UHC '24 MEDICARE BASICS

A consumer with only part a residing in the plan service area can enroll in which plan type to get part d coverage

A stand alone part d 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 not true about the coverage gap?

All members reached the coverage gap

Which of the following is a characteristic of a drug tier

All of the drugs in the tear have the same copayment or co-insurance

Provided other eligibility requirements are met. Who is eligible for Medicare?

Consumers, age 65 and older, consumers under 65 years of age with a qualifying disability and consumers of all ages with ESRD or ALS who are receiving social security disability insurance for ALS

Which of the following best describes eligibility to enroll in a MA plan?

Entitled to part A and emerald in part B reside in plan service area may have pre-existing conditions such as ESRD

Which of the following best describes eligibility to enroll in a standalone prescription drug plan?

Entitled to part A and/or enrolled in part B and reside in the service plan area.

Lisa turned 65 and is now eligible for Medicare. She already received social security benefits. How does she enroll in original Medicare?

Her enrollment in Medicare parts A and B is generally automatic if she meets all the eligibility requirements

Jennifer is in rolling into a Medicare advantage plan and wants to know what counts towards the out-of-pocket maximum. Which of the following is accurate?

Incorrect Answer: All out of pocket cause she pays towards her health care and prescription drug expenses would count towards the out-of-pocket maximum.

Which of the following are true about the Medicare access and chip reauthorization act of 2015 (macra) plans and the impact of plants c and f? Select too

Incorrect answer: consumers already enrolled in plan c or f are required to change plans

Which statement is true about Medicare supplement open enrollment?

It is the 6-month period that starts the month. The consumer is 65 or older and is enrolled in Medicare part B.

Which of the following defines a Medicare advantage plan?

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

Which of the following statements is correct about HMO inmate plans?

Members must receive covered services from contracted network providers with limited exceptions

Which type of inmate plan is an HMO plan that also covers certain benefits out of network, generally at a higher cost ?

POS point of service plan

Which of the following is not true of Medicare supplement insurance plans

Plan benefit amounts automatically. Update when medicare changes car sharing amounts, such as deductibles, coinsurance and co-payments

Margaret currently has an MAPD Plan. What would happen if you enrolled her into a stand-alone PDP?

She would be disenrolled automatically from her MAPD plan

Which of the following best describes the late enrollment penalty?

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 coverage for 63 or more continuous days.

Which statement is true about members of a Medicare advantage plan who want to enroll in a Medicare supplement insurance plan?

The consumer must be in a valid MA election or disenrollment period.

Through which means is financial assistance offered to a consumer who qualifies for low income subsidy for their part of Medicare part d cost

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. 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

Utilization management rules