UHC BASIC KB22

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

Which consumer is eligible for a stand-alone Medicare Prescription Drug Plan?

Joseph, who is enrolled in Medicare Part A and Medicare Part B and resides in the plan's service area

Which of the following best defines Medicare Part D?

It is a government program, offered only through a private insurance company or other private company approved by Medicare, which provides prescription drug coverage.

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 must cancel their Medicare Supplement Insurance policy according to their carrier's rules.

Which of the following defines a Medicare Advantage (MA) Plan? (Select 2)

-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.

Which of the following statements is NOT true about the Coverage Gap?

ALL MEMBERS REACH THE COVERAGE GAP

Which of the following is NOT true about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) impact to Plans C and F?

Consumers already enrolled in Plans C or F are required to change plans.

Which of the following consumers are eligible for Medicare if other eligibility requirements are met?

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

Janice wants to enroll in a Medicare Advantage plan. Which of the following is NOT an eligibility requirement?

Does not have any pre-existing conditions, such as diabetes or End Stage Renal Disease (ESRD)

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

Milton is retiring on his 65th birthday. He is eligible for Medicare and already receives Social Security benefits. How does he enroll in Original Medicare?

His enrollment in Medicare Parts A and B is generally automatic if he meets all eligibility requirements

Which statement is true of Medicare Supplement Insurance Plans?

Insured members have the freedom to choose any doctor who accepts Medicare patients.

Which of the following statements is correct about HMO MA Plans?

Members must receive covered services from contracted network providers.

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 of the following lists drug tiers from least expensive cost share to most expensive cost share?

Preferred Generics, Generics, Preferred Brand (and some higher-cost generics), Non-Preferred Drug (and some higher-cost generics), Specialty

Which of these statements is true about the drug utilization management (UM) rules?

Prior authorization, quantity limit, and step therapy are some examples of the UM rules.

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

Jennifer is enrolling into a Medicare Advantage (MA) plan and wants to know what counts toward the Out-of-Pocket Maximum. Which of the following is accurate?

The Out-of-Pocket Maximum will include her costs toward any Medicare-covered Part A or B services.

Which of the following best describes the Late Enrollment Penalty (LEP)?

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 or more continuous days.

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).

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

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 their Medicare Supplement Open Enrollment period or does not meet Guaranteed Issue criteria.

Step Therapy, Prior Authorization, Quantity Limit, 7-day limit, Dispensing Limit and Limited Access are all examples of what?

Utilization Management Rules

Which statement is true about a member of a Medicare Advantage (MA) Plan who wants to enroll in a Medicare Supplement Insurance Plan?

WRONG

Which is true about Medicare Supplement Open Enrollment?

WRONG -Medicare Supplement Open Enrollment runs annually from October 15 through December 7.

Which of the following statements does NOT correctly define prescription drug stages?

WRONG-The coverage gap ends when the member has spent $7,050 (in 2022) in out-of-pocket expenses for the plan year

Can a consumer who qualifies for Low Income Subsidy receive financial assistance for their part of Medicare Part D costs?

Yes, through subsidies such as lower or no monthly plan premiums and lower or no copayments