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.