Which part of Medicare helps with inpatient hospital stays, hospice care, and provides limited home health benefits? - CORRECT ANSWER Part B
Part
... [Show More] D
Part A(Right)
Part C
Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan? - CORRECT ANSWER -A consumer can use a Medicare Supplement Insurance Plan and an MA Plan at the same time.
-When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is not automatically disenrolled from his/her MA Plan.
-A member does not need a valid election period to disenroll from an MA plan.
-When a consumer enrolls in a Medicare Supplement Insurance Plan, he/she is automatically disenrolled from his/her MA Plan.(wrong)
Which of the following consumers would be eligible for Medicare? - CORRECT ANSWER -Consumers age 65 or older and consumers under 65 years of age with certain disabilities except for ESRD or ALS
-Consumers age 65 or older, consumers under 65 years of age with certain disabilities for more than 24 months and consumers of all ages with ESRD or ALS(right)
-Only consumers age 65 or older with certain disabilities and consumers of all ages with ESRD or ALS
-Consumers age 62 or older, consumers under 62 years of age with certain disabilities and consumers of all ages with ESRD or ALS
Which of the following defines a Medicare Advantage (MA) Plan? (Select 3) - CORRECT ANSWER An MA Plan does not have to provide benefits equivalent to Original Medicare.(wrong)
-An MA Plans is part of Medicare and is also called Part C.(right)
-An MA Plan is a health plan option approved by Medicare and offered by private insurance companies.(right)
-An MA Plan provides Medicare hospital and medical insurance (Medicare Part A and Part B) and often include Medicare prescription drug coverage (Part D).(right
Janice wants to enroll in a 2021 Medicare Advantage plan. What eligibility requirements must she meet? (Select the two answers that apply.) - CORRECT ANSWER -Not have End Stage Renal Disease (permanent kidney failure)
-Reside in the plan's service area(right)
-Entitled to Medicare Part A and enrolled in Part B(right)
-Entitled to Medicare Part A and/or is enrolled in Part B
Which of the following statements is correct about HMO MA Plans? - CORRECT ANSWER -Members that use out-of-network providers for routine office visits must pay a penalty in addition to any copayment.(wrong)
-Most benefits are covered out-of-network but at a higher cost.
-Members must receive covered services from contracted network providers.
-There are no exceptions to the provider network requirement for obtaining certain services from out-of-network providers.
Which type of MA Plan is an HMO plan that also covers some benefits out-of-network, generally at a higher cost? - CORRECT ANSWER -Private Fee-for-Service (PFFS)
-Medicare Supplement Insurance Plan
-Preferred Provider Organization (PPO)
-Point-of-Service (POS) Plan(right)
When does Medicare Supplement Open Enrollment take place? - CORRECT ANSWER -During the first three months a consumer is 65 or older and enrolled in Medicare Part B.
-During the first six months a consumer is 65 or older and enrolled in Medicare Part B.(right)
-Annually from October 15 to December 7.
-During the three months prior to the consumer's 65th birthday, the month of their birthday, and the three months following the month of their 65th birthday and enrolled in Medicare Part B.
A consumer with Original Medicare might be interested in an MA Plan because: - CORRECT ANSWER -MA Plans eliminate Medicare Part A premiums.
-By joining an MA Plan they will no longer be a part of the Medicare program.
-MA Plans typically provide additional coverage beyond Original Medicare and often have established copayments for some benefits.(right)
-It has a larger network of providers and skilled nursing facilities.
Which of the following statements is true about a Medicare Supplement Insurance Plan member who wants to enroll in an MA Plan? - CORRECT ANSWER -Medicare Supplement Insurance cannot be used in conjunction with an MA Plan; therefore, after receiving confirmation of enrollment into the MA Plan, the member should submit to their Medicare Supplement Insurance carrier a written request to cancel his/her policy.(right)
-The member must submit a written request to cancel their Medicare Supplement Insurance Plan the same day they submit their MA Plan enrollment application.
-When a member enrolls in the MA Plan their current Medicare Supplement Insurance Plan will automatically cancel.
-The member should not cancel their Medicare Supplement Insurance Plan because Medicare Supplement Insurance can be used in conjunction with an MA Plan.
Which of the following best defines Medicare Part D? - CORRECT ANSWER -It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical coverage.
-It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage.(right)
-It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides hospitalization coverage.
-It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides medical and hospitalization coverage.
Which of the following is a fact about Medicare Prescription Drug Plans? - CORRECT ANSWER -To enroll, the consumer must reside in the plan's service area
-All drugs are covered
-Medicare Part D is part of Medicare Supplement Insurance Plans
-Benefits never vary by plan(wrong)
Aside from a stand-alone Medicare Prescription Drug Plan, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - CORRECT ANSWER -They could sign up for a pharmacy savings card through their local pharmacy.
-There is no other way a Medicare consumer could get Part D prescription drug coverage.
-They could enroll in a Medicare Advantage Plan or other Medicare health plan that includes prescription drug coverage.(right)
-They could enroll in a Medicare Supplement Insurance Plan.
Which of the following statements is not true about the Coverage Gap? - CORRECT ANSWER -For 2021, the coverage gap begins when the member has incurred $4,130 in medication spending for the year
-The use of lower cost generic medications may prevent the member from reaching the coverage gap
-All members reach the Coverage Gap(right)
-Some plans offer additional coverage through the coverage gap, usually at a higher monthly plan premium
-If a member reaches the coverage gap, they will have access to the Plan's negotiated pharmacy discount rate for Medicare Part D medications
Which of the following options are drug utilization management (UM) rules? (Select 3) - CORRECT ANSWER -Step Therapy(right)
-Quantity Limit(right)
-TrOOP (True Out-of-Pocket) costs
-Prior Authorization(right)
-Total Drug Cost Limit
Which of the following best describes the Late Enrollment Penalty (LEP)? - CORRECT ANSWER -The amount added to the member's monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 90 continuous days or more.
-The amount added to the member's monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or went without creditable prescription drug coverage for 63 continuous days or more.(right)
-The amount added to the member's monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or stand-alone prescription drug plan when they were first eligible for Medicare Parts A and/or B or during the next available Annual Election Period.
-The amount added to the member's monthly plan premium if [Show Less]