Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP? - ✔✔ She would be disenrolled automatically from
... [Show More] her MAPD Plan.
What is Medicare Part D? - ✔✔ A voluntary program, offered by private insurance companies that are contracted with the federal government, that provides prescription drug coverage for an additional monthly plan premium
Which of the following statements is true about eligibility requirements for stand-alone Medicare Prescription Drug Plans? - ✔✔ A consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B
Aside from a Medicare Advantage Plan or other health plan that includes prescription drug coverage, how else could a Medicare-eligible consumer get Part D prescription drug coverage? - ✔✔ They could enroll in a stand-alone Medicare Prescription Drug Plan (PDP).
In what order do the four prescription drug coverage stages occur? - ✔✔ Deductible, Initial Coverage, Coverage Gap, Catastrophic Coverage
Which of these statements is true about the drug utilization management (UM) rules? - ✔✔ Prior authorization, quantity limit, and step therapy are some examples of UM rules.
A consumer may have to pay a Late Enrollment Penalty (LEP) 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 or more continuous days
Through which means is financial assistance offered to a consumer who qualifies for Low Income Subsidy for their part of Medicare Part D costs? - ✔✔ Through subsidies such as lower or no monthly plan premiums and lower or no copayments
Formulary is defined as: - ✔✔ A list of medications covered within the benefit plan, based on CMS guidelines and developed in collaboration with physicians and pharmacists.
When is a Medicare Supplement Insurance consumer subject to underwriting and screened for eligibility? - ✔✔ When the consumer is not in their Medicare Supplement Open Enrollment or does not meet Guaranteed Issue criteria.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which went into effect January 1, 2020, applies to all carriers offering Medicare supplement plans. - ✔✔ TRUE
Which of the following is true about Medicare Supplement Insurance Plans? - ✔✔ Plan benefit amounts automatically update when Medicare changes cost sharing amounts, such as deductibles, coinsurance and copayments.
a consumer currently has original Medicare and is enrolled in a stand alone prescription drug plan what will happen if the consumer enrolls in an MA plan that has integrated prescription drug coverage - ✔✔ the consumer will be automatically disenrolled from the standalone PDP upon in Roman in the MA plan that has integrated prescription drug coverage
aside from a standalone Medicare prescription drug plan how else could a Medicare eligible consumer get Part D prescription drug coverage - ✔✔ they can enroll in a Medicare Advantage plan or other Medicare health plan that includes prescription drug coverage
which of the following statements is not true about the coverage gap - ✔✔ all members reach the coverage gap
which of these statements is true about the drug utilization management UN rules - ✔✔ prior authorization quantity limit and step therapy are some examples of the coverage rules
how does a consumer who qualifies for low income subsidy receive financial assistance through their part of Medicare Part D costs - ✔✔ through subsidies such as lower or no monthly plan premiums an lower or no copayments
which of the following list drug tiers from least expensive cost share to most expensive cost share - ✔✔ preferred generics generics preferred brand nonpreferred drug specialty
which of the following is true about Medicare supplement insurance plans - ✔✔ plan benefit amounts automatically update when Medicare changes cost sharing amounts such as deductibles coinsurance and copayments
which definition best describes Medicare Part A - ✔✔ the part of Medicare that helps with the cost of inpatient hospital stays it also helps with Hospice care and some skilled care for homebound
which statement is true about members of a Medicare Advantage plan who wants to enroll in a Medicare supplement insurance plan - ✔✔ the consumer must be in a valid MA election or disenrollment.
Who is eligible for Medicare - ✔✔ consumers age 65 or older consumers under 65 years of age with certain disabilities and consumers of all ages with ESRD or a LS
which of the following defines a Medicare Advantage plan select two - ✔✔ MA plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage
MA plans must provide benefits equivalent to original Medicare and most plans also offer additional benefits
to be eligible for this plan type consumers must meet the following requirements entitled to Medicare Part A and enrolled in Part B reside in the planned service area which plan is described - ✔✔ Medicare Advantage
Which type of MA plan is an HMO plan that also covers some benefits out of network generally at a higher cost - ✔✔ point of service POS plan
when is Marys Medicare supplement open enrollment period if she turns 65 on September 23rd 2019 and her Medicare Part B effective date is September 1st 2019 - ✔✔ September 2019 through February 2020 [Show Less]