate what type of additonal coverage? Correct Answer: part D prescription drug coverage
If a customer wants to keep their stand alone prescription drug plan, what may the customer want to enroll in? Correct Answer: MA-only PFFS plan
What is a stand alone drug plan called? Correct Answer: PDP
WHat is PFFS? Correct Answer: Private Fee for Service (PFFS) - Plans that allow you to go to any doctor or hospital that accepts their terms
If a customer lives in a rural area, what type of plan may they want because it gives them freedom to access doctors that may not be in their network? Correct Answer: PFFS plan
Do HMO's require referals? Correct Answer: Yes
Do PPO's require a referal? Correct Answer: No
When a member enrolls in a MA plan, they receive their coverage from medicare or the MA plan? Correct Answer: MA plan
When a customer is enrolled in a MA plan, they must continue paying their premiums for what other plan? Correct Answer: Part B
MA plans have a maxium annual limit on OOP costs called a? Correct Answer: MOOP amount ( Maxium out of pocket)
When a member is enrolled in a MA plan, they are automatically disenrolled from any other MA plan or PDP( prescription drug plan) in which they are enrolled as of the new plans_____? Correct Answer: effective date
An exception exisits for MA-only PFFS plans as a member can also be enrolled in a what? Correct Answer: Stand alone PDP
If a member enrolls in a MA plan, what must the member do? Correct Answer: Cancel in writing their medicare supplement insurance policy with the carrier after their request to enroll in MA plan has been approved.
Medicare supplement insurance policies cannot be used in conjunction with what type of plan? Correct Answer: MA plan
A medicare supplement insurance plan helps to cover some of the OOP costs associated with? Correct Answer: original medicare.
A medicare supplement insurance plan does NOT pay the cost-sharing of what type of plan? Correct Answer: MA plan
when a client enrolls in a MA plan, will it automatically terminate their MA plan? Correct Answer: NO
Can a customer call to terminate their Med Sup plan? Correct Answer: no it must be done in writing
What are the different types of MA plans? Correct Answer: HMO, POS, PPO, RPPO, PFFS, SNP, and MSA
For an HMO, they customer must us IN network providers, what are the exceptions to their rule? Correct Answer: Emergencies, Urgent care, and renal dialysis services.
In a HMO plan, does a member have to choose a PCP? and do they require referrals to see a specialist? Correct Answer: Yes
In a POS plan, does a member need a referral from their PCP to see a specialist? Correct Answer: yes
Can a member with a POS plan see a specialist? Correct Answer: Yes, but they may have to pay a higher cost, and there coverage limits
With a PFFS plan, can a member seek treatment from any medicare eligible provider who agrees to accept the plans conditions and payment rates? Correct Answer: Yes
Does a PCP need to be selected with a PFFS plan? Correct Answer: No
What is the only plan to offer non-network PFFS plans? Correct Answer: UHC
What are SNP's for? ( Dual SNP) Correct Answer: People who have both medicare and Medicaid
Institutional SNP? Correct Answer: Nursing homes
Chronic condition SNP? Correct Answer: people who have certain chronic medical conditions
MSA? Correct Answer: Medical savings account
What does a MSA do? Correct Answer: Combines a high deductible medicare advantage plan and a bank account
How does MSA plans work? Correct Answer: the plan deposits money from emdicare in the account which can then be used to pay for medical expenses until their deductible is met
Does UHC currently offer a MSA? Correct Answer: no
MA plans include some key features such as? Correct Answer: Prescription drug coverage, PCPs and a OOP maxium
In a MA-Part D plan, A member will be disenrolled from their stand alone PDP upon enrollment in a ? Correct Answer: MA-PD
in a MA-part D plan, A member will be disenrolled from their MA-PD upon enrollment in? Correct Answer: a stand-alone PDP
With MA only, a member will be disenrolled from their stand alone PDP upon enrolling in a? Correct Answer: Non-PFFS MA-only plan
in MA-only, a member will be disenrolled from their non-PFFS MA-only plan upon enrolling in a? Correct Answer: Stand alone PDP
most MA plans require a what? although not all plans require that the chosen____ cordinate the members care Correct Answer: PCP selection
If a PCP is required and the customer does not indicate one on the enrollment application, a _____ will automatically assigned Correct Answer: PCP
To avoid member complaints, encourage customers to select a ____and make sure the _____ is accepting new patients Correct Answer: PCP
In which plan ( HMO/POS) are out of network benefits available at a higher cost? Correct Answer: POS
With a PFFS plan, does a PCP need to be selected? and are prior authorizations or referrals from a PCP required? Correct Answer: No, NO
once a member with a MAP reaches the maximum OOP expenses, is there cost sharing for any additional services? Correct Answer: no
MA plans with an OON component may or may not have an? Correct Answer: OOP maximum for OON services depending on the plan
All medicare covered ( part A and part B) services count torward the? Correct Answer: OOP maxium with MAP's
Services and deatures that do not count toward the maxium OOP in a MAP include? Correct Answer: plan premium, part D prescription drugs and any non-medicare covered services such as eyewear and hearing aids
Is the OOP maximum amount different between MA plans? Correct Answer: Yes
UHC strongly discourages Dual-eligible customers, from enrolling into a PFFS plan due to? Correct Answer: having potential negative impacts to the customer
What does dual eligible customers mean? Correct Answer: having both medicare and medicaid
Before enrolling any customer into a PFFS plan, ask if they are enrolled in a state _____ program? Correct Answer: medicaid
If a customer is enrolled in a state medicaid program, explain to them that a PFFS plan may Correct Answer: Impact their ability to continue seeing their current providers, and may create OOP expenses they may not be able to afford.
If a customer on medicaid applies for a PFFS plan, the customer may be responsible for? Correct Answer: cost sharing
Only enroll a dual eligible customer into a PFFS plan if the customer insists on enrolling and disclose the potential impacts of Correct Answer: enrolling
What type of plan can be network based or non-network based? Correct Answer: PFFS
UHC does not offer network-based ___ plans? Correct Answer: PFFS
what is deeming? Correct Answer: a key feature of a PFFS plan is that the member can choose their health care provider both at home and when they travel in the US [Show Less]
