Kahoot Medicare-- test questions _multi choice
Individuals who qualify for Original Medicare are:
1. Age 65 years or older 2. Under age 65 with certain disabilities 3. Those at any age who have been diagnosed with ESRD
What plans does not require referrals?
1. Allwell from Louisiana Healthcare Connections 2. Allwell from Arkansas Health & Wellness
How can Bob be qualify to join Medicare?
1. ESRD 2. Disability under age of 65 3. 65 or older
Which are acceptable ways for a member to voluntarily disenroll for Centene?
1. Enrolling into another plan 2. Giving or faxing a signed written notice
Which are acceptable ways for a Member to voluntarily disenroll for Centene?
1. Giving or send in a signed written notice 2.Enrolling into another plan
Medicare Advantage Part C Plans may include:
1. Lower out of pocket costs 2. A Maximum out of pocket (Moop) 3. Benefits like dental, vision, hearing, transportation & gym
Which of the following could be considered Special Election Periods (SEPs)?
1. Member's plan no longer offer coverage 2. The member has extra help, Medicaid, or MSP 3. The member moves or changes address
Which of the following could be considered Special Election periods (SEPs)?
1. Member's plan no longer offer coverage 2. The member moves or changes address 3. The member has extra Medicaid or MSP
In which two circumstances can a D-SNP member disenroll?
1. Once a quarter for the first 3 quarters of the year 2. During AEP
Who is eligible for Original Medicare?
1. People 65 and over 2. People with ESRD 3. People with certain disabilities
A DSNP member has how many months to regain his Medicaid before being disenrolled?
2 to 6
Fred qualifies for Medicare based on attaining age 65. When can he enroll?
3 months before, month of, & 3 months after his 65th birthday
If the plan receives a disenrollment notice ob 2/27, when will the disenrollemnt be effective?
3/1
If the plan receives a disenrollment notice on 2/27, when will the disenrollment be effective?
3/1
How many months can a member live outside of his service area before being disenrolled?
6
What system would I use to as a back up system for employer plan?
ABS
Which 6 states does not require referrals?
AR, IL, KS, LA, MO, OR
What is the branding for plans in South Carolina?
Allwell from Absolute Total Care
If a member states they live in a specific Parish, what health plan would they be asking about?
Allwell from Louisiana Healthcare Connections
What is the branding for plans in Indiana?
Allwell from MHS
What is the plan name for Kansas?
Allwell from Sunflower Health Plan
What is the plan branding for Florida plans?
Allwell from Sunshine Health
What is the branding used for plans in TX?
Allwell from Superior Health Plan
What is the name of New Mexico Plan?
Allwell from Western Sky Community Care
What is the name of New Mexico plan?
Allwell from Western Sky Community Care
What system would I use to view medical claim outside of Omni?
Amisys
A beneficiary just turned 65 on 07/14. What are the first and last months during which she can enroll?
April and October
What system would you use to view pharmacy claim information?
CVS / COS
CMS stands for
Centers for Medicare and Medicaid Services
What system would I use to see EOB (eligibility of benefits)?
Emdeon
Original Medicare is a _________ plan
FFS
I can use a Medigap police to help pay for the out of pocket cost on an MAPD
False
I can use a Medigap policy to help pay for the out of pocket costs on an MAPD
False
Medicare Advantage plan premiums are paid directly to CMS
False
People are automatically enrolled into Medicare Part D.
False
What system would you use to view what the member sent to us (information)?
FileNet
What states plans are branded as Allwell from Peach State Health Plan?
GA
Original Medicare does not cover
Hearing aids and dentures
Illinicare is the name for what state plan?
Illinois
What does Medicare Part A cover?
Inpatient Hospital
Bob joins an MAPD plan effective date June 1st., 2020. How can he be qualify to make the change for the remaining of the year?
It is only with an SEP
When is open enrollment period?
Jan 1st - March 31st
What are the 2 states that have a flower in the name?
Kansas Mississippi
What are the two states that have a flower in the name?
Kansas Mississippi
What system would I use as a source of truth for member's Eligibility and for Member Demographics, enrollment information (final hammer)?
MARx
Allwell from Home State Health is the plan branding for what state?
MO
What system (outside of Omni) do we use to view detail premium for the member?
Market prominence
What system would I use to see detail enrollment for the member (actual system our enrollment department uses)?
Market prominence
The handbook CMS mails to beneficiaries every year is called:
Medicare & You
If a member is DSNP, she has
Medicare and Medicaid
If a member is DSNP, she has:
Medicare and Medicaid
Original Medicare includes which part or parts?
Medicare part A & B
What system would I use to view or go in to the back door to check member's account?
Member Secure Portal
Is an MAO required to reinstate a member who pays his past due premiums?
No
Bob joins an MAPD plan effective date June 1st., 2020. Between June and December can Bob switch / change his plan?
No, he cannot for the current year.
What system would we use to view what we send the information to the member?
OCOE
This plan has the "eye" on the name
OH
What system would Centene use on a daily bases to find the information we need?
Omni
Out of the options below, which one does not have "Allwell" in the title?
Oregon
Which one does not have "Allwell" in the title out of the options below?
Oregon
What does Medicare part B cover?
Outpatient Hospital
Member of this plan are referred to as "Participants"
PA
The late enrollment penalty applied to which part of Medicare?
Part D
What system would I use (the system of truth) to view provider's information?
Protico
______________ determines eligibility for and enrolls people into Medicare
SSA
Bob just turned 65 in November, where can he go to enroll Medicare?
SSA office
What system would I use to take (process) member's payment?
Softheon
SEP stands for:
Special Election Period
An MAO can deny a voluntary disenrollment if the request is received outside of an election period 1. True 2. False
True
An MAO can deny a voluntary disenrollment if the request is received outside of an election period.
True
An MAO is required to reinstate if there is an erroneous death indicator
True
There is an additional premium for Part D
True
Which state is Allwell from Coordinated Care from?
Washington
A member notifies us that his plan terminated multiple provider networks, would this qualify as an SEP? 1. Yes 2. No
Yes
A member notifies us that his plan terminated multiple provider networks. Would this qualify as an SEP?
Yes
An MAO plans to involuntarily disenroll a member, Does the MAO have to send a notice to the member first?
Yes
An MAO plans to involuntarily disenroll a member, does the MAO have to send a notice to the member first?
Yes
Does a member have to have a chronic condition to enroll in a C-SNP plan?
Yes
Does a member have to have chrinic condition to enroll in a C-SNP plan?
Yes
If a Member has an MAPD plan and loses Part B coverage, does the MAO have to disenroll the member?
Yes
If a member has an MAPD plan and loses Part B coverage, does the MAO have to disenroll the member?
Yes
Oct 15th, AEP seasons, Bob changes plan to Centene MAPD for effective date of 1/1/2021. Now it is January 15th, Bob doesn't like his Centene and wants to go back to BCBS MAPD. Can he?
Yes, because of OEP, only 1 time change
Bob's Part A and B are effective on May 1st. Can he join a MAPD plan?
Yes, he can join MAPD (IEP) or MA (ICEP)
Member asks why he has a $29 LEP for part D. The best response is:
You have gone at least 63 days without part D coverage.