UHC 2021 Medicare Basics Test

what are two options for Medicare consumers to get Part D prescription drug coverage assuming maybe all eligibility requirements select two

1. enroll in a standalone Medicare prescription drug plan PDP 2. enroll in a Medicare Advantage plan or other Medicare health plan that includes prescription drug coverage

a consumer may have to pay a late enrollment penalty if they did not enroll in a Medicare Advantage plan with the Part D benefits or stand alone prescription drug plan when they were first eligible for Medicare parts A and or Part B or win without credible prescription drug coverage for

63 continuous days or more

formulary is defined as

Alyssa medications covered within the benefit plan based on CMS guidelines and develop in collaboration with physicians and pharmacists

which of the following are MA plans that focus on using network providers to maximize the benefits and reduce out of network expenses

HMO POS PPO

which of the following is not a correct statement about in network provider services

HMO POS plans only cover in network services

which of the following defines a Medicare Advantage MA plan

MA plans are healthy plan options approved by Medicare and offered by private insurance companies

which of the following defines a medical advantage MA plan select two

MA plans or health plan options approved by Medicare and offered by the Centers for Medicare and Medicaid Services CMS MA plans provide Medicare hospital and medical insurance and often include Medicare prescription drug coverage

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

a consumer with original Medicare might be interested in an MA plan because

MA plans typically provide additional coverage beyond original Medicare and often have established copayments for some 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

a government program offered only through a private insurance company or other private company approved by Medicare that provides prescription drug coverage describes which of the following

Medicare Part D

which of the following statements is true about a Medicare supplement insurance plan member who wants to enroll in an MA plan

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

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

assuming the following consumers meet all other eligibility requirements which consumer is not eligible for standalone Medicare prescription drug plan

Sharon who is not enrolled in Medicare Part A or Medicare Part B

which of the following statements does not correctly define prescription drug stages

a deductible and the amount the member must pay for every prescription medication regardless of what stage they are in

What is Medicare Part D?

a voluntary program offered by private insurance companies that are contracted with the federal government that provides prescription drug drug coverage for an additional monthly plan premium

what is Medicare Part D

a voluntary program offered by private insurance companies that are contractid with the federal government that provides prescription drug coverage for an additional monthly plan premium

which of the following statements is not true about the coverage gap

all members reach the coverage gap

what is true about Medicare supplement open enrollment

by federal law Medicare supplement open enrollment is the 1st six months a consumer is 65 or older and enrolled in Medicare Part B

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 is not true about the Medicare access and CVP reauthorization act of 2015 MACRA impact a plan C&F

consumers already enrolled in playing C or F are required to change plans

In what order do the four prescription drug coverage stages occur

deductible initial coverage coverage gap catastrophic coverage

when does Medicare supplement open enrollment take place

during the first six months a consumer is 65 or older and enrolled in Medicare Part B

Janice wants to enroll in a 2021 Medicare Advantage plan what eligibility requirements must she meet select the two answers that apply

entitled to Medicare Part A and enrolled in Part B reside in the planned service area

Larry wants to enroll in a 2021 Medicare Advantage plan he has end stage renal disease permanent kidney failure what else will be requirements must he meet select the two answers that apply

entitled to Medicare Part A and enrolled in Part B reside in the planned service area

which of these statements is not true about the drug utilization management UM rules

if a medication has a UM rule the member will not be able to get that medication

What must be explained to consumers enrolling in an HMO health maintenance organization MA plan select three

in most cases they will pay the entire cost of the service if they see an out of network provider they must see contract in network providers in order to receive coverage under the plan the exception to the provider network requirement is emergency visits urgent care and renal dialysis services which can be obtained from out of network providers

what is the amount added to the members monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or standalone prescription drug plans when they were first eligible for Medicare parts A and/or B or went without credible prescription drug coverage for 63 continuous days or more

late enrollment penalty LEP

when presenting an MA plan what must an agent do when discussing a consumer's health care providers

make sure the consumer understands any provider network limitations look up each provider's network status and make sure the consumer understands that using out of network providers may result in additional expenses if the plan has network limitations

which of the following statements is correct by HMO MA plans

members must receive covered services from contracted network providers

and states where Medicare supplement insurance underwriting criteria can apply all the following underwriting criteria apply except

most consumers who are switching from another Medicare supplement plan are entitled to guaranteed issue and therefore are not subject to underwriting

being 65 or older being under 65 years of age with certain disabilities for more than 20 four months and being any age with E SRD or LS or each eligibility requirements for which program

original Medicare

being 65 or older being under 65 years of age with certain disabilities for more than 20 four months and being any age with E SRD or a LS or each eligibility requirements for which program

original Medicare

Joseph has original Medicare And was a patient in hospital last week what part of Medicare helps cover the cost to the inpatient hospital stay

part A

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 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

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 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

which of the following options or drug utilization management UM rules select three

quantity limit prior authorization step therapy

Margaret currently has an MA PD plan what would happen if you enrolled her into her stand alone PDP

she will be disenrolled automatically from her MA PD plan

member Doug enrolled in a health maintenance organization HMO MA plan he saw an out of network doctor and received a bill for the entire cost of the visit Doug called Medicare to complain and stated that he was never told about these types of costs what should the agent and explain better to Doug when he was enrolled in the plan select three

that dog must receive coverage services from contract in network providers that in most cases Doug will pay the entire cost of the service if he sees an out of network provider that exceptions to the provider network requirement are emergency visits urgent care and rental dialysis services which can be obtained from out of network providers

which of the following best describes the late enrollment penalty LEP

the amount added to the members monthly plan premium if they did not enroll in a Medicare Advantage plan with Part D benefits or standalone prescription drug plan when they were first eligible for Medicare parts A and or B or went without creditable prescription drug coverage for 60 three continuous days or more

which of the following statements is true about eligibility requirements for Medicare prescription drug plans

the consumer must be entitled to Medicare Part A and/or enrolled in Medicare Part B

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.

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

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

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

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 can enroll in a stand alone Medicare prescription drug plan PDP

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 can enroll on a standalone Medicare prescription drug plan PDP

through which means is financial assistance offered by consumer who qualifies for low income subsidy for their part of Medicare Part D costs

three subsidies such as lower or no monthly plan premiums an lower or no copayments

how does a consumer who qualifies for low income subsidy receive financial assistance for their part of Medicare Part D costs

through subsidies such as lower or no monthly plan premiums an lower or no copayments

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 is not true of Medicare supplement insurance plans

to see a specialist insured members must obtain referrals from a primary care physician OR insured members must have their care coordinated through a primary care physician

the new MACRA legislation which went into effect January 1st 2020 applies to all carriers offering Medicare supplement plans

true

which of the following is true about Medicare supplement insurance underwriting criteria in states where underwriting applies

underwriting is required if the consumer is not in his/her Medicare supplement open enrollment period or does not meet guaranteed issued criteria

which statement is true about a member of Medicare Advantage MA plan who wants to enroll in a Medicare supplement insurance plan

when a consumer enrolls in a Medicare supplement insurance plan he/she is not automatically disenrolled from his/her plan